Lower back pain when lying down is a common complaint, and it can stem from a variety of issues, ranging from simple muscle strains to more complex conditions like arthritis or sciatica. This discomfort can be a minor annoyance or a significant disruption, especially when it interferes with your sleep and daily life by causing muscle stiffness and limited movement.
This article will delve into the potential causes of lower back pain that worsens when you lie down. We will explore how these causes are diagnosed and what treatment options are available to help you find relief.
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Verywell / Laura Porter – Alt text: Illustration depicting a person experiencing lower back pain while lying down, highlighting the common symptom discussed in the article.
Common Reasons for Lower Back Pain When Lying Down
Experiencing back pain primarily at night is often not indicative of a serious underlying health issue. It’s helpful to differentiate between two types of back pain:
- Acute Pain: This is short-term pain, typically lasting from a few days to a few weeks. It’s frequently triggered by a specific injury or event.
- Chronic Pain: This type of pain is long-lasting, persisting for several months or even longer. Often, chronic pain isn’t directly linked to a specific injury.
Here are some of the prevalent causes of lower back pain that may become more noticeable or intense when you lie down:
Muscle Strains and Ligament Sprains
A lumbar strain or sprain, affecting the muscles or ligaments in your lower back, is a frequent occurrence. These injuries happen when these soft tissues are overstretched, often due to sudden movements, heavy lifting, or poor posture.
These types of injuries are usually acute, meaning the pain is temporary and should subside within a few days or weeks as the tissues heal.
Ankylosing Spondylitis
Ankylosing spondylitis (AS) is a less common form of arthritis that causes persistent inflammation in the neck and back. A hallmark of AS is that symptoms, including pain and stiffness, often worsen during the night and in the early morning. Individuals with AS also have a higher susceptibility to spinal fractures.
AS is sometimes associated with other conditions like osteoporosis (decreased bone density) and psoriasis. Physical therapy is often beneficial in managing AS symptoms and improving mobility.
Spinal Osteoarthritis
Osteoarthritis (OA), also known as degenerative arthritis, is a widespread cause of joint pain. It develops as the cartilage that cushions your joints wears down over time. Over 32.5 million people in the US are affected by OA.
The lower back is a frequently affected area in OA. Spine osteoarthritis can lead to increased nighttime back pain, possibly because you are less active and less distracted from the pain when resting.
Sciatica
Sciatica refers to pain that originates from the sciatic nerve. This pain often radiates from the lower back, through the hip, and down the leg.
Certain sleeping positions can put pressure on the sciatic nerve, which runs from your lower spine down to your feet. This pressure can trigger or worsen sciatica pain, causing sharp, shooting pains down your leg, particularly when lying down.
Sciatica typically affects only one side of the body at a time, although it can occur bilaterally. For most people (around 80%), sciatica pain usually resolves on its own within about six weeks.
Spinal Tumors
While spinal tumors are rare, they can be a cause of nighttime back pain. People with cancer, in general, experience sleep disturbances at higher rates. When a tumor develops on the spine, it can compress nerves and structures, leading to pain that intensifies when lying down due to pressure changes and lack of distraction.
Research indicates that spinal tumor-related pain often disrupts sleep, but surgical intervention can lead to significant improvement.
Spinal Stenosis
Spinal stenosis is a condition characterized by the narrowing of the spinal canal. This narrowing can compress the spinal cord and nerves, leading to pain, numbness, and weakness. Lumbar and thoracic stenosis are types that affect the lower back.
As spinal stenosis progresses, the pain may become less responsive to rest. Sitting or lying down may no longer provide significant relief. This chronic condition can, in severe cases, lead to serious complications including paralysis.
Osteomyelitis
Osteomyelitis is a bone infection, usually caused by bacteria. Staphylococcus aureus is a common culprit. These infections can spread throughout the body or recur in the same location.
Back pain is the most common symptom when osteomyelitis affects the vertebrae in the spine. Other symptoms of infection, such as fever, may also be present. Treatment for osteomyelitis includes antibiotics and pain management, but it can be a challenging condition to treat effectively.
Other Potential Causes
Lower back pain when lying down can also be related to conditions that cause pain at other times but become more noticeable at night. When you are busy during the day, you might not focus on the pain as much as when you are trying to relax and sleep.
Other potential causes of nighttime back pain include:
- Endometriosis
- Kidney stones
- Other forms of arthritis
- Pregnancy
- Uterine fibroids
When to Seek Medical Advice for Back Pain
While everyone’s pain tolerance varies, it’s advisable to consult with a healthcare provider if your back pain:
- Started immediately after an injury, such as a car accident.
- Wakes you up at night or prevents you from falling asleep.
- Radiates to other areas of your body, especially down your legs.
- Persists for more than a week.
- Is accompanied by weakness, numbness, or tingling in your lower body.
