Lower Back Pain When Lying Down
Resting or laying down at night after a long day should be a relaxing experience, but lower back pain when laying down can make it hard to relax. Lower back pain in the morning after sleeping can also be disruptive to your day. Back pain is a common experience, with about 80% of people experiencing back pain in their lives. Fortunately, most back pain can be relieved with simple, non-invasive techniques. If lower back pain does not go away after a few weeks of self-care, a physical therapist can help.
The Spine Supports the Body
Back pain comes from the tissues around the spine. The spinal column is the structure that supports the body and is made of bones called vertebrae. There are dozens of vertebrae that lead from the neck down into the lower back or “lumbar region”. Cushioning pads between the vertebrae called intervertebral discs act like shock-absorbers and prevent the vertebrae from grinding. The vertebrae are held together by ligaments, and muscles are attached to the spine by tendons. The spinal column is not solid bone; the spine is like a sturdy, segmented tube. The open space within the spine (the “spinal canal”) protects the spinal cord. The spinal cord runs from the brain down into the base of the spine and is made of the many nerves the body needs to transmit electrical signals that let us feel and move. Nerves come out of the spine at various places to transmit signals to and from different parts of the body to the brain. Strain or injury to any part of the spine can result in back pain.
Injuries or Diseases Can Cause Back Pain
If your lower or upper back hurts when laying down, there may be a disruption to your spine causing the pain. Most back pain is acute, or lasting only a few weeks. Chronic back pain lasts 12 weeks or more.
Injuries are a common source of back pain and arise from harmful physical activity or bad posture. Heavy lifting with incorrect posture or injuries from accidents can strain the muscles, tendons, and ligaments around the spine. Though resting can sometimes help, back pain may feel worse when lying down or sitting down due to the increased pressure on parts of the spine. Excessive bed rest can make back pain worse as the muscles get stiff and sore.
- Sprains occur when the ligaments are overstretched.
- Strains stem from tears in the tendons or muscles.
- Spasms, or uncontrollable and sudden contractions of muscles, can occur after an injury to the spine.
- Traumatic injuries, like those experienced in accidents or falls, can disrupt the spine and should be evaluated by a Doctor of Physical Therapy. Issues like damaged vertebrae might need different care than strains or sprains.
Congenital Spine Abnormalities
Congenital spine abnormalities, or spinal disruptions that a person is born with, may change the structure or curve to the spine. Scoliosis causes a side-ways curve, lordosis causes an inwards curve, and kyphosis (also called hunchback) causes an outwards curve of the spine. These disruptions to the normal curve of the spine can cause pain and extra pressure on other organs in the body. Back pain when laying down could be caused by a soft mattress exacerbating the already altered curve of the spine. Spinal stenosis, or a narrowing of the spinal canal that pinches the nerves in the spinal cord, can be congenital or develop over time. Spinal stenosis associated pain is typically worse when standing and is relieved when sitting down.
Infection of tissues in or around the spine can cause inflammation and pain. Back pain accompanied by swelling, inflammation, and/or fever could be an infection and requires immediate medical attention.
Diseases that affect the spine can cause pain. Osteoporosis occurs when the bone is weak and increases the risk for vertebral fractures. Inflammatory diseases such as psoriatic arthritis and ankylosing spondylitis can cause inflammation and pain in the lower back with movement or when laying down.
Degeneration of Spinal Tissue
Degeneration of spinal tissues occurs naturally throughout life as the spine experiences normal wear-and-tear throughout years. Vertebrae may degenerate and press against nerves that run through the spine. Intervertebral discs wear down and lose their ability to cushion the vertebrae. Discs can also become herniated or ruptured, causing a bulging disc that may compress spinal nerves and cause pain. The nerves may get more compressed when sitting, making back pain worse when lying down or sitting. A specific nerve named the sciatic nerve originates in the lower spine and runs into the legs. Compression of this nerve can cause a burning, shooting pain that runs down one of the legs (sciatica).
Non-spinal issues can also cause the sensation of back pain. Kidney stones, fibromyalgia, endometriosis, and pregnancy may cause back pain without any injury to the spine. In rare cases, tumors can also cause persistent back pain and require medical treatment. These situations should be addressed by a medical provider.
Some spine issues may feel worse at night or when lying down or sitting. Increased pain may be caused by more compression on the spine in certain positions.
Doctors Use Medical Tests to Diagnose Back Pain
Most back pain does not need a diagnosis to start treatment. However, doctors can use diagnostic tests to identify more serious causes of back pain. Tests that doctors may use to help diagnose your back pain include:
- Blood tests - can identify the presence of an infection or other disease.
- Electrical signaling tests - used to make sure that the muscles and nerves in the spine and working properly. Disruptions in the electrical signals could indicate that there is damage to the muscle or nerves. Electromyography (EMG) measures electrical signals that travel through the muscles. Nerve conduction studies (NCS) measure electrical signals that travel through the nerves.
