Waking up with Lower Back Pain

Persistent lower back pain is a common phenomenon among most people across the country. Almost 80% of all Americans at some point in their life have experienced this type of discomfort. If you are among those who frequently wake to a stiff and sore back, you are not alone. Chronic everyday lower back pain is typically at its worst in the morning.

On this page

    It’s the result of subtle chronic causes that are often preventable. But, lower back pain can be treated once the cause has been properly identified. Lower back pain has triggers that develop and escalate over time. They can also result due to untreated medical conditions. Listed below are some of the common causes of waking up in the morning with back pain.

    Inflammatory Back Pain

    Unlike typical back pain, inflammatory back pain is not brought on by physical trauma. This condition is caused by inflammation in the vertebrate and is aggravated by immobility. Studies have shown that patient’s pain lessened with increased activity. Likewise, the condition worsened if they remained sedentary.

    In severe cases, a condition called Ankylosing Spondylitis (AS), causes the spine can become fused due to abnormal bone growth. This further limits mobility as AS progresses. There is currently no known cause for AS, but it is believed genetic factors are a contributor. This condition afflicts more men than women with the earliest symptoms developing in late adolescence.

    Ankylosing Spondylitis is a severe disorder; inflammation alone does not indicate its presence. Other symptoms must also be experienced (along with back pain) for an AS diagnosis to be determined. These  include:

    • Stiffness in the lower back and buttocks
    • Extreme fatigue is present
    • Stiffness in lower back or hips
    • Running a mild fever
    • Lose of appetite

    Additional AS Complications:

    • Blurred vision and eye sensitivity – *seek immediate medical attention
    • Heart issues – aorta can become enlarged and inflamed
    • Compression fractures – thinning bones can cause vertebrae causing spinal cord pressure and poor posture

    Chronic Low-Grade Inflammation

    Chronic low-grade inflammation happens as a consequence of “metabolic syndrome”. This refers to the biological dysfunction that occurs due to aging (and other factors such as low fitness levels). Inflammation is a natural consequence of aging. Adults over the age of 40 may experience “inflammaging” or chronic low-grade inflammation all over their body. Younger adults may also experience chronic low-grade inflammation due to poor fitness, obesity or increased stress levels. The lower back is usually one of the first and most vulnerable spots to be affected by inflammation.

    Sometimes, people suffering inflammation may initially be misdiagnosed as fibromyalgia patients. In this condition, the tolerance for pain is reduced due to neurological dysfunction. The consequent pain experienced is usually unexplained. However, some fibromyalgia patients may be suffering from inflammation.

    Since inflammation is fairly common and natural with age, it is difficult to diagnose or treat. Like most age-related problems, inflammation can also be reduced by leading a healthy lifestyle:

    • Regular exercise to maintain adequate fitness levels
    • A healthy diet that helps to keep blood sugar in check
    • Decreasing sources of anxiety, stress, insomnia, etc.
    • Quitting habits that harm your health (drinking, smoking, etc.)

    Sleeping Positions

    Sleeping in the wrong positions may result in frequent back pains. This is usually the culprit for people who are unable to identify any other major reason (age, injury, medical disorder, etc.) for their back pain. A good night’s sleep is essential for preparing your body and mind for the activities during the day. However, the quality of sleep can also harm your body.

    Poor sleeping posture puts pressure on the spine and causes it to flatten out. Usually, an awkward posture causes only minimal damage when held for a short period. However, since the average person sleeps for 6-8 hours every night, the wrong posture can be held long enough to have an adverse effect on your body. It can cause muscle tissues to experience sustained compression, oxygen starvation and pinching. Often, we may start out by sleeping in the “right” posture and subconsciously change it while sleeping.

    Most times, poor posture is not dramatically evident. It could be a slightly awkward posture that is frequently repeated and held for long periods. Since we have little control over our nighttime posture, we can unknowingly end up in awkward positions.

    • Sleeping on Your Stomach: This is usually considered the most harmful posture as it flattens the lumbar spine and forces the neck to be turned for a long period of time. It is ideal for growing out of this posture. However, some of the strain on the lower back can be relieved by placing a pillow under your hip.
    • Sleeping on Your Back: Sleeping on your back on a soft mattress can be equally harmful as it has the opposite effect — excessive curving of the lumbar spine. It is caused due to the weight of the legs. However, a medium-firm mattress can solve this issue. Further, sleeping with a fluffy pillow below the knees (and a skinny pillow under the head) can make sleeping on your back an excellent position for good sleep. See the best mattresses for sleeping on your back.
    • Sleeping on Your Side: One of the best postures for back support is sleeping on your side. Not only does it protect the curves of the spine, but also relieves heartburn and acid reflux. The best way to ensure this position is maintained throughout the night is to lodge a pillow between the knees. This can limit the amount of movement. See the best mattresses for side sleepers.

