Does the following scenario sound familiar? You wake up every morning with substantial pain and stiffness in your lower back, sometimes to the point where it takes a half-hour just to get out of bed and get your day started. But by midmorning the pain has lessened substantially, and by noon you feel almost normal. Then the same cycle starts up again the next day—and the day after that.
Morning back pain is a common condition; it can also be an incredibly frustrating one. Even if the pain doesn’t last all day, waking up stiff and sore every morning makes it difficult to get through your morning routine. In this blog post we’ll explain why your lower back pain is worse in the morning, and what you can do to find relief.
Morning Back Pain: What Causes It
Sometimes, back pain after sleeping can be attributed to sleeping posture, or your mattress and/or pillow. If your mattress isn’t providing appropriate support—the kind that allows your spine to maintain the proper curvature—it could be causing serious discomfort.
But the most common cause of morning back pain is a medical condition called lumbar facet arthritis.
Facet joints are one of the building blocks of the spine. Each of your spine’s vertebral bodies is made up of a disc—a round, flat shock absorber—and two facet joints, which act as stabilizing joints. Healthy facet joints have cartilage, or connective tissue that enables smooth movement with no friction. (The same is true of any joint in the body—hip, knee, ankle, or anywhere else.)
At some point in their lives—usually as they get older—some people are affected by degenerative arthritis in their facet joints. This condition causes the cartilage between the joints to break down, creating friction during joint movement and causing the joint lining to become irritated and inflamed. There may also be high levels of inflammatory mediators, like cytokines (proteins released from cells), present in the facet joint tissue, which contribute to the pain.1 As a result of this condition, lumbar facet arthritis sufferers experience swelling, pain, and stiffness in the lower back, and sometimes muscle spasms as well.
Lumbar facet arthritis can affect people as early as their mid-30s, but it more commonly occurs in people aged 60 to 75.
Are you considering surgery for severe, disabling back or leg pain? Read about a new alternative to fusion called total joint replacement.
Why is lower back pain worse in the morning?
Arthritis in just about any joint—hips, knees, and ankles included—is usually worse in the morning. That’s because the inflammatory response continues at full force when activity is at a minimum during the night. During those hours, the inflammation builds up, causing stiff, painful joints in the lower back in the morning, and sometimes radiating into the buttocks and proximal thigh.
As you get up and move through the day, the inflammatory response lessens, and less inflammation means less swelling. So the painful joint becomes less painful, and the muscle spasms occur less frequently.
Morning Back Pain Relief: What You Can Do
A doctor’s visit will be necessary to diagnose facet arthritis. In addition to doing some information-gathering about your pain and your history of injury, a doctor may also recommend an MRI or X-ray to help pinpoint the problem. However, it’s important to note that the degree of pain is not always directly proportional to the findings presented on a diagnostic imaging test. Someone with mild arthritis may be experiencing a lot of back pain; conversely, some people have severe radiographic evidence of arthritis and only mild back pain.
But if you are waking up stiff and sore every morning, there are things you can do to manage the pain. Treatments usually start with more conservative measures and, if your situation requires it, may eventually include surgery. As always, talk with your doctor before starting any type of treatment. Morning pain relief methods include:
- Medication. A long-acting, anti-inflammatory prescription drug, such as meloxicam, is often used to treat pain or inflammation caused by arthritis. It works by reducing hormones that cause inflammation, and so reduces the inflammatory response through the night. Taken before bed, a 24-hour medication will be effective in the morning and hopefully reduce the amount of tightness, pain, stiffness, and swelling you experience.
- Physical therapy. Exercise can help control inflammation in the joints, and increase the strength and flexibility in your back. Consult a physical therapist to learn specific exercises you can do that will be beneficial to help calm the pain and decrease muscle spasms at the same time.
- Steroid injections. Steroids help reduce inflammation—and thus reduce pain—when injected directly into the affected area. Steroid injections vary in how quickly they work and how long the effects last.
- Nerve ablation. There is a nerve in the spinal column that provides sensation to spinal joints. That nerve branch can be deadened (called an ablation) or severed (called a rhizotomy) to relieve pain and muscle spasms.2 This technique may help the pain for a few months up to a year; however, the treated nerves may regenerate, meaning the pain will likely return to its previous level. And repeating ablation hasn’t been shown to work well. So while this method can provide several months of relief, it cannot be considered a cure.
- Surgery. Most people—more than 80%—respond to conservative treatments, particularly at the early onset of morning back pain. They may help keep the pain at a low level, or even allow you to have periods with no pain at all. But if your pain is approaching a level that is disabling—for example, a 7 or 8 on a scale of 1–10 for most of the day—and prevents you from working, traveling, etc., it may be time to consider a surgical option. Two options are currently available:
- Fusion—During a fusion, a surgeon removes the disc material located at the affected level of your spine and all or part of the associated facet joints, packs the space with bone graft, and then inserts spacers, screws, and rods into the bones to temporarily hold everything in place. Eventually the bone graft fuses, the body heals, and what were once two separate vertebrae are now joined as one solid mass of bone. As a result, your spine has one less joint after surgery than it had before. Fusion has not been shown to have good long-term results for most patients; that’s because the impact of having one less joint means your body won’t move in the same way after surgery, which has both short-term and long-term effects.3
- BalancedBack Total Joint Replacement—While fusion removes a joint and limits mobility (usually causing more pain), the BalancedBack procedure replaces the function of the affected joint—both the disc and the facet joints. It works on the same theory as total joint replacement in the hips and knees. The new, productive joint allows the levels above and below to function naturally after surgery, giving BalancedBack patients an advantage over fusion patients.4 (You can learn more about BalancedBack here.)
Remember that there can be numerous causes of morning back pain, so the first step in managing it is understanding why it occurs—and knowing when to see a doctor for advice.
1 Igarashi, A., Kikuchi, S., Konno, S., & Olmarker, K. (2004). Inflammatory cytokines released from the facet joint tissue in degenerative lumbar spinal disorders. Spine, 29(19), 2091-2095.
2 Paulsen, R. T., Carreon, L., Busch, F., & Isenberg-Jørgensen, A. (2019). A pilot cohort study of lumbar facet joint denervation in patients with chronic low-back pain. Danish medical journal, 66(3).
3 Hedlund, R., Johansson, C., Hägg, O., Fritzell, P., Tullberg, T., & Swedish Lumbar Spine Study Group. (2016). The long-term outcome of lumbar fusion in the Swedish lumbar spine study. The Spine Journal, 16(5), 579-587.
4 Pan, A., Hai, Y., Yang, J., Zhou, L., Chen, X., & Guo, H. (2016). Adjacent segment degeneration after lumbar spinal fusion compared with motion-preservation procedures: a meta-analysis. European Spine Journal, 25(5), 1522-1532.