You got to bed on time, you slept enough, but still you wake up with lower back pain in the morning. What’s the deal? Well there are several things that can cause pain or stiffness in the morning that you may never have even heard of. This could have serious implications for your long term health so keep reading.
Contents
- Why mornings hurt
- Pain or Stiffness?
- Morning routine
- Sleep hygiene tips
Disclaimer:
You should consult with a healthcare provider before starting any new physical activity. This article is for educational purposes and is not meant to replace an assessment, diagnosis, or treatment from a qualified professional. Note; no doctor patient relationship has been formed.
Why Mornings Hurt
Pain early in the morning (or at night) is a key feature of inflammatory back pain. Inflammatory back pain means that the pain is a result of inflammation primarily and is in contrast to mechanical back pain which is pain in response to mechanical stress (tension, compression, shear, torsion). (1)
The chart above shows a comparison of signs and symptoms between inflammatory and mechanical back pain. There is a lot of variability depending on the person, but if the general pattern matches one or the other, then you can increase your confidence in that classification.
One thing to note about the chart above; with mechanical back pain, it is usually worse with certain movements, but potentially better with other movements (i.e. rest from the painful one). The key is that the movement or mechanics of your back affects the pain in a specific/consistent way. The LBPfix program has an assessment that determines which movements hurt and which are likely to help and then delivers exercises and advice based on your pattern.
With inflammatory back pain, that pattern is likely not present, it just feels better with movement in general, and worse at rest (night/morning). So what causes inflammation in the lower back? There are a few things, some much more likely than others. Let’s start with the most likely.
Injury
Ligament sprains and muscle strains are the most common causes of acute lower back pain. Disc injuries like herniations and annular tears are also relatively common, but will often be associated with sharp, burning, or electrical leg pain that is often worse than the back pain. These injuries can have a significant inflammatory component (2-5 days usually).
For this reason, they can have a pattern that resembles inflammatory back pain despite being a source of mechanical low back pain in the longer term. If your back hurts in the morning(s) after some sort of trauma or even just a new or stressful activity for your lower back, a muscle strain, ligament sprain or a disc injury are the most likely explanations. (2)
Disease process
This term spondyloarthropathy means pathology of the spinal joints, of which there are a few different types. The most common one affecting the lower back area is Ankylosing Spondylitis (AS) or Axial Spondyloarthritis. This condition has a strong genetic component compared to other causes of back pain, so if you have blood relatives with AS or other inflammatory/autoimmune conditions, you should go talk to your family doctor about testing.
Other diseases that could cause an inflammatory pattern of back pain are numerous, and increasingly rare; other autoimmune conditions, psoriatic arthritis, certain types of cancer.
Infection
A spinal infection is not like having an upper respiratory tract infection like the cold or flu. It is an emergency because it can cause serious, permanent damage to your spine. If your back pain is associated with cold or flu symptoms and there is redness, swelling and heat right over the spine you should go to the ER. Luckily this is quite rare and is likely not the case for you.
Pain or Stiffness?
Morning pain and morning stiffness can indicate very different issues. Stiffness in the morning is normal to a certain extent, because you just laid still for several hours. Morning stiffness that is pronounced or specifically in your lower back however, may indicate something more.
Morning stiffness correlates very strongly with disc space narrowing, and moderately with osteophytes. The two together are the hallmarks of the degenerative process, aka osteoarthritis. (3) This sounds bad, but is actually the normal change associated with aging. Of course we would rather have less degeneration than more, but it cannot be altogether avoided. Morning stiffness in combination with existing lower back pain strengthens the correlation above. (4)
Morning Routine
Morning routines are so hot right now. Ashton Hall became an icon of sorts, despite having the most ridiculous morning routine conceivable. The moment has already come and gone as with any viral fad these days, but people with lower back pain in the morning are probably still wondering what their morning routine should be.
Your morning routine can include any number of useful activities depending on what you need to get done, what you enjoy doing, and what goals you have. Some sort of physical activity is a good idea, even just walking or stretching can help to wake you up and decrease pain or stiffness.
Walking is a great option because it will likely get you outside and the bright light. Even on a cloudy day the sunlight is much brighter than indoor lights and is extremely helpful for waking up and regulating your sleep/wake cycle.
