When It Is An Emergency
You should seek emergency treatment for the following.
- The stiffness and pain after an acute injury are so severe that you are unable to move
- Changes in vision or eye pain
- Weakness in your legs, sensation changes in your legs or groin, and/or loss of control over bowel and bladder function
- Systemic symptoms such as fever and fatigue along with severe back pain
What You Should Be Doing For Morning Stiffness
Stiffness is not only from aging but also from the habits you have developed
Two of the most common questions I get asked, is Why does my back hurt so much in the morning? and What can I do so it doesnt hurt anymore?
Its a very common question but there is a real solution to it. It involves beginning with this simple exercise taught below that you should do everyday.
Stretch When You Wake Up
Morning back pain can often be relieved by stretching right before you get out of bed. While youre lying on your back, reach your arms over your head and reach your feet in the opposite direction. Hold this position for as long as you comfortably can, then bring your knees to your chest. Stretching your lower back in this way can relieve any compression that occurred during the night.
Once you sit up, plant your feet firmly on the ground, shoulder-width apart. Reach your arms over your head and then sway from side to side. These stretches are some of the basic movements in the McKenzie Method for musculoskeletal care emphasizing patient empowerment and self-treatment.
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Why Your Mattress Matters For Back Pain
If youre waking up with back pain, you may be sleeping on the wrong mattress. However, your bed is typically not the cause of back pain. In any case, a good mattress can help relieve issues that cause back pain.
A good mattress that is well suited to your needs will help to align your spine. This alignment can alleviate aches and pains. People who suffer from lower back pain should look for a mattress that doesnt put pressure on pain points, particularly the shoulders and sacrum. These beds are typically firm enough that your shoulders dont sink, but soft enough to feel comfortable. Look for a 5-7 rating on the mattress firmness scale .
Still In Pain Consider Seeing A Doctor
If you routinely wake up with extreme morning back pain, or your pain hasnt responded to self-care measures such as stretches and a new mattress, it might be time to consider more immediate relief. Ask your doctor if you can take non-steroidal anti-inflammatory drugs , such as ibuprofen. Acetaminophen may be another option for occasional back pain if you cant take NSAIDs.
If over-the-counter medications dont help, your doctor will probably send you for imaging and diagnosis to determine the root cause of your morning back pain and suggest a course of pain management therapy to relieve your immediate pain. Your doctor might also suggest exercise therapy to help correct the underlying skeletal or muscular problems that led to your pain.
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How To Treat Morning Stiffness
“Some people wake up feeling amazing and don’t notice much stiffness but I think if we put them to the test and measured their strength or flexibility, they would be slightly worse in the morning than throughout the day,” Dr Richardson says.
“If it’s not affecting you, you don’t need to do anything about it.”
But if you do feel super stiff and uncomfortable doing early morning exercise, then Dr Richardson says it’s important you start with gentle movement.
“You probably will notice for the first half an hour of that exercise that you need to pay attention to what you’re doing and not overdo it,” she says.
“But as you warm up, you’ll find that you can do more and more and it becomes a lot more comfortable. Gentle movement encourages better fluid flow so better blood flow, better synovial flow and better lymphatic flow. All of this helps to lubricate our muscles and joints and get them moving.”
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It’s important to listen to your body, so if your instructor is encouraging you to contort your body into a challenging yoga pose or do a particular weight-bearing exercise that feels icky, then adjust to suit yourself.
“Even if an instructor hasn’t acknowledged that you might be uncomfortable, there’s nothing wrong with listening to your body,” Dr Richardson says.
Take It Slow When Getting Up
Taking it slow when you get out of bed can be beneficial. You may want to use your arms to sit up slowly before moving your legs off the side of the bed. Once you plant your feet on the ground, shoulder-width apart, you can stand up slowly, using your leg strength instead of your back to help you up.
After carefully standing, you can further relieve tension by reaching your arms up above your head and stretching slowly from side to side.
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Tips For Dealing With Morning Stiffness
There actually has been a modified-release prednisone tablet developed. Taken at approximately 10 pm, the tablet delivers a dose of prednisone to the body about 4 hours later, which is considered the best time to suppress IL-6. Some clinical studies published in 2011 suggested that this is the best way to manage morning stiffness. The drug called Lodotra in Europe where it was approved before the US approval performed well in studies. The FDA approved it in 2012 under the name Rayos.
