Could you address the morning low back pain that so many of us have…it is not the mattress but wear and tear or accidents (in my case) that has the back way too sensitive to bending, working in the yard, torque…mine is a bit hyper-moble and grinds if I twist too one side too much too.
Over night, as a back sleeper, it gets so painful and stiff….hate this… waking up only to be in bad pain.
PS…I have to back sleep due to other neck injuries and not being able to sleep on my sides…
Thank-you so much,
Thanks, Jean, for your question.
This issue of waking up in the morning feeling stiff and sore in the lower back or mid-back or even being awakened in the night can be a very challenging problem to solve.
I once saw a gentleman with a complaint of being awakened in the night by lower back and thoracic pain. He felt okay during the day for the most part but could rarely sleep more than three or four hours at a time.
The pain would wake him up, force him out of bed, and often he would climb into a hot tub for 30-45 minutes to ease the stiffness and soreness.
I’ve often told my students that you can’t diagnose something you’ve never seen or heard of and in this gentleman’s case, I was familiar with some of his problems but the specific complaint of pain only during the night was new.
Very few people I asked – doctor friends, therapists – had run into this problem and if they had, no one had solved it.
And, at the time, this issue of back pain in the night was no where to be found on the Internet.
So, this is a case where ultimately I failed.
Then, about three years later, I developed the same problem and it took me several years to figure it out.
Solving this sort of problem is or can be a very personalized solution because there are a number of things that can create the stiffness and soreness.
I’m going to assume that serious medical diseases have been ruled out because night pain is one of the “red flags” when it comes to spine pain complaints. If you have pain that wakes you up during the night, get checked by your family doctor. It’s probably nothing serious but it’s always best to know that.
When you hear “grinding” as you turn or bend, most often that’s from joints that have a rough surface and whose joint fluid is thin. The joint fluid, synovial fluid, normally has the consistency of egg whites and serves as a protective, weight bearing surface for the joint. When the fluid thins or becomes watery, it doesn’t lubricate the joint as well and the surfaces can rub together. In technospeak, that’s called “crepitus”.
You can sometimes have crepitus, for example in the knee, and be asymptomatic. So, just because it exists doesn’t mean that you will have other symptoms.
Crepitus means though that something isn’t quite right with the joint(s) so what can happen is that too much motion, load, pressure, etc can overload the joint and soft tissues, disrupt the biochemical balance, and create a low grade inflammatory reaction which then leads to symptoms of pain and stiffness.
And many times, the symptoms are delayed. So, for example, you might work in your yard on Saturday morning and then Sunday night have a rough night’s sleep from the pain and stiffness and end up wondering what happened because you spent Sunday lounging around.
Flexibility is Your Friend
One part of the pain and stiffness in the morning stems from joints that don’t tolerate cumulative load as I mentioned above.
Another part is a lack of flexibility in the hips and trunk.
No joints in the body enjoy being placed at the end of their available range of motion and left there for extended periods of time.
Yet, this is often what happens when you sleep.
If you lie on your back, flat, with hips that do not have adequate extension range of motion (this is the motion where the hips move backward), the tightness in the hips will tug or pull on the lower back. This may not bother you for an hour or so but after a while, the tissue “creeps” and as the tissue hits its physiologic limit, you will start to hurt.
Or maybe your hips have enough flexibility but your spine doesn’t. Either way, what happens is similar to taking your wrist, bending it backward, and then leaning on it for an extended period. Two things will happen. You’ll start to hurt and then when you move out of the position, your wrist/hand will hurt a lot and feel very stiff until you move it around. This is basically what happens in the spine when you lie in certain positions during the night.
Build Healthier Joints
I advise clients to make sure they have at least 30 minutes a day of moderate cardiorespiratory exercise – walking, elliptical, swimming are reasonable choices. Running has a lot of impact so I don’t suggest that and cycling is tricky because of the position of the spine – forward bent and usually near the near of your available motion (flexed – remember the wrist example?). The key is to get your heart rate up so you’re breathing a bit hard and sweating.
The “aerobic” exercise helps improve local blood flow to the tissues of the spine. These tissues, especially the disc, depend on an infiltration of blood by increasing the rate of perfusion. Exercise is really the only way to do this.
I also use short sessions of rest / movement. Our go to drill for this is what we call a “90/90 rock and roll” (those of you who have been to Sports Center may know this already).
- Use a swiss ball (physioball, stability ball), lie in a comfortable position on your back (pillow under your head, maybe some pillows for your arms).
- Place your legs up on the swiss ball
- Slowly move the legs side to side about 3 inches.
- Do this for 5 minutes every few hours.
This drill, for most people, is incredibly helpful. It not only feels good but it gives your tissues some much needed rest. I think of it as making a deposit in your body’s “bank account”. The position and motion help recharge your tissue and reduce the chances of cumulative overload.
