Staying hydrated is essential, but how much water do you really need each day? While the general goal is around 100 ounces for men and 73 ounces for women, your actual needs depend on factors like activity, weather and metabolism. Water isn’t just about quenching thirst—it supports blood flow, glowing skin and even your teeth. Learn more in the Cleveland Clinic Diet App, located in the app store today!5d
Why Your Lower Back Pain Is Worse in the Morning (and What To Do About It)
Your sleep position, immobility, mattress and underlying conditions can all cause morning back pain
There’s nothing worse than waking up on the wrong side of the bed. But it can be hard to avoid when you wake with lower back pain in the morning. A back that throbs, aches or sends shooting pain down your legs can quickly set the tone for your day.
Most people experience lower back pain at some point, and more than 20% have chronic lower back discomfort. It’s the second most common reason people in the U.S. visit their primary care provider — behind colds and flu.
Whether you experience lower back pain all day or only in the morning, understanding what’s contributing to the pain may help you fix it. Pain management specialist Tara-Lin Hollins, MD, shares what might be behind your morning back pain and offers tips to help you wake up pain-free.
4 causes of lower back pain in the morning
Back pain and sleep have a complicated relationship. Pain can disrupt your sleep, and poor sleep can make you more likely to have higher pain. Getting to the bottom of your pain may help end the cycle.
Dr. Hollins says several factors can contribute to morning back pain.
1. The wrong sleep position
You spend a third of your life sleeping or resting, so if your spine is out of alignment while you sleep, it can have a significant impact on your body. Your sleep position affects your alignment and may (or may not) support the natural curvature of your spine.
“It’s common to be so tired at bedtime that you fall into bed and sleep however you hit the bed,” Dr. Hollins says. “But you may not be sleeping in the best position for your spine.”
The most beneficial sleep positions for your back are on your:
Side, with your knees partially bent
Back, as long as you don’t have sleep apnea (which worsens when sleeping on your back)
Sleeping on your stomach makes you more likely to twist your neck to the side — a quick way to throw your neck and spine out of alignment.
2. Lying down for hours
When you sit all day at your desk without moving, it can make you stiff. Similarly, when you sleep, you’re not moving much for seven to eight hours. Lying immobile for a long period could cause you to wake up with back or hip pain.
“Our bodies are not supposed to be stagnant for multiple hours,” Dr. Hollins explains. “Stiffness can settle in, and inflammation can build up. Then, when you try to move in the morning, releasing the inflammation can be painful.”
Tricky, right? After all, you want a good night’s sleep, and lying immobile while you doze is often a sign that you got all of your ZZZs. But to avoid lower back pain, Dr. Hollins advises taking some time to stretch before you jump out of bed.
3. An unsupportive mattress or pillow
Your mattress is your main source of back support while you sleep. And your pillow ensures proper neck alignment. A mattress that’s damaged, too soft or sagging can cause your lower abdomen to sink deeper than the rest of the spine, pulling your back out of alignment.
“All too often, people opt for a soft mattress, thinking it will be more comfortable,” Dr. Hollins notes. “You don’t want a hard mattress, but it should feel firm and supportive. You shouldn’t sink into it.”
Need tips for choosing the best mattress for your back? We can help.
4. An underlying condition or pregnancy
Some conditions or chronic diseases may put you at higher risk for morning back pain. Chronic conditions that affect both sleep and morning back pain include:
Pregnancy can also bring back pain in the morning due to:
Additional strain on your lower back muscles
Shifting center of gravity
Increased weight
How to stop waking up with lower back pain
Lifestyle changes, like achieving a healthy weight and exercising every day, are always helpful for back pain. But Dr. Hollins also recommends actions related to sleeping that may additionally help reduce or eliminate your morning back pain.
Add supportive pillows
Pillows are a great way to support your back’s alignment. Your typical sleep position should guide the pillows you use:
Back sleepers. Choose a head pillow that supports your neck and lets your head sink in. Place a pillow under your knees to support your spine’s natural curvature.