    Your Mattress

    Another frequent contributor to poor quality of sleep and back pain is sleeping on the wrong mattress. Old mattresses lose their ability to maintain proper support and alignment. One study found that replacing mattresses older than nine years with new medium-firm ones can improve sleep quality. That said, ideal firmness levels will vary depending on your weight, age, physical condition, and preferred sleep position.

    A good mattress should provide back support as well as good sleep quality. Although most of this is determined by personal preferences, it is important to understand the basic components of a mattress. For instance, the number and arrangement of coils in a mattress can shed light on the amount of support it provides. The thickness and density of foam padding used determines firmness and comfort level.

    Unfortunately, there is no single standard for the best mattress. Since comfort is highly subjective, different mattresses have a negative impact on different people. It is also difficult to identify our own personal preferences. Even a mattress that may feel comfortable to sleep on may not provide the best sleep quality. By testing different types of mattresses and pillows, some people may notice a difference. Ultimately, the mattress must provide a balance of back support and comfort.

    Disc Degeneration

    One of the natural consequences of aging is a medical condition called “disc degeneration disease”. The natural decay due to years of wear and tear on the body occurs in many places. The spinal cord is particularly susceptible to this erosion process. In this condition, intervertebral spinal discs intended to protect their vertebrae from rubbing against each other, begin to naturally deteriorate. Thus, they are unable to effectively perform their function. This may result in the misalignment of the spine or inflammation of the bone.

    Although discs naturally stiffen over time, the pain caused by disc degeneration does not progressively become severe. Usually, a low-intensity chronic pain may be experienced with short intervals of severe pain. However, the spine stabilizes and pain subsides with enough time. Therefore, disc degeneration is usually not “treated” through any medical procedure.

    Pain may be reduced and managed through exercise (or physical therapy) and lifestyle modifications. Light exercise can help condition muscles to support the degenerating spinal cord. It also keeps the body increases the flow of oxygen throughout the body. Other lifestyle changes (such as eating healthy, avoiding excess alcohol and incorporating movement into your routine) will improve spine and muscle health.


    Another medical condition that may be responsible for lower back pain is fibromyalgia. It is a neurological dysfunction that decreases a person’s pain threshold. It causes widespread musculoskeletal pain. Although the pain is experienced all over the body, waking up with lower back pain may be particularly more painful. This is because people suffering from fibromyalgia are unable to feel completely rested even after a long night of sleep. Extreme fatigue can worsen the pain experienced in the morning.

    Fibromyalgia is difficult to diagnose. The varying severity, further, complicates the detection of the disorder. Some people may have a mild version of fibromyalgia that is never diagnosed or detected. Since it is a neurological condition, its treatment usually involves lifestyle changes that can alter the person’s sensitization of pain. They may also include doctor prescribed pain medication. The following steps can serve as a treatment for suspected fibromyalgia:

    • Improving Sleep Quality and Overall Health: This includes fitness, nutritious diet, and staying properly hydrated.
    • Therapy: Mental health is just as important as physical health. Particularly for a neurological disorder, therapy and medication are essential to tackle depression and anxiety.
    • Alternative Therapy: Other approaches to pain management can also be tested. This includes acupuncture, music therapy and so on.

    Myofascial Pain Syndrome

    Similar to fibromyalgia, myofascial pain syndrome (MPS) also causes widespread pain across the body. It occurs due to an infestation of “trigger points” that are usually aching patches of muscle tissue. Sore or aching back muscles can be one of the major symptoms of this condition. Causes are due to several issues (including fibromyalgia). Poor posture is a common cause for trigger points to flare up. The spinal muscles, being vulnerable during sleep, tend to bear the brunt of this impact. Treatment for MPS includes pain-alleviating measures such as applying heat and massaging the area.


    Osteomalacia refers to a vitamin D deficiency that results in the weakening of bones. Dull pain in the lower back, hips, and legs is associated with this deficiency. The pain is also heightened at night as additional pressure may be felt on affected bones. A weak lower back, for instance, may bear the brunt of the body throughout the night. This results in a dull aching pain in the morning.

    Signs of osteomalacia are usually evident in an X-ray. Pain experienced in the bones or muscles can also indicate the deficiency. Usually, those who are not exposed to the sun are at the risk of developing osteomalacia. Hospitalized patients or house-bound older adults are often diagnosed with vitamin D deficiency. Symptoms include:

    • Fatigue
    • Acute soreness after physical activity (like exercise) that takes longer to resolve
    • Low pain threshold
    • Depression

    Treatment usually involves ensuring the body receives sufficient vitamin D and calcium to strengthen bones. Aside from sunlight, food such as salmon, mackerel, egg yolks, sardines, etc. can prevent the risk of osteomalacia. If there is a medical condition that prevents your body from absorbing nutrients effectively, vitamin D supplements may be prescribed by the doctor.


