Why your low back hurts in the morning

By Paul Kochoa, PT, DPT, CGFI

Lower back pain is a common condition that can affect most people.  It can start as a dull ache, a sharp pain, numbness or tingling, tightness, soreness, or can even include pain in the buttocks, hips, and legs.  In most cases, it can go away on its own.  But it may not, it may become chronic, or it may go away and recur, which can lead to difficulty moving and doing things in daily life.  It’s time to see a physiotherapist.

First off, if you have back pain that is combined with loss of bowel or bladder control or numbness in the groin area, seek emergency medical treatment as soon as possible.  These two symptoms are marks of a serious medical emergency condition called cauda equina syndrome.  Furthermore, don’t forget about the “red flags” that I’ve previously written about.  Your physiotherapist can go into further detail if you have any specific questions.

When dealing with back pain, some patients will come to me and ask why their back pain is worse in the morning, or why they wake up with a great deal of stiffness upon rising from bed.  This is a common symptom.  And to figure out why this happens, we have to understand the structure of the back itself.

The back is basically a stack of bones, the vertebrae, that are separated by the discs which are structurally like a jelly donut.  The discs have an aqueous center, the nucleus pulposus, surrounded by a harder outer covering, the annulus fibrosis.  The disc doesn’t have a blood supply or nerves to give it any nutrients, it relies on simple absorption of fluid and nutrients from the surrounding interstitial fluid.

The disc acts like a sponge, it compresses when squeezed and expands when that compressive force is removed.  During the day, when we are up and about, the compressive forces of gravity act on the disc and squeeze some fluid out of them.  At night, we spend all our time sleeping in a non weight-bearing position.  This relief of compressive force allows the disc to slowly absorb fluid and expand.  You can imagine the space between the vertebrae are now filled in more with an expanded disc.

When you wake up and get out of bed, your back then assumes a vertical, weight-bearing position again and the compressive forces return to the now expanded discs.  This is a common reason why your back is stiff or more painful in the morning.  But it’s not the only reason.  Just as there are different causes to back pain, there may be just as many reasons why your back may feel more painful in the morning.  To find out more, go see your local physiotherapist for an evaluation.

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