Side sleepers. For your head, choose a thick pillow that keeps the top portion of your spine straight and parallel to the mattress. Place a small pillow between your knees to help even out your hips.
Stomach sleepers. Don’t use a pillow for your head, or choose a very thin one. Put a thin pillow under your lower abdomen to keep your spine aligned.
“Look for pillows that are specific to your sleep position,” Dr. Hollins advises. “But no matter which position you use, adding pillows strategically around your body can support your spine and reduce morning pain.”
Adjust your sleep position
If you’re used to sleeping in the same position every night, it can be challenging to change it. But small adjustments may help:
Place both arms in the same position if you sleep on your back — instead of flinging one arm over your head — to keep your spine aligned.
Bend your knees when sleeping on your side to help balance your body and reduce any pressure on your lower spine.
Put pillows in front of you if you sleep on your side so you don’t roll onto your stomach.
Sleep on your left side whenever possible to take pressure off your internal organs.
“You want to be as comfortable as possible when you go to sleep,” Dr. Hollins says. “That way, you’ll be more likely to stay in a supportive sleep position.”
Replace your mattress regularly
According to the Sleep Foundation, the general guideline is to replace your mattress every six to eight years. But you may need a new mattress sooner if yours is:
Making noise (if it’s an innerspring mattress)
Noticeably sagging or damaged
Causing muscle or joint stiffness, especially if you don’t have the same stiffness when you sleep at hotels or other homes
When choosing a new mattress, choose a “medium firm” mattress — level 6 out of 10 on the mattress firmness scale. It may reduce your back pain symptoms by nearly half.
Pause before you get up
Most people get out of bed as soon as they wake up, Dr. Hollins points out. But taking a few minutes to prepare your back for transitioning to sitting, standing and walking can help with morning back pain.
Stretch while you’re still in bed. While on your back, bring one knee to your chest. Hold it for three seconds, let it go and then, switch to the other leg.
Warm your muscles. Slide a heating pad under your back to warm your muscles. Use one that’s designated as safe for use in the bed and has an auto shut-off. Keep the sheet or your shirt between the pad and your skin.
Take your time getting up. First, sit on the edge of the bed and let your back adjust. Then, use your legs — not your back — to stand up.
See your healthcare provider if your back pain worsens or occurs most mornings for two or three months. They can check for underlying back issues and may prescribe physical therapy.
“Don’t wait six or eight months to see your provider,” Dr. Hollins urges. “They can provide guidance about the best stretches to do, and your back will thank you.”
Do you miss seeing a stack of pancakes on the brunch table? Now you don’t have to. These grain-free, sugar-free, dairy-free pancakes are the perfect guilt-free treat. They’re easy to make, and the whole family will love them. Yum!
Ingredients
3 large omega-3 eggs ¾ cup almond milk ½ tablespoon freshly squeezed lemon juice 1 teaspoon pure vanilla extract ½ cup coconut flour ½ teaspoon baking powder ½ teaspoon baking soda Pinch of sea salt ¼ cup roughly chopped walnuts coconut oil, for greasing the skillet (about ¼ cup) 1 pint fresh blueberries ½ cup arrowroot 1 teaspoon cinnamon
Directions
In a large bowl, whisk the eggs and then add the almond milk, lemon juice, and vanilla. Whisk until well-blended. In a separate bowl, mix together the coconut flour, cinnamon, baking powder, baking soda, salt and arrowroot. Add the dry ingredients to the wet mixture, ¼ cup at a time, while continuously whisking. Once combined, gently fold in the walnuts.
Grease a large skillet and place over medium heat. Once the skillet is hot, use a ladle to pour 3-inch pancakes onto the skillet. Cook until bubbles appear, then flip. The pancake should cook on each side for about 2-3 minutes. Repeat with rest of the batter. Add a tablespoon or more of coconut oil to the hot griddle, as needed.
Make a blueberry sauce by simmering the blueberries in a small saucepan with 2 tablespoons of water for 10 minutes before serving.
