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:

• Degenerative disk disease, which occurs when your spine’s cushioning wears away with age
• Fibromyalgia, which causes muscle pain and spasms throughout the body
• Spinal arthritis, which affects up to 95% of people ages 60 and older
• Spinal cord issues like sciatica, spinal stenosis or a herniated disk

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.”