If you have inflammatory arthritis, managing morning stiffness involves working with your healthcare provider to control the inflammation. No matter what type of arthritis you have, here are some tips which may help:
- Sleep in a position that supports your joints.
- Be sure that your bedroom or sleep environment is warm. Dial-up a comfortable temperature on the thermostat and use heating pads and electric blankets for extra warmth.
- Before getting out of bed, do simple stretching exercises in bed to limber up.
- When you first get up, take a hot shower. Standing under the warm water will relax you.
- Do a few more exercises once your muscles begin to loosen up.
- Easier said than done, but when you go to bed, let go of work, stress, or any problems. Consciously plan to escape stress to help reduce tension and allow your body to relax before falling asleep.
- If possible, delay your activities until later in the day. If you work, consider requesting a later start time.
The Standing Hip Shift Exercise
Illustration below
This movement is rarely taught, yet we often perform a variation of it every day during our everyday routine .
If it hurts, dressing and putting on your socks is not easy to do first thing in the day. You have developed significant stiffness in your hips so that it remains with you overnight. Although you may become more flexible towards the end of the day, your weaker hip muscles continue to make you prone to becoming very stiff.
The exercise targets weaker, tighter and often neglected lumbar region, hip and leg muscles. It is to be done with upright support and requires practice as balance, and hip shifting is encouraged.
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Myths About The Causes Of Morning Back Pain
There are some popular ideas about what causes back pain that are probably wrong :
All of these causes are discussed below, along with many treatment options and suggestions. Click the green headings above to jump down to a section.
Are There Psychological Factors That Drive Morning Pain
The book Back Sense proposes that morning back pain is caused by stressful night-time mental patterns manifesting as back pain. I do not generally dismiss the role of psychology in back pain. Its actually a major theme in my writing about back pain. See The Mind Game in Low Back Pain. But I do think that author is indulging in a simplistic mind-body connection theory. Ive written crankily about this kind of logic elsewhere .
Its a bit of a reach to say that you have such a problematic, pain-causing mental state like clockwork every morning between 6am and 7am exclusively. Applying How to Simplify Chronic Pain Puzzles to the problem, it is much more likely that there is simply a time limit on how long you can lie in bed without tissue crankiness.
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Causes Of Morning Stiffness/ Back Pain
A few basic reasons for morning stiffness and pain are:
1) Sleeping Position
The main culprit and the most obvious reason of your morning back pain is most likely an improper sleeping posture.
Poor position during sleep can put a pressure on your spine, causing it to flatten. This can cause a strain in the back and put pressure on the joints of the back.
The most likely position to cause trouble is sleeping on your stomach.
In a lot of cases, poor quality mattresses also play an important role in messing with the natural curve of our spine, which may happen especially to side sleepers, as sleeping on the side places additional pressure on our spine which now rests in an unnatural position.
2) Being Over-Weight or Physically Inactive
Having extra weight doesnt only result in back pain in the morning, it can cause a lot of other health problems including pain in the rest of the joints, especially the knees and ankles, as well as pain in legs and the back during the rest of the day.
If you top that with a sedentary lifestyle and lack of physical exercise, the pain is bound to get worse.
3) Degenerative Changes in the Spine
Degenerative disc disease occurs naturally as we age. This means that the spinal discs between vertebrae begin to wear out as the normal process of aging occurs.
4) Inflammatory Back Pain
5) Fibromyalgia
6) Osteomalacia or Vitamin D Deficiency
Myofascial Pain Syndrome And/or Fibromyalgia
There are two common types of widespread moderate body pain, both somewhat mysterious and controversial, both known for affecting the back more than other areas, and both known for their morning hijinks:
Theres likely lots of overlap between these conditions. Fibromyalgia isnt really an explanatory diagnosis it just labels a common pattern of symptoms that probably have different causes in different people. MPS is a hypothetical problem with muscle tissue that is a possible explanation for some body pain, and that type of pain is extremely common in fibromyalgia patients.
Fibromyalgia is associated with morning back pain because:
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Dealing With Morning Stiffness
You may be able to manage morning stiffness with medication or changes in your habits. Start by bringing up this symptom with your healthcare provider.
A prescription drug called Rayos is a delayed-release form of the corticosteroid prednisone, which is a powerful anti-inflammatory. Rayos is generally taken around 10 p.m. and it releases the medication about four hours later. That’s thought to be the best time to suppress IL-6.
