Waking Up With Lower Back Pain: Causes, Prevention, Treatment, and Best Exercises

There’s nothing better than a good night’s sleep — until you wake up with back pain. There are many reasons why you might experience back pain in the morning when you wake up, including your sleep position, a bum mattress, an underlying medical condition, or simply wear and tear on your spine that comes with age.

The good news: “While a lot of people wake up and complain of back pain, most report that it gets better — or even disappears — as they go about their day,” says Heather Broach, PT, DPT, a physical therapist at Hinge Health.

Here, learn more about what causes back pain after sleeping, and how to prevent and treat it — especially with exercises from our Hinge Health physical therapists.

What Is Back Pain?

Back pain, especially lower back pain, is very common. In fact, more than 80% percent of us will experience it at some point. It’s usually not serious, but it can be frustrating, as it can prevent you from doing activities such as your job, hobbies you enjoy, or even simple aspects of your daily routine.

Back pain, including morning back pain, can strike anyone, regardless of their age, gender, health issues, or how fit (or sedentary) they are, says Dr. Broach. You may be more at risk to develop it, however, if you are:

• A smoker

• Overweight or obese

• Older

• In a physically strenuous job

• In a very sedentary job

• Anxious or depressed

Even if you don’t have any of these risk factors, you may still find that you occasionally find yourself hobbling around in the morning with a stiff back. This is because bedtime is normally the time when your back muscles can stretch out and relax. While that’s generally a good thing, “if they’re not strong, they can have trouble adjusting and spasm as a result. This can cause pain in the morning,” says Dr. Broach. “But stiffness isn’t bad or scary. It’s simply your body’s way of asking to move more and for you to load your muscles, using gentle stretches and exercises.”

Why You Wake Up with Back Pain

Here are some of the most common reasons you may experience back pain in the morning.

Your sleep position. If you sleep on your stomach, it can be very hard on your back. “It puts a lot of pressure on your back muscles since this position affects the natural curve of your spine,” explains Dr. Broach. This may even be true if you’ve gotten away with sleeping in this position for years without experiencing any morning back pain. “When you’re a teenager or a young adult, your body is bouncy enough to recover,” she notes. “But as you get older, and become more sedentary, this position can simply put too much strain on your back.”

Your mattress. Can a mattress cause back pain? Actually, yes. Humans spend about a third of their lifetime sleeping, so it makes sense that the surface you sleep on can contribute to pain and stiffness, notes Dr. Broach. “Most people need a more firm mattress than they think they do,” she explains.

An underlying medical condition. One of the most common causes of morning back pain is degenerative disc disease, says Dr. Broach. Over time, normal age-related wear and tear can cause spinal discs to think and wear down. “During the night, while you sleep, the discs in your spine rehydrate, which means water enters them and plumps them up,” explains Dr. Broach. “This can worsen existing disc problems and irritate surrounding tissue, causing it to swell and inflame.”

Inflammation caused by inflammatory arthritis in the spine, such as ankylosing spondylitis, can also lead to morning back pain and stiffness, as can spinal stenosis, a condition that puts pressure on your spinal cord and the nerves within your spine.

While this might sound scary, be reassured that such underlying issues respond well to measures like exercise therapy and medication, so you can get relief for morning stiffness and soreness.

Pregnancy. Many types of pregnancy aches are common. Chief among them: waking up with back pain. One way to help avoid this is to sleep on your side, with one or both knees bent. You may also find it helpful to place a pillow between your knees, and another one under your belly, or use a full-length body pillow. The good news is this should resolve once you give birth.

When to See a Doctor

If you wake up with morning back pain, chances are that it doesn’t indicate a serious problem. But if it doesn’t get better after moving around, and doesn’t respond after a few weeks to simple lifestyle measures such as gentle exercise, stretches, and over-the-counter topical or oral anti-inflammatories, such as ibuprofen (Advil) or naproxen (Aleve), it’s a good idea to see your doctor, advises Dr. Broach. See a doctor if you notice any of the following:

• Your back pain doesn’t get better within a few weeks

• You experience fever, chills, or unexplained weight loss

• Back pain is accompanied by leg weakness

• You’ve lost bladder and/or bowel control

• You have a history of cancer or osteoporosis

Prevention Tips

If you’re prone to morning back pain, there are many things you can do to manage and prevent achiness and stiffness.

Try another sleep position. The best sleep position to prevent back pain is on your back, says Dr. Broach. This distributes weight evenly across your body and doesn’t put pressure on your spine. For more support, put a pillow under your knees and a small rolled towel under the small of your back. Side sleepers take heart: This position is fine, too, as long as you put a pillow between your legs if you notice pain in the morning. If you’re a devoted stomach sleeper who can’t kick the habit, consider placing a pillow under your pelvis and lower abdomen to reduce strain on your spine.