To serve, place 3 pancakes on a plate and top each stack with the blueberry sauce.
Nutritional information (per serving)
Makes 2-3 servings.
Calories 423 Total Fat 19 g Protein 12 g Fiber 14 g Sugar 14 g Sodium 416 mg
This savory Greek appetizer is usually made with a lot of butter and a lot of feta cheese, which is delicious, but not really heart-healthy. Our just-as-delicious recipe offers a lighter, heart-healthier alternative!
Ingredients
Olive oil cooking spray
1 small onion, minced
One 10-ounce package frozen, chopped spinach
1/3 cup crumbled reduced-fat feta cheese
1/4 cup 1% cottage cheese
1/8 teaspoon ground nutmeg
1 1/2 tablespoons chopped fresh dill
Freshly ground pepper
1 tablespoon egg substitute
5 sheets frozen phyllo dough, thawed
Refrigerated butter-flavored cooking spray
Directions
Preheat the oven to 350 F. Coat a baking sheet with olive oil cooking spray.
Coat a large nonstick skillet with olive oil cooking spray. Add the onion and spinach; saute over medium-high heat until the spinach is thawed and the onion begins to wilt, 8 to 10 minutes. Stir frequently to break up clumps of spinach. Add the feta and cottage cheese along with the nutmeg, dill, pepper and egg substitute; mix well. Remove from heat and cool for 5 minutes.
Cut the phyllo dough into four lengthwise strips, covering the dough you’re not using with a damp tea towel so it doesn’t dry out. Coat each strip with the butter-flavored spray. Place a tablespoon of spinach mix on top of a strip of dough and fold over to make a triangle; continue folding over as if folding a flag. Place on the prepared baking sheet. Repeat, using all the remaining phyllo and filling. Coat each triangle with the butter-flavored spray. Bake for about 20 minutes, until browned. Serve warm.
Nutrition information (per serving)
Makes 20 pieces (10 servings/2 pieces serving)
Calories: 50 Total fat: 1.5 g Protein: 3 g Carbohydrate: 7 g Dietary fiber: 0 g Cholesterol: 0 mg Sodium: 180 mg Potassium: 60 mg
This transitional and restorative yoga pose provides a full-body stretch
Physical therapist Dawn Lorring, PT, MPT, walks through the steps of how to do downward dog correctly and shares its many benefits.
From beginner’s yoga to more advanced practices, downward dog is one of the most popular poses…with a few common misconceptions.
Rounding your back, placing your feet too far apart or putting too much weight into your wrists can all create a deeper stretch than intended — which increases your risk of injury.
Physical therapist Dawn Lorring, PT, MPT, walks through the steps of how to do downward dog correctly and shares its many benefits.
What is downward dog?
Downward dog (also known as downward facing dog, facing dog pose or Adho Mukha Svanasana in Sanskrit) is a foundational yoga pose. It’s often used as a transition between movements, like sun salutations. It’s also a form of active resting, active stretching and strengthening. This allows you to check in with yourself and re-evaluate your intentions during your practice.
You do downward facing dog by putting your body into an inverted V-shape (or pyramid), as if there were a straight line that runs through the top of your head up your spine and out of your butt toward the ceiling.
How to properly do downward facing dog
Facing dog pose won’t usually be your first movement when doing yoga. Before trying it, it’s best to loosen up your muscles and joints and find ways to work it into your overall yoga practice.
Once you’re warmed up and ready to go, follow these steps:
Start on all fours with your hands shoulder-width apart and your knees in line directly behind your hips.
Spreading your fingers wide, press down into your hands and tuck your toes (almost like you’re using them to grip the floor beneath you).
As you exhale, bring your hips up and back, as if there’s a string pulling your butt toward the ceiling, so your body creates an inverted V-shape (or pyramid).
Focus on straightening your back, not rounding it, so your head and neck are relaxed between your upper arms. It helps to focus on pressing through your arms to “push” the ground away from you and keep your arms active.
Keep your legs straight and, if it’s comfortable for you to do so, try to drop your heels down to the floor.
