Why Does my Back Hurt in the Morning?

If I punch you: IT HURTS

If I pour gas on a cut: IT HURTS

The first scenario is well understood, pain of a common mechanical origin. The second is pain of a chemical origin, less frequently appreciated but plays a significant role in morning lower back pain that is commonplace with many adults. This is often a source of frustration due to its longevity and this article will help to clarify the origins as well as give proactive options to resolve.

Why Do we Have Morning Back Pain?

Unfortunately while sleeping, we subconsciously place the joint surfaces of adjoining spinal vertebrae and the correlating nerves that exit each level of the spine in a position of compression. The magnitude thereof is not at a level to wake us immediately and unfortunately as the night progresses, there is unrelenting irritation of both the joint surface and neurologic structure. (It’s the same reason why 65 year olds don’t like to squat down for a long period of time.)

Ongoing irritation triggers regional musculature to contract/tighten attempting to protect the source of pain via our bodies inherent “fight or flight” mechanism. When the combination of joint, neurologic and musculature pain gets to a point where it activates higher centers of our brain, we wake up. This is MECHANICAL PAIN.

Whenever tissue is damaged, (in this case joint surfaces (cartilage and bone) and discal structure (the jelly donut designed cushion between the vertebra) and still has the capacity to heal, our body will use fuel in the healing process. Like a car, whenever you burn fuel, there is a byproduct or “exhaust”. This is commonly called “inflammatory fluid”. During the night, our systems slow down including the volume of blood being pumped around, especially to bone and musculature, yet the exhaust continues to accumulate. (Think about waking up the morning after the first football practice or the first trip to the backyard garden come spring).

Just like gasoline, inflammatory fluid is a noxious chemical substance and when it touches a nerve it generates pain. When we get out of bed and start moving around, more blood starts to move in and around bones and muscles, thus flushing out the chemical exhaust with the perception of “loosening up”. This is CHEMICAL PAIN.

A crucial thing to think about with both of these pain types is not to fear them but to address them proactively. This is the expertise of the physical therapist. As well, you need your sleep which is crucial to your overall well being.

How to Decrease Back Pain at Night

• MOVEMENT. Gentle stretching before you go to bed and before you get out of bed can be a great help. See Buisman Blog post “BED STRETCHES FOR THE SPINE” and “DAY STRETCHES FOR THE SPINE”. This addresses MECHANICAL PAIN.
• POSITIONING. Beat up spines of arthritic origin classically liked to be flexed or forward bent, thus ending up in a fetal position, painful side up, pillow between the knees, with top arm dangling off of the bed toward the floor is a good starting point. Modify as necessary to find a place of “quiet” and position with pillows to keep you there. Spines suffering from discal based injury like to be in a neutral position. On your back with hips and knees maintained at 90 degree angles via pillows or a foam bolster is ideal. This addresses MECHANICAL PAIN.
• MEDICATION. Try an over the counter non steroidal antiinflammatory drug (ask your doctor if this is appropriate for you), sometimes used in conjunction with acetaminophen, noting that both options have versions that add a sleep agent. This addresses CHEMICAL PAIN
• HEAT/ICE. Heat may be the best option in the morning if you are stiff. The heat relaxes the muscle and increases blood flow. As the day progresses, ice may be the best route. It slows the inflammatory (chemical pain) process and also increases blood flow. This may be the best bet right before bed. This addresses CHEMICAL PAIN.

Twin Cities Shoulder is a specialty shoulder care practice under the umbrella of OrthoRehab Specialists Inc. ORSI is an outpatient orthopedic and neurologic private practice that has provided physical therapy care for over 30 years in the Twin Cities metro. Terry Buisman PT is the co-owner of ORSI and heads TCS. His specialty is adult shoulder (non/post-surgical/adhesive capsulitis) as well as combined shoulder and spinal based pathology.