Additionally, seek medical attention if the pain is severe or if you notice signs of infection such as redness, warmth, swelling, or fever. You can start by seeing your primary care physician, who can provide treatment or refer you to a specialist like a rheumatologist.
Immediate medical attention is necessary if you have lower back pain and a history of cancer. Urgent evaluation is also needed if you experience unexplained weight loss or sudden problems with bladder control alongside back pain.
Diagnosing the Cause of Nighttime Back Pain
To determine the cause of your lower back pain, your healthcare provider will begin with a physical examination and a review of your medical history. Be prepared to discuss your symptoms and any relevant medical conditions.
Your doctor will ask you to describe your pain in detail. It’s helpful to consider:
- When the pain started.
- What activities or positions make it better or worse.
- The nature of the pain (e.g., aching, sharp, burning, throbbing).
- The intensity of the pain.
- If you have any other symptoms like numbness or tingling.
Further diagnostic tests may be required, including:
- Neurological Tests: These assess muscle strength and sensation to determine if the pain is related to nerve issues or spinal problems.
- Imaging Tests: MRI or CT scans can help rule out serious conditions like cancer, infection, or fractures.
- Lab Tests: Blood tests, such as a complete blood count, may be ordered to check for infection or if unexplained weight loss suggests cancer or inflammatory arthritis.
Treatment Strategies for Lower Back Pain at Night
Treatment approaches will depend on the underlying cause of your back pain. Initial treatments often focus on pain relief and may include:
- Heat or ice application.
- Over-the-counter (OTC) pain medications.
- Gentle stretching and light exercise.
- Physical therapy to strengthen core muscles that support the lower back.
- Corticosteroids to reduce inflammation.
- Epidural injections, which deliver pain medication directly into the spine.
Since the pain occurs at night, improving your sleep environment is crucial. This might involve adjustments to your sleeping position, pillows, or mattress to provide better support and reduce pressure on your back.
Complementary therapies can also be beneficial, such as:
- Acupuncture
- Chiropractic care
- Gentle exercises like yoga and tai chi
- Hydrotherapy
- Massage therapy
- Stress management techniques
If the pain is severe or doesn’t improve with conservative treatments, your healthcare provider might recommend surgery. Surgery can be a viable option for conditions like degenerative disc disease, sciatica, and spinal osteoarthritis, and in some cases of ankylosing spondylitis.
For serious underlying conditions like cancer, spinal tumors, or osteomyelitis, your healthcare provider will discuss specialized treatment options, which may include surgery, radiation therapy, or other immediate interventions.
Managing and Coping with Nighttime Back Pain
Certain factors can increase your risk of developing chronic lower back pain. These include:
- Being overweight or obese.
- Having a physically demanding job that involves heavy lifting.
- Working in positions that require frequent bending or twisting of the lower back.
- Smoking history.
Some research also suggests that anxiety and depression can contribute to the risk of chronic back pain. While not all causes of nighttime lower back pain are preventable, adopting healthy habits can help maintain back health and minimize pain. These include:
- Maintaining a healthy weight.
- Engaging in regular exercise.
- Quitting smoking.
- Practicing good posture.
- Avoiding activities that strain your back, like heavy lifting with improper form.
- Using ergonomic chairs at home and work.
- Changing sitting positions frequently and taking breaks to walk and stretch.
- Wearing comfortable, low-heeled, supportive shoes.
Achieving Restful Sleep Despite Back Pain
Nighttime back pain can be managed with OTC or prescription medications, heat or ice therapy, and stretching. Adjusting your sleep position or mattress may also provide relief. A physical therapist can play a key role in your recovery. However, the most effective treatment will always depend on accurately identifying and addressing the underlying cause of your pain.
Why Does My Back Hurt When Lying Down?
In Summary
Back pain that occurs when you lie down can have numerous causes, some more serious than others. Identifying the cause is crucial, especially if you frequently experience lower back pain at night.
Muscle strains are the most common culprit, but conditions like arthritis, sciatica, and spinal changes can also contribute to nighttime back pain.
Often, simple remedies like OTC pain relievers, heat, ice, and gentle stretching can provide relief. Adjusting your pillow or mattress might also help. If the pain persists, seeking professional medical diagnosis and treatment is essential.
A Final Word from Verywell
To help my patients understand lower back pain when lying down, I use an “A.B.C.” approach. “A” stands for antecedent (what you did during the day before lying down), “B” for behavior (what you are doing while lying down), and “C” for consequence (the pain you feel). Antecedent factors can include daily activities, posture at work, and mattress firmness. Behavior factors include sleep position and even mental health. This framework can guide conversations with healthcare providers to develop a personalized plan to address the root cause of your pain, empowering you to take control.
— FOREST MILLER, OTR/L, MEDICAL EXPERT BOARD
