Your abdominal muscles are just one component of your core. The gluteal muscles, diaphragm, hip flexors, and hip adductor muscles also comprise your core. These large muscle groups help control the movements you make throughout the day. Strengthening these muscles helps to absorb forces from daily activities and decrease the forces that move through joints.
Here is a group yoga poses that can help to improve your core muscles. Try holding them for two to three breaths at first, then increase the number of breaths to challenge yourself. On the one-sided poses, be sure to repeat on the other side!
Note: Poses should be entered into and moved out of slowly to protect muscles and joints. If you are having specific pain that has been ongoing for longer than two weeks or you have a specific injury, it is always best consult a qualified health care provider, such as a physical therapist, who can develop a plan specific to your needs.
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.”
Physiotherapists rarely get a mention, but they improve the lives of millions of people every single year and so many of us would struggle without them. Huge thanks to every single one of you.
RCSI welcomes progress in physiotherapist referral for medical radiological procedures
RCSI University of Medicine and Health Sciences has welcomed the policy decision to permit physiotherapists to refer patients for medical radiological procedures, and the progress made in implementing this important new measure which will make it quicker for patients to access a diagnosis and begin their treatment.
Physiotherapist referral for medical radiological procedures results in fewer health professionals being involved in the patient pathway. At present, physiotherapists with advanced training can refer their patients for radiological investigations, such as X-ray, in several jurisdictions including England, Sweden, Canada and New Zealand.
Physiotherapists in Ireland will soon be invited to undertake advanced training which will allow them to refer their patients for radiological procedures. Initially, clinical specialist physiotherapists working in roles in specific clinical areas in the HSE are being invited to train for the authority to refer. In early 2025, application to the training programmes will then be opened more widely.
Professor Suzanne McDonough, Head of the RCSI School of Physiotherapy, said: “This is an important development which will lead to efficiencies in the patient pathway and reduce barriers to effective treatment for a range of musco-skeletal conditions.
“The evidence from the countries which already permit physiotherapist referral for radiological procedures is positive, with no serious adverse events reported and with many advantages for the patient and the health system,” added Professor McDonough.
An Expert Working Group was established in March 2024 to support the development and implementation of this policy. The group includes representation from Department of Health, Health Service Executive, CORU, UCD and the Irish Society of Chartered Physiotherapists.
Established in 1999, the RCSI School of Physiotherapy aims to educate professionally safe, competent, reflective and analytical physiotherapists.
Physiotherapists rarely get a mention, but they improve the lives of millions of people every single year and so many of us would struggle without them. Huge thanks to every single one of you.
If you’re planning to start an exercise program and wondering where to begin, start with your core first, says physical therapist Brittany Smith, DPT. People often think of the core muscles as being the abdominal muscles, but the core includes the muscles in the abdomen, back and hips, all working together as a group.
“The core muscles provide stability for the entire body as it moves,” says Smith. “These muscles are activated when you stand up, turn, bend, reach, twist, stoop and move in most other ways. Everything starts with your core.”
Strong core muscles help you maintain good posture, while weak ones can lead to slouching and slumping. Poor posture can be a cause of aches and pain, especially in the back.
Getting started with your core
To get your core muscles in shape, you need to exercise.
“Our bodies were made to move, so any physical activity is really important,” says Smith.
She recommends these specific core-strengthening exercises below.
The first one engages the deep muscles in the abdomen, called the transverse abdominis. “These muscles help hold us in a better position to stabilize our core, thereby stabilizing our arms and legs,” says Smith.
“The more you work on these muscles, the more it will become second nature to hold these muscles tight when you’re lifting grocery bags, doing yard work or any other kind of physical activity,” says Smith. This will help support your body.
Other muscles that tend to be weak are the gluteus maximus in the buttocks, and the gluteus medius and gluteus minimus on the side of the hip. The bridge and clamshell exercises can help strengthen these muscles.
Smith emphasizes that getting the proper position of these exercises correct is more important than the number of repetitions you do. “It’s better to take your time, maybe do fewer reps, but with better quality,” she says. For that reason, it can be helpful to have the guidance of a physical therapist to get started.
Move on from the core
Core exercises are the starting point of overall fitness because you need to hold those muscles engaged while you strengthen other muscles, such as the biceps in the arms or the quadriceps in the legs.
Smith suggests setting short-term goals (for about a month) and then more long-term goals. Once you have achieved short-term goals, such as getting around more easily, add other types of weight-training or resistance exercises to build muscle elsewhere.
With any exercise you do, always listen to your body, warns Smith. If you have pain other than muscle burn, take it easy. Reduce the number of repetitions, the weight or the duration of the exercises. Then build up gradually. “You don’t have to be in pain to make gains,” she says.
Beginner exercises for core strength
For each of the following, work up to one to two sets of 10 to 15 repetitions once a day.
Abdominal bracing
Lie on your back with your knees bent and feet flat on the floor. Contract your abdominal muscles, and press the arch of your back down toward the floor, pulling your belly button toward your spine. Hold for 5 to 10 seconds. Make sure your lower back stays flat on the floor. Relax and repeat.
Bridge
Lie on your back with your knees bent and feet flat on the floor with your arms at your sides. Squeeze your abdominal and buttocks muscles, push your heels into the floor and slowly lift your buttocks and hips off the floor. Keep your back straight. Hold for 5 to 10 seconds.
Clamshell
Lie on your side with knees bent in line with your hips and back, draw up the top knee while keeping contact of your feet together as shown. Don’t let your pelvis roll back during the lifting movement. Hold for 5 seconds.
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