Some habits that also may help include:
- Supporting your joints while you sleep, possibly with pillows or braces
- Staying warm by using electric blankets or heating pads, or turning up the thermostat
- Doing simple stretching exercises before you get out of bed
- Taking a hot shower first thing in the morning to relax your joints and muscles
- Doing light exercise once you begin to loosen up
- Trying to let go of stress before going to bed
- If possible, delaying activity until later in the day, such as requesting a later start time at work or not making early appointments
Some methods may work better for you than others. Experiment with different changes and see what helps.
Can Nocturnal Back Pain Be A Sign Of Something Serious
Guidelines for discovering serious spinal health problems list a number of “red flags,” among them nocturnal back pain.
Nocturnal back pain can be a symptom of spinal tumors. It could be a primary tumor, one that originates in the spine, or it could be a metastatic tumor, one that results from cancer that started elsewhere in the body and then spread to the spine.
Nocturnal back pain is also a symptom of spinal bone infection and ankylosing spondylitis , a condition that can cause the spine to fuse in a fixed, immobile position.
Other “red flags” include:
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Reasons Your Back Pain Is Worse When You Wake Up
1) Fluid in spinal discsSpinal fluid is necessary to allow for all of our spinal motions without it the spine would crack and break. The fluid is a shock absorber that circulates nutrients and chemicals filtered from the blood and removes waste products from the brain. Our spinal discs constantly fill and empty of this fluid. Our spinal discs are at their fullest in the morning because they fill up with fluid when we lie down at night. This means that when we get up in the morning we will be a little bit taller than usual, but also a little bit stiffer! This stiffness can cause morning back pain that will ease off as the day goes on. Practicing gentle back exercises such as cat/cow will help to get the spinal fluid moving and alleviate any discomfort caused by it.
What Makes My Joints Stiff In The Morning
Image: Bigstock
Q. Why are my joints so stiff when I wake up? Is there anything I can do about it?
A. Stiffness in the back, knees, or feet is a common complaint I hear from older individuals. People often say, âIâm just getting old,â but old age alone does not cause morning joint stiffness. It is usually an indication of worn joints, muscle tightness, or inflammation from arthritis.
As your joints get older, the spongy cushion of cartilage begins to dry out and stiffen. The joint lining also produces less synovial fluid, which lubricates the joint. Weak muscles and stiff tendons also tend to tighten during sleep. Osteoarthritis, , and rheumatoid arthritis, , both can trigger morning stiffness.
The average episode lasts only about 10 to 15 minutes. The stiffness goes away as you move and warm up the joints and muscles. However, stiffness from rheumatoid arthritis may last more than an hour.
You cannot reverse the effects of joint aging, and while certain medications can help manage arthritis pain and inflammation, stiffness can still occur. Still, you can reduce the severity and frequency of morning joint stiffness by being more active and engaging in exercise to increase muscle strength and flexibility. Maintaining a healthy weight also can help. Finally, donât be swayed by joint health supplements, such as glucosamine or chondroitin. These do not appear to help manage symptoms in the long term.
William Kormos, M.D.
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Herniated Disk In The Lower Back
A herniated, ruptured, or “slipped” disc means that a vertebral disc â one of the soft pads of tissue that sit between each of the vertebral bones â has becomes squeezed out of shape. Its cushioning material has been forced against, and possibly through, the ring of fibrous tissue that normally contains it. This causes pain, numbness, and weakness in the legs.
The normal aging process causes the discs lose moisture and become thinner, making them more vulnerable to “slipping.”
Most susceptible are men from ages 30 to 50. Smoking, obesity, lack of exercise, and improper lifting are also risk factors.
Symptoms include pain, weakness, numbness, and tingling in the back, leg, and foot.
Diagnosis is made through patient history, neurological examination, and MRI scan.
Treatment begins with rest, nonsteroidal anti-inflammatory drugs, physical therapy, and sometimes epidural steroid injections into the back to ease pain and inflammation.
Surgery to remove the herniated part of the disc â the part that was squeezed out of place â can also be helpful.
Rarity: Common
Top Symptoms: lower back pain, moderate back pain, back pain that shoots down the leg, back pain that gets worse when sitting, leg weakness
Urgency: Primary care doctor
Why Does My Back Hurt More In The Morning
There are many reasons why some people might experience back pain when they wake up in the morning. Morning back pain is often attributed to the morning being the most vulnerable time for your spine.
This vulnerability can be due to what you do before bed or how you sleep, but your back pain might also be a sign of an underlying issue with your nervous system.
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