Sometimes low back pain is at its worst first thing in the morning.  

What does it mean if getting out of bed is an ordeal for your back?  And, more importantly, what can you do about it?

There are a few theories about why back pain can be bad in the morning. Maybe one or more of them will apply to your case:

Sol vs. Gel 

The most common substance in your body is water. But there are a lot of solid particles mixed in with it. 

The balance between solids and liquids is carefully orchestrated.  At any given moment, many of your connective tissues are poised about midway between being a liquid with solids dissolved in it (a sol) and being a solid with liquids dissolved in it (a gel).

One of the important factors that keeps your body liquid and flowing is movement.  

When you’re asleep and not moving, your tissues congeal.  The common experience with arthritis – that stiffness and pain are worse in the morning – is an example of this.

When you wake up, it can take a while for your joints to regain their natural lubrication. It’s almost like a reptile having to warm itself in the sun before it can activate its muscles.

If this seems to apply to you, here’s what you can do about it:

• Drink extra water during the day.
• Before you get out of bed in the morning, stretch and mobilize your spine.  Reach up with your right arm overhead and elongate the right side, then repeat with the left.  Gently twist to the right and left a few times.
• Consider glucosamine sulfate as a supplement.  Glucosamine is the molecule in your cartilage that binds water. It’s true that recent research has tended to debunk its benefits, but it’s highly unlikely to do harm and I’ve had a number of patients who think it’s the greatest. Extra glucosamine may help you stay more fluid.

Kinky

You don’t sleep in an exactly symmetrical position. So inevitably, even though you’re at rest, a few ligaments, tendons, discs, or muscles will be twisted, compacted, or over-stretched.

Even though the distortion of these tissue is minimal, the negative effects are multiplied as the hours tick by. Your body takes corrective action and creates inflammation.

No wonder you wake up in pain. If this scenario seems applicable to you, here’s what you can do about it:

• Before going to bed, do some gently limbering movements for your spine. That way you’ll minimize any areas of tissue tightness at the start of your night’s rest.
• Make sure you’re consuming a healthy diet that fights inflammation. You may also want to use some anti-inflammatory supplements including EPA and DHA, curcumin, boswellia, and white willow bark.
• Your mattress may be too stiff and not conform locally to the shape of your body parts.

Disc Ooze

A lot of people with low back pain have problems with bulging or herniated intervertebral discs.

The extent of the bulge or protrusion varies considerably depending on your posture and activity.  

If you lie on your back all night, the disc gel will ooze backward, making your pain or nerve impingement worse. If you lie on your side, the disc fluids can ooze sideward, also making your pain worse.

If your low back pain seems to result from this phenomenon, here’s what you can try:

• Make sure your mattress doesn’t sag.  
• Before going to bed, perform a few repetitions of the cobra pose.  That will ensure that your disc fluids are well-centered in the disc space before you fall asleep.
• When you wake up, perform a few repetitions of the cobra pose before getting out of bed.

Sleep Disturbance

Lack of sleep is reason enough to have stiff, painful muscles, an irritable mood, and a lower tolerance for pain. 

Even if you’ve spent seven or eight hours in bed, the quality of your sleep may be inadequate if your bedroom isn’t dark enough or it’s too noisy. Sleep apnea will also interfere with a good night’s rest.

Some people say they only need four or five hours sleep a night.  It’s possible that a few genetic freaks can thrive with limited sleep (Ruth Bader Ginsburg, maybe?), but most people are just kidding themselves that four or five hours is adequate.

If poor sleep is a problem for you, try these strategies:

• Have a fixed bedtime every night. And make sure it’s seven to eight hours before you have to get up in the morning.
• Wear a sleep mask or use ear plugs if light or sound are problems.
• Use a calming meditation ritual for twenty minutes before bed every night.
• Talk to your doctor if you think sleep apnea could be a factor for you.

No need to wake in pain each morning.  Implement one or more of these tested strategies to move toward a more healthy future.

Dr. Lavine has been an innovator in the use of movement and touch to promote health since 1981. He practices in New York City and Princeton, NJ.