Adjust your posture by shifting your weight between your hands and feet until you sink comfortably into the position.
Hold this pose for 10 to 15 seconds at a time, making sure to breathe throughout.
For a more relaxed stretch, bend your knees a little and readjust your posture as needed.
When you’re done, exhale and move into your next pose or slowly lower yourself to the floor to enter child’s pose.
“Downward facing dog isn’t about keeping your heels on the ground or holding it for long periods of time,” clarifies Lorring. “It’s really about making sure you’re going to a place that’s comfortable for you, so you can adjust your body as often as you need in this pose.”
Facing dog pose variations
If you have a hard time getting down on your hands and knees, try this wall variation:
Face the wall and place both your hands out in front of you so your palms are flat and your fingers are stretched out.
Keeping your head and back straight and your hands on the wall in front of you, slowly walk your legs backward.
As you move, walk your hands down the wall so you hinge at your hips and look directly at the floor.
Keeping your head and neck relaxed, hold this pose for 10 to 15 seconds before slowly returning to stand.
If you feel stress or discomfort in your wrists, you can modify by rolling up a towel or the edge of your yoga mat and placing the roll under the heels of your hands. This will decrease some of that pressure.
For a more challenging stretch that deeply engages your hips and hamstrings:
While in the downward facing dog position, lift one leg up and stretch it toward the ceiling.
For a deeper stretch, bend your outstretched leg back and over your body, so your knee is facing away from you.
Repeat this process with the other leg, holding the pose for as long as you feel comfortable on either side.
Downward dog benefits
Downward facing dog provides a full body stretch, while also strengthening and working your:
Adho Mukha Svanasana helps improve your flexibility and control, and provides you a moment of active rest. It also increases blood flow to your head and upper body when you’re in the inverted V position. But because of this, you should talk to your yoga instructor, athletic trainer or healthcare provider before starting this position if you have:
“Facing dog pose tries to improve flexibility but also builds the strength to control that flexibility,” says Lorring. “If you’re feeling excessive stress to a certain part of your body, then you’re probably holding the pose for too long or you’re trying to go into a range that you’re not ready for. We can help you get there.”
A top-down view of a chocolate smoothie bowl (thick smoothie served in a bowl with a spoon) garnished with chia seeds, large coconut flakes and cacao nibs. Healthy vegan breakfast. The smoothie portion contains banana, chocolate, almond milk and ice.
This pudding is packed with health-promoting chia seeds, almond milk, cinnamon, cocoa, coconut flakes and dried fruit. It’s the perfect chocolate treat.
Ingredients
½ cup Chia seeds
1 cup vanilla almond milk, unsweetened
1 cup 2% milk (may use all almond for non-dairy option)
1½ tablespoons honey
1 tablespoon cocoa powder, unsweetened
1 teaspoon cinnamon
1 teaspoon vanilla extract
2 tablespoons coconut flakes, unsweetened
2 tablespoons dried tart cherries, or other unsweetened dried fruit
Directions
Place chia seeds, milks, honey, cocoa, cinnamon and vanilla in a glass container with a tight lid.
Seal and shake well to combine. Refrigerate for at least 5 hours or overnight.
Serve topped with coconut flakes and dried fruit to garnish.
Note: For a smoother texture, blend pudding in a high power blender before refrigerating. Be sure to blend well to avoid a gritty texture.
Nutrition information
Makes 6 servings
Each 1/2 cup serving contains:
Calories 140
Total fat 7g
Saturated fat 2g
Trans fat 0g
Protein 4g
Total carbohydrate 16g
Fiber 6g
Sugar 7g
Cholesterol 5mg
Sodium 150mg
Shoulder pain, stiffness or weakness can make it difficult to carry out everyday tasks, like reaching for something on a high shelf, driving a car or brushing your hair. If you have pain that won’t go away, it’s time to see a doctor.
There are a number of possible causes of shoulder pain, but the most common causes of shoulder pain are rotator cuff injuries, rotator cuff tears and osteoarthritis, says orthopaedic surgeon Mark Schickendantz, MD.