If you work early in the morning, just getting to work is fine if you are productive and feeling well overall. If you are having a hard time getting your day started, then maybe try some of these suggestions as needed. Don’t overcomplicate your mornings.
Other things that could be helpful to do in the morning are journaling, planning, meditation or other mindfulness practice. These can be good for productivity, but also great for psychological/emotional benefit. If you feel like dunking your face in ice water, you can certainly do that too. Maybe skip the banana peel rub on the face though.
Sleep Hygiene Tips
Sleeping well is probably more important than you think. If you are not sleeping well or getting enough sleep, that should be your priority for improving any health problem you have. There are some very simple things that you can do today that will help you get to sleep quicker and stay asleep better so that you can wake up with less lower back pain in the morning.
Sleep environment
Cold, dark, and quiet. It is really that simple. Too cold is better than too warm, because you can warm up with blankets. Use ear plugs and/or an eye mask if you need them. You can use white noise if it helps you sleep too. Try not to do too much in your bedroom other than sleeping so that you associate it with sleeping mostly.
Nutrition
Eating healthy is important for every aspect of health. The problem is it takes time for the benefits of a healthy diet or for the harms from a poor diet to become obvious. There are, however, two nutrients that will have immediate and negative impacts on your sleep – alcohol and caffeine.
Alcohol is something to be reduced or eliminated from your diet as much as possible, but especially before bed. If you are drinking alcohol, try to have it earlier and have less than you might have otherwise. Caffeine is only an issue if you have it too late in the day. Aim to stop caffeine intake at least 8 hours before you plan to sleep.
Wind down
This one can be tough, because you might get home from work late, or have extra work or lots of chores to do in the evenings. Do your best to get those things done early so that you can relax for 30-60 mins before bed.
Do something relaxing during that time like reading or listening to music. Stretching or some sort of meditative practice would be great options too. Watching TV is not a great option because it is subconsciously stimulative at least because of the bright light.
Remove wakefulness cues
Our modern environment is great for productivity, but not great for relaxation and sleep quality. Having bright lights on in the evening is probably not a great idea because it is giving signals to the body to stay awake. Try turning the lights down or off earlier in the evening, and turn the TV off as early as possible.
Our Framework: How LBPfix Can Help
1. Identify Your Pain Driver: We classify your pain into one of four movement intolerance types
2. Prescribe the Right Movement Strategy: Once we know your pain type, we match it with corrective movements
3. Build Long-Term Resilience: As pain settles, we help you:
Move confidently without flaring up
Rebuild core control and lifting mechanics
Return to work, sport, or life without setbacks
Ready to Fix Your Low Back Pain?
Take our 2-minute quiz to find out if you’re a good candidate to our program – no strings attached!
References
- Winkler AE, Miller M. Update on Axial Spondyloarthritis. Mo Med. 2022 Jan-Feb;119(1):79-83. PMID: 36033135; PMCID: PMC9312440.
- Ford, J.J., Kaddour, O., Gonzales, M. et al. Clinical features as predictors of histologically confirmed inflammation in patients with lumbar disc herniation with associated radiculopathy. BMC Musculoskelet Disord 21, 567 (2020). https://doi.org/10.1186/s12891-020-03590-x
- Chamoro M, de Luca K, Ozbulut O, Oei EHG, Vleggeert-Lankamp CLA, Koes BW, Bierma-Zeinstra SMA, Chiarotto A. Association between clinical findings and the presence of lumbar spine osteoarthritis imaging features: A systematic review. Osteoarthritis Cartilage. 2023 Sep;31(9):1158-1175. doi: 10.1016/j.joca.2023.04.014. Epub 2023 May 6. PMID: 37150286.
- Scheele J, de Schepper EI, van Meurs JB, Hofman A, Koes BW, Luijsterburg PA, Bierma-Zeinstra SM. Association between spinal morning stiffness and lumbar disc degeneration: the Rotterdam Study. Osteoarthritis Cartilage. 2012 Sep;20(9):982-7. doi: 10.1016/j.joca.2012.05.011. Epub 2012 Jun 12. PMID: 22698441.