    Pregnant women often experience back pain during the 5th and 7th month of pregnancy. It may also appear as early as eight weeks into pregnancy. This is because the ligaments in the body become softer and stretch to prepare your body for delivery. During this time, there is a constant strain on your lower back and pelvis. This back pain may not be restricted to the night. While sleeping, your body tends to be still for long periods. This prolonged lack of movement creates additional stiffness and soreness of the lower back.

    Some steps to alleviate this discomfort are to make small changes while sleeping. A full body pillow, for instance, supports the weight of the baby so that there is little pressure on the mother’s spine. In this case, the woman lies on her side so that the pillow can curve around the belly. Other suggestions include:

    • Using a firm mattress that provides adequate back support
    • Keeping the back straight at all times
    • Using a pillow under the knees or between the knees to restrict movement

    If the back pain is particularly intense, you must consult your doctor. Back pain during the third trimester can sometimes indicate early labor. There may also be some exercises recommended by physiotherapists to deal with pregnancy back pains.

    Nighttime Tissue Stagnancy

    The human body naturally resists being still for long periods of time. Sitting, standing and even lying down for a long time often feels comfortable temporarily. But, the desire to move increases as time passes. The negative impact of being still is not only psychological torture but, also harmful to the body. Being still while sleeping is one of the most common reasons for people to experience soreness or back aches in the morning.

    Tissue stagnancy occurs as a result of being still. When the body is still, there is very little blood flow and circulation. Restricted blood flow is especially harmful when we have twisted our body in an awkward sleeping position that is held for a long time. This is why most people who sleep for a longer time may wake up with bodily pain and soreness. The pain can also be interpreted as your body’s “wake up call”. Younger people are less likely to experience tissue stagnation. Their bodies are more resilient and can maintain blood circulation levels despite being still. Older adults, however, may be more prone to soreness caused by nighttime stagnation.

    Minor Injury

    Sometimes existing minor injuries may be aggravated while sleeping. Additional soreness can be caused to vulnerable areas due to awkward sleep positions. Often, injuries caused by old accidents are prone to be reinjured while sleeping. That said, back pain caused by such incidents cannot sufficiently explain chronic back pain. But, if it occurs frequently enough, an aggravated injury might explain pain experienced in the morning.

    Treating Lower Back Pain

    Waking up with back pain can impact your entire day. Even if the soreness wears off, your sour mood and lack of focus can continue all day. It is important to ensure you are getting the right quality of rest. This involves making some significant adjustments to your sleep routine:

    Mattress and Pillow Upgrades

    The right kind of mattress and pillow can go a long way in providing a comfortable night’s sleep. Conversely, a mattress that is unable to provide proper back support and comfort can result in aches and stiffness. It’s important to identify your comfort preferences and support needs before replacing old mattresses. Research has also found that medium-firm mattresses tend to improve back pain and sleep quality.

    Changing your pillow may also improve sleep. Feather pillows and memory foam pillows are most popular but individual preference will vary. An orthopedic pillow can also be a viable option. A comparative study between the three types found that those who used an orthopedic pillow experienced better sleep quality.  Keep in mind, the thickness of your pillow will differ due to sleep position and body type. A side sleeper with broad shoulders will require a thicker pillow to keep their body properly aligned. A dedicated back sleeper needs a bit thinner pillow, so their heads are not pushed upward in an awkward position. Lastly, some stomach sleepers may be more comfortable with no pillow at all. Just remember, stomach sleeping puts your body in an unnatural position and can cause further lower back and neck pain.

    The Sleep Break

    When awake, the human body is accustomed to moving around and ensuring the body is not stagnant for long periods of time. However, while we are asleep it is difficult to have any control over the stillness of our body. Even if we are uncomfortable while asleep, we may not be conscious enough to realize it or do anything about it.

    In such cases, an “anti-nap” or sleep break can help break the stillness experienced during sleeping. Just as people with desk jobs take frequent “stretch breaks”, a long night’s sleep can be broken up with occasional breaks from sleeping. This can be done naturally by waking up when you feel pain or discomfort. However, sometimes the pain may not be enough to wake you up. In such cases, an alarm can force you to get up and reset your sleeping posture.

    A forced sleep break can wake you up from an awkward sleeping posture. During these breaks, you can choose to take care of your back (with massages, heat therapy, etc.) or move around and increase blood circulation. This ensures that tissue stagnation does not occur due to stillness.

    Pre-Sleep Routine

    Finally, sleep “hygiene” can be an essential aspect of ensuring a good night of sleep. It involves small lifestyle changes and habits to incorporate every night. This includes limiting the use of screens before bedtime, decluttering your bedroom, maintaining a consistent sleep schedule.

    There could be several reasons you are experiencing lower back pain. It’s important to recognize this early and make proper lifestyle adjustments. Following some of the steps we have outlined above can go a long way in helping you get rid of your lower back pain. We recommend consulting your doctor regarding any lingering back pain. Working together with your physician, the best form of treatment can be determined.


    You Might Also Like...