1. Rotator cuff injuries
The rotator cuff is a group of four muscles and their tendons that surround the shoulder joint, and connect the shoulder blade to the upper arm bone. Bursae, small sacs near the joint, provide lubricating fluid that decreases friction among the bones, tendons and ligaments.
Rotator cuff problems occur through overuse, and they include tendonitis, strains and partial and complete tears of the tendon.
Tendonitis is when the rotator cuff tendon becomes inflamed and irritated; bursitis is when the bursae swell. Tendonitis and bursitis cause pain in the front and side of the shoulder, and you might also feel some stiffness.
“These two conditions can occur with activities that involve using your arms overhead, like tennis, yoga or painting a room,” Dr. Schickendantz says. “Often the pain will be worse at rest and improve with activity.”
Treatment involves rest, applying ice, and taking nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, which is sold under the brand names Advil and Motrin, or naproxen, which is sold under the brand name Aleve. After a few weeks, most people with tendonitis recover, Dr. Schickendantz says.
2. Rotator cuff tears
If you experience shoulder pain at night that makes it difficult to fall asleep or awakens you, you may have a tear in one or more of the rotator cuff tendons.
“Night pain is the hallmark of a rotator cuff injury,” Dr. Schickendantz says.
You also may have this type of injury if you feel pain when lifting your arm overhead and weakness in the shoulder when trying to lift anything above shoulder level.
A rotator cuff tendon can tear from a single event, like falling down on an outstretched arm. It also can happen from a motion that is repeated over time. For example, a plumber who frequently uses his or her arms overhead can develop a rotator cuff tear. The rotator cuff also can weaken with age.
Treatment is rest, avoiding aggravating activities, physical therapy, applying ice, and NSAIDs. Some people with more severe pain may be helped with a corticosteroid injection, which is a powerful anti-inflammatory medication.
“I usually reserve the use of corticosteroids for someone who has severe night pain and is not responding well to oral medications,” Dr. Schickendantz says.
Surgery to repair the rotator cuff tendon is an option if these measures don’t give relief.
3. Osteoarthritis
Osteroarthritis happens when cartilage, which is the cushioning material that covers the ends of your bones, deteriorates, which leads to pain and stiffness.
Osteoarthritis causes a deep ache in the back of the shoulder. As osteoarthritis worsens, stiffness in the shoulder develops. People with osteoarthritis typically lose the ability reach behind their back.
“Patients often say they are unable to scratch their back or thread a belt,” Dr. Schickendantz says.
Osteoarthritis symptoms develop over time. For some people, an old shoulder injury from sports or some other activity, may kick off the degenerative process that years later results in osteoarthritis. But many people have no specific cause — it’s just wear and tear over time.
Treatment for osteoarthritis of the shoulder is similar to treatment for a rotator cuff tear, involving physical therapy, NSAIDs and ice. If the condition is severe, you can undergo shoulder joint replacement surgery, which is similar to joint replacement for hips and knees.
There is something special about using fresh peas straight out of the pod. This recipe was inspired by our root-to-stem philosophy of cooking: It always seems like such a waste to throw away the pea pods, but they are relatively inedible. To make use of the pods, we’ve pureed them into a spring-fresh pasta sauce. Remember: Pasta for breakfast is a great choice, especially when it’s loaded with healthful pea protein.
Ingredients
Kosher salt 1 pound fresh English peas in pods (yields about 1 cup shelled peas and about 3 ½ cups pods) ½ cup water ¼ cup extra-virgin olive oil 2 small spring onions or 2 large shallots, chopped 2 small spring garlic (whites) or 3 garlic cloves, minced 2 tablespoons Greek yogurt (optional) 12 ounces whole grain pasta, such as linguine, rigatoni or small shells Freshly ground black pepper ¼ cup fresh mint (peppermint preferred), thinly sliced Espelette pepper to taste (optional) Grated Parmigiano Reggiano cheese (optional)
Directions
Bring a large pot of water to boil and add enough salt to make it salty like the sea.