Make sure you’re well hydrated. This might seem obvious but soft tissues need water to remain as pliable as possible. I suggest drinking at least half of your lean body weight in ounces per day.
Supplements can help. This is controversial because there have been studies that suggest Glucosamine and Chondroitin Sulfate don’t work for arthritic joints. Bottom line though is chondroitin Sulfate is a disease modifying agent for osteoarthritis. It slows the progression of the disease and deterioration of the joint cartilage. If you have osteoarthritis and have clearance from your doctor (people who have diabetes, are allergic to shellfish or take blood thinners need to visit with their doctor first), you should be taking at least 800 mg of Chondroitin Sulfate for at least two years. This is how long it takes for the supplement to slow the deterioration of the cartilage and the disease modifying effects are independent of symptoms. So, take it even if you feel fine.
Remove gluten from your diet. Recent studies have shown that some people may have non-celiac disease gluten sensitivity and if so, that may trigger a systemic immune response which can keep joints irritated. This wasn’t too challenging for me since I already didn’t eat breads, pastas, refined grains in general but gluten, as you may know, is in a LOT of foods – like beef jerky for one. Remove gluten for thirty days and pay attention to how you feel. For me, it helped. If after thirty days you feel better then you can always titrate some back into your diet to find your threshold if you want to.
Work on flexibility of the hips and trunk. Flexibility and mobility are not the same thing. Mobility involves using the flexibility you have. But at night, you’re not moving or at least not much. So, what you need is flexibility. You need enough such that whatever position in you’re in – side or back – your joints are not lying at the end of their available motion or flexibility.
- For the trunk, I often us “touchdowns”. You assume the position above using the swiss ball. Then, place your arms as inthe photo. Now, slowly slide the arms up toward your head as far as you can with ease. Stop, hold the position, breathe slowly and deeply for about thirty seconds and then return to the starting position. Do this for three minutes at least twice per day.
- For the hips, the motion you need the most is extension. But, you have to improve this without also extending the lumbar spine. Place one leg on the swiss ball. Place the other on floor. Now, if in this position you feel even a slight tension in the front of the hip, you’ll need a small towel roll under the knee for the first few minutes to allow the tissues to “creep”. While in this position, slowly roll the leg that is on the floor in and out. You should feel some changes in tension in the hip. Do this for three minutes at least twice per day.
Get yourself in the best physical shape you can. Sometimes this means you have to start adding exercise to your life in small amounts and in a graduated way. Other times, it means you need to rebuild the infrastructure first (check out my book, “Build a Rock Solid Core” for more details). In any event the healthier and stronger you are, the better. It’s not a guarantee that your sleep problems will vanish but I can promise you that the weaker you become, the easier it is for your spine to be overloaded.
Now, just to lighten things up a bit:
Experiment with sleep surfaces and positioning in bed
No question that the sleep surface can influence force into the soft tissues. If you don’t believe me, try sleeping one night on the kitchen floor and I think you’ll change your mind.
The tough part is figuring out which mattress works best for you because, as I mentioned above, there are a few other things that come into play for you during the night. Sometimes, you have to get some help to sort this out. A coach can help you during the process, help you figure out where to spend your time and energy when it comes to joint health, flexibility and even the sleep surface.
I went through several mattresses over almost three months. I used MattressFirm and was very pleased with their attitude and service. You have 100 days to figure out which mattress is best for you (and I have no financial deal with MattressFirm – just letting you know what I did) and you can swap out a mattress for the cost of delivery which, in Austin, is about $80.
In my case, I have a curvature in my spine that makes it a bit more challenging to lie comfortably in just about any position. So, I did two things. I bought a Tempurpedic soft mattress and a frame that adjusts. Prior to the adjusting frame, I used pillows to create a slight bend in my spine that actually helps straighten it out. I just got tired of all the pillows.
This combination, along with the other things I mentioned above, has changed my attitude about sleep from dread to wonder – I wonder how much better I’ll sleep tonight.
I’ve often said, “I wish I knew then what I know now.” But there’s no upside to spending much time thinking about the things you missed or the magnitude of your failures other than how those things can help you going forward.
Work on flexibility of the hips and trunk, building healthier joints, getting yourself in good shape and experimenting with sleep surfaces to improve your sleep and how you feel in the morning.
Here’s to sleeping better.
If you have a question you would like me to answer, submit your question to me here. I do my best to answer the questions here in the blog and will not disclose personal identifying information other than your first name.
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About Doug Kelsey
|Doug Kelsey is a physical therapist and healthy lifestyle “guru”. Doug is formerly an Associate Professor and Assistant Dean for Clinical Affairs at the University of Oklahoma Health Science and is the owner of Sports Center Physical Therapy in Austin, Tx. He writes on how to “actively age” – how to get healthy and fit over your lifetime and take charge of your health. He and his brother Joshua created the ActiveAge Blueprint.|