- Imaging techniques – these allow a doctor to see the structures in and around the spine and identify any damage or disruptions. Some imaging techniques include:
- X-rays are used to create an image of bones in the body and can show fractures or misaligned vertebrae.
- Computerized tomography (CT) scans show the soft tissues like ligaments and muscles around the spine. This image allows a doctor to see tumors, damaged intervertebral discs, or narrowing of the spinal canal (spinal stenosis). To better visualize the spine, doctors can inject a dye into the spinal canal to see herniated discs or fractures with an x-ray or CT scan. Imaging with this dye is called a myelogram.
- Magnetic Resonance Imaging (MRI) allows a doctor to see both the bones and soft tissues around the spine. This technique helps a doctor identify inflammation, infections, tumors, and rupture of the intervertebral discs.
In most cases, back pain is not medically serious and can be treated without the need for diagnostic tests. However, some back pain requires immediate medical attention. Talk to your doctor if back pain coincides with unexplained weight loss, inflammation or fever, new inability to control the bladder or bowels (incontinence), or any tingling or numbness in the legs.
Treating Back Pain Starts at Home
Most back pain can be relieved by at-home care. The type of care needed for back pain depends on if the pain is acute (short-term) or chronic (long-term, 12 weeks or more).
Treating Acute Back Pain
Early care for acute lower back pain starts with heat/ice, stretching, and gentle exercise. Bed rest is not recommended except in cases of severe pain. Experts recommend moving whenever possible to prevent the muscles in the back from becoming stiff and sore, which could make back pain worse. Medications like non-steroidal anti-inflammatory drugs (NSAIDs, like aspirin and ibuprofen), and analgesics (like Tylenol) can help manage lower back pain. A physical therapist can help you learn the stretches and exercises that relieve lower back pain.
Treating Chronic Back Pain
Experts recommend starting with non-invasive treatments for chronic back pain such as heat and ice, stretching/exercising, massage, and dry needling. Electrical stimulation may be helpful in relieving pain. While there are several medications available to relieve back pain, the American College of Physicians recommends starting with non-invasive and non-drug therapies. Medications may have side-effects or risks of addition, especially prescribed opioids. If chronic pain persists, spinal injections may help relax muscles and treat pain. Steroidal injections can treat pain for inflammation-associated sciatica, but steroids are not advised for long-term use.
If chronic, severe pain does not respond to non-invasive treatments, your doctor may recommend surgery as a last-resort option. Surgery is not always successful and can have a long recovery period. During surgery, doctors can repair or replace damaged intervertebral discs, re-align or fuse vertebrae, or implant nerve stimulators that disrupt pain signals with electrical stimulation. Physical therapy can help the recovery process after surgery.
A Healthy Lifestyle Prevents Lower Back Pain
Forming habits to take care of your body can prevent lower back pain when lying down or sitting. Risk factors for developing back pain include genetics, age, physical activity, and general health.
Physical activity strengthens the muscles that support the spine. If those muscles become weak due to inactivity, the spine is not stabilized and can cause pain. A healthy diet with plenty of vitamin D and calcium supports bone health so that the spine is strong and healthy. Exercise and a nutritious diet also help manage a healthy weight. Excess body weight puts more stress on the spine which can cause pain and speed up the degeneration of intervertebral discs. Smoking disrupts the flow of oxygen-rich blood to the spine, which can cause deterioration of the discs and spinal tissues; therefore, quitting smoking is a great way to maintain a healthy lifestyle and prevent back pain. If you experience back pain, a physical therapist can show you exercises that will help stabilize your spine and prevent pain.
Good posture and providing proper support for you back are also important for preventing back pain. Hunching over a desk all day without back support can cause back pain. This pain can be avoided by creating an ergonomic work space and taking frequent breaks from sitting to stretch and walk around. Frequent heavy lifting, pushing, or pulling may also cause painful spine injuries. If lifting is necessary, make sure to use the correct form and do not twist your back while lifting. Uncomfortable, unsupportive, and heeled shoes can also contribute to back pain. Heeled shoes change how your spine bends while standing, resulting in pain. This can be avoided by wearing supportive, low-heeled shoes. If you have lower back pain in the morning after sleeping, your mattress could be to blame. While a worn-out or unsupportive mattress allows excess curvature of the spine, a firm mattress properly supports the spine to prevent pain.
Physical Therapy Helps Relieve and Prevent Back Pain
Physical therapy can help prevent and relieve back pain when laying down. Physical therapists are experts on the stretches, exercises, and massage needed for non-invasive back pain treatment. A physical therapist can also help you identify other areas of your life that could be contributing to back pain like poor posture or a non-ergonomic workspace.
FYZICAL offers a wide variety of physical therapy services by qualified providers across the U.S. To find a FYZICAL Therapy & Balance Center near you, visit our website at FYZICAL.com. Our highly skilled therapy providers are 100% focused on your optimal health so you can Love Your Life®!
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