Meanwhile, wash the peas. Pull off the stem ends: remove the peas and place in a small bowl. Reserve the pods.
Fill a bowl with cold water. Set aside. Add the empty pea pods to the pot of boiling water and cook for 5 minutes. Using a slotted spoon or spider, remove the pods from the boiling water and transfer to the bowl of cold water to cool quickly. Drain the pea pods and add to a Vitamix or high-speed blender. Add ½ cup water. Puree for 2 to 3 minutes.
Place a fine strainer over a bowl and add the pea pod puree to the strainer, pressing on the solids to release as much puree as possible into the bowl. Discard the solids in the strainer. Reserve the puree in the bowl; season to taste with salt and pepper.
Cook the pasta in the pot of boiling water until al dente, stirring occasionally.
Meanwhile, in a large skillet, heat the olive oil over medium heat. Add the onions and garlic and sauté until softened, 3 to 4 minutes. Add the peas and cook 2 minutes. Stir in the reserved pea pod puree and Greek yogurt, if using, and cook just until heated through. (Don’t overcook the peas or puree as the sauce will turn brown).
Using tongs or a spider, transfer the pasta to the sauce in the skillet. Toss until combined. Season to taste with salt and pepper. Transfer the pasta to the serving bowl. Add the basil and mint. Serve with Espelette pepper and grated Parmigiano Reggiano cheese, if using.
Nutritional info (per serving)
Makes 4 servings.
Calories: 554 kcal Total fiber: 12 g Soluble fiber: 0.1 g Protein: 15.5 g Total fat: 16.7 g Saturated fat: 2.0 g Healthy fats: 12.1 g Carbohydrates: 84 g Sugars: 7.7 g Added sugars: 0 g Sodium: 178 mg Potassium: 433 mg Magnesium: 14 mg Calcium: 134 mg
Source: The What to Eat When Cookbook by Michael F. Roizen, MD, Michael Crupain, MD, MPH and Jim Perko, Sr, CEC, AAC.
Do you miss seeing a stack of pancakes on the brunch table? Now you don’t have to. These grain-free, sugar-free, dairy-free pancakes are the perfect guilt-free treat. They’re easy to make, and the whole family will love them. Yum!
Ingredients
3 large omega-3 eggs ¾ cup almond milk ½ tablespoon freshly squeezed lemon juice 1 teaspoon pure vanilla extract ½ cup coconut flour ½ teaspoon baking powder ½ teaspoon baking soda Pinch of sea salt ¼ cup roughly chopped walnuts coconut oil, for greasing the skillet (about ¼ cup) 1 pint fresh blueberries ½ cup arrowroot 1 teaspoon cinnamon
Directions
In a large bowl, whisk the eggs and then add the almond milk, lemon juice, and vanilla. Whisk until well-blended. In a separate bowl, mix together the coconut flour, cinnamon, baking powder, baking soda, salt and arrowroot. Add the dry ingredients to the wet mixture, ¼ cup at a time, while continuously whisking. Once combined, gently fold in the walnuts.
Grease a large skillet and place over medium heat. Once the skillet is hot, use a ladle to pour 3-inch pancakes onto the skillet. Cook until bubbles appear, then flip. The pancake should cook on each side for about 2-3 minutes. Repeat with rest of the batter. Add a tablespoon or more of coconut oil to the hot griddle, as needed.
Make a blueberry sauce by simmering the blueberries in a small saucepan with 2 tablespoons of water for 10 minutes before serving.
To serve, place 3 pancakes on a plate and top each stack with the blueberry sauce.
Nutritional information (per serving)
Makes 2-3 servings.
Calories 423 Total Fat 19 g Protein 12 g Fiber 14 g Sugar 14 g Sodium 416 mg
Filled with healthy fats and fresh ingredients, this dish will leave you feeling satisfied, nourished and ready to embrace your weekend warrior: https://cle.clinic/3BSXeDL
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