Select the right mattress. A 2021 review of 39 studies published in the Journal of Orthopaedics and Traumatology found that a medium-firm mattress is best to promote back comfort, sleep quality, and spine alignment. As for when to replace your mattress, recommendations vary. The National Sleep Foundation suggests every six to eight years, especially if you’re getting poor sleep, you notice you sleep better at hotels, or you notice sagginess or damage.

Start a soothing bedtime routine. It’s all too easy for many of us to go straight from hours of sitting at our computer to collapsing into bed at the end of a long day. But just as this can cause sleep problems such as insomnia, it can affect back problems as well, says Dr. Broach. You need to give your body the chance to relax and stretch. This helps loosen muscles so they don’t tighten up during sleep. Try some gentle stretches before bed to ease the transition on your body. Bring your knees up to your chest to relieve tight back and hip muscles. Try to hold this position for a minute or two, until you can feel muscles loosening.

Stay active throughout the day. Aim to include regular aerobic exercise that also strengthens muscles in your back, hips, and torso, such as walking or swimming, advises Dr. Broach. It’s also a good idea to do core-strengthening exercises. “The abdominal muscles are key to support your lower back, and help prevent back pain in the morning,” she says.

Lift the right way. If you strain back muscles after you lift a heavy object, muscles can tighten up and spasm during the night and cause excruciating morning pain, explains Dr. Broach. The American Academy of Orthopedic Surgeons recommends that when you lift heavy items like luggage, you keep your knees bent, rather than bending at the waist.

Treatment for Morning Back Pain

The following tips from our Hinge Health physical therapists and medical doctors can provide relief for mild to moderate back pain upon waking.

• Heat. While ice is better for an acute injury (like an ankle sprain), heat is often best for morning back pain. “It increases blood flow to the area, which will make it more receptive to stretches and light exercise,” explains Dr. Broach. Even heading straight into a soothing, hot shower as soon as you wake up can help.

• Over-the-counter (OTC) medication. Pain relievers such as ibuprofen (Advil, Motrin), naproxen (Aleve), and acetaminophen (Tylenol) can be helpful for back pain. It’s important to make sure that you are safely able to take these medications, based on your medical history.

• Topical pain relievers. These OTC products come in creams, salves, ointments, and patches. They deliver pain-relieving substances such as ibuprofen, menthol, or lidocaine through your skin.

• Complementary treatments. Talk to your provider if you’re interested in trying alternative treatments for back pain relief, such as massage, acupuncture, or chiropractic care.

While all of the above steps can help with morning back pain, one of the most effective is exercise therapy. It may seem counterintuitive to move when you hurt. But gentle movement can actually help the healing process. If you do have time for a quick morning walk, do so. “When you walk, the vertebrae in your spine move up and down, which can help stretch out spasming muscles and help realign spinal discs,” says Dr. Broach. It also releases endorphins, feel-good brain chemicals that can help relieve pain.

Gentle movement also includes targeted stretches and exercises, which can make a big difference in relieving back pain and preventing future episodes. Here are a few gentle exercises from Hinge Health that are commonly used to prevent and treat back pain. Dr. Broach recommends doing them as soon as you wake up.

The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.

PT Tip: Sit on Your Sit Bones

Believe it or not, how you sit during the day can impact back pain while you sleep, says Dr. Broach. When you sit for long periods of time — for example, in the car, or in front of a computer at work — make sure that you are actually sitting on your sit bones, which are the bones under your bottom that help support your pelvis.

How to do this: Slide your hands under your bottom, to find your sit bones. Once you’ve found those bony protuberances, rock your pelvis back and forward, feeling those extremes of motion. Once you feel that you are balanced, you’re most likely sitting on them correctly.

How Hinge Health Can Help You

If you have joint or muscle pain that makes it hard to move, you can get the relief you’ve been looking for with Hinge Health’s online exercise therapy program.

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app, when and where it works for you.

Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you.

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References

1. Back Pain During Pregnancy. (2020, May). American College of Obstetrics and Gynecologists. https://www.acog.org/womens-health/faqs/back-pain-during-pregnancy

2. Caggiari, G., Talesa, G. R., Toro, G., Jannelli, E., Monteleone, G., & Puddu, L. (2021). What type of mattress should be chosen to avoid back pain and improve sleep quality? Review of the literature. Journal of Orthopaedics and Traumatology, 22(1). doi:10.1186/s10195-021-00616-5

3. Chou, R. (2021, September 20). Patient Education: Low Back Pain in Adults (Beyond the Basics. UpToDate. https://www.uptodate.com/contents/low-back-pain-in-adults-beyond-the-basics

4. Foley, L. (2020, March 17). When Should You Replace Your Mattress? Sleep Foundation. https://www.sleepfoundation.org/mattress-information/when-should-you-replace-your-mattress

5. Park, D. K. (2021, August). Low Back Pain. American Academy of Orthopaedic Surgeons. https://orthoinfo.aaos.org/en/diseases--conditions/low-back-pain/

6. Slide show: Sleeping positions that reduce back pain. (2020, May). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/back-pain/multimedia/sleeping-positions/sls-20076452