Back Pain in the Morning: What Are Some Possible Causes?

For many patients, morning back pain isn’t a symptom of a larger spinal issue, but a manifestation of other bad habits. Before seeking professional help, consider common environmental causes of back pain:

• Bad Mattress: Firm bedding supports your spine better through the night, and well-worn, cratered mattresses may aggravate your back while you sleep. Discover some tips on how to choose a mattress for lower back pain in this blog.
• Poor Sleep Position: Sleeping on your stomach causes your lower back to extend, placing it under pressure. Side sleepers who don’t bend their knees (or sometimes even prop a pillow between their knees) may also be irritating their backs as they sleep.
• Poor Ergonomics: Bad posture? Work in a bad environment? Your ergonomics may take a toll on your back that worsens at night when you’re still.

Optimizing Your Sleep Setup

Mattress Considerations

Research supports what many back pain sufferers discover through experience: mattress firmness matters. A study published in The Lancet found that people with chronic low back pain who used medium-firm mattresses experienced better pain relief and less disability after 90 days compared to those using firm mattresses. A 2021 systematic review confirmed that medium-firm surfaces promote comfort, sleep quality, and proper spinal alignment.

The ideal mattress supports your spine’s natural curves while distributing your body weight evenly, preventing pressure points that can contribute to morning stiffness.

When to replace: Sleep medicine experts commonly recommend replacing most mattresses every 7-10 years, though actual lifespan depends on the mattress type, your body weight, and how heavily it’s used. Consider replacement if you notice:

• New or worsening back pain in the morning that improves as you move throughout the day
• Visible sagging, permanent body impressions, or uneven support
• Waking up more rested after sleeping elsewhere (hotel, guest bed, etc.)

Short-term solution: If you can’t replace your mattress right away, adding a 2-3 inch memory foam or latex topper can improve comfort and support. While research on toppers specifically is limited, sleep specialists often recommend them as a practical way to extend the life of an aging mattress or adjust firmness levels.

Sleep Positions That Help Reduce Morning Back Pain

The right sleep position can make a meaningful difference in how you feel when you wake up. These positions are commonly recommended by national spine and health organizations, but the best sleep position is the one that controls your symptoms and lets you rest. Here’s how to adjust your setup based on where your back hurts:

For Lower Back Pain

Best position: Side sleeping with a pillow between your knees

Side sleeping with your knees slightly bent and a firm pillow between them helps keep your spine, hips, and pelvis aligned and may reduce morning low back pain. The pillow helps keep your hips, knees, and ankles stacked and prevents your top leg from pulling your spine out of alignment. Your head pillow should keep your head level with your spine, not tilted up or down.

Alternative: Back sleeping with a pillow under your knees

If you prefer sleeping on your back, placing a pillow under your knees and, if needed, a small rolled towel under your lower back can help maintain its natural curve and ease strain.

Avoid: Stomach sleeping

Stomach sleeping puts the most pressure on your spine because it counters the natural curves of your spine and forces your neck to rotate. If you can’t sleep any other way, placing a pillow under your hips can lessen the strain.

For Upper Back Pain (Between Shoulder Blades)

Best position: Back sleeping with proper neck support

For upper back discomfort, many people do best sleeping on their back with a pillow or small neck roll that supports the natural curve of the neck, while keeping the shoulders flat on the mattress and the head from being pushed too far forward.

Modified side sleep: Hugging a body pillow

If you’re a committed side sleeper, using a full-length body pillow can help keep your shoulders from collapsing inward and may reduce strain across the upper back.

For Herniated Disc or Sciatica Pain

Best position: Fetal position (side sleeping with knees drawn toward chest)

For many people with a herniated disc or sciatica, a gentle fetal position on your side (with your knees drawn toward your chest and a pillow between them) can open the spaces between vertebrae and may reduce pressure on irritated nerves.

For acute flare-ups: Semi-reclined position

During severe flare-ups, sleeping in a semi-reclined position (such as in a recliner or with your upper body supported at about a 30-45 degree angle and your knees bent) can sometimes make sciatic pain more manageable.

For Spinal Stenosis

Best position: Elevated upper body with bent knees

Many people with lumbar spinal stenosis feel best in positions that gently flex the spine, such as sleeping on the side in a loose fetal position or with the upper body elevated and the knees bent. Using an adjustable bed, wedge pillows, or extra pillows to raise your head and upper body 30-45 degrees, while supporting your knees in a bent position, can help reduce nerve compression and ease nighttime symptoms.

Note: If pain persists despite trying these positions, talk with your clinician for personalized guidance.

How to Relieve Back Pain After Waking Up

While morning back pain is often harmless and attributed to bad sleeping posture (which can worsen over time), it’s important to see a doctor if you wake up with extreme pain. However, if your back pain is caused by an injury or pre-existing condition, there are steps you can take before heading out the door:

• Try Heat: A morning hot pack or shower can loosen up your back and get you ready for the day.
• Take a Painkiller: Acetaminophen reduces morning pain, while ibuprofen helps reduce inflammation in the morning, so it doesn’t get worse throughout the morning.
• Exercise Your Way Out of It: While light exercise may be difficult first thing, here are some low back stretch ideas from a Healthline article that may help relieve morning pain.

Back Pain in the Morning Might be a Sign of a Medical Condition

If you’ve sorted out the environmental factors that contribute to morning back aches, it might be a medical condition that causes those achy mornings. You’ll need to seek a professional diagnosis for treatment options, but you may suffer from:

• Herniated Disc: The tissue that sits between and cushions vertebrae may break down and inflame surrounding tissue, a condition known as a herniated disc. Also known as a slipped or ruptured disc, a herniated disc’s pain is worse in the morning due to long stretches of inactivity when sleeping.
• Inflammatory Back Pain: Inflammation caused by an autoimmune disorder may cause spinal tissue to swell and inflame. You’ll likely need treatment outside of orthopedic care to address this issue.
• Ankylosing Spondylitis: Swelling of the joints in the spine can cause pain and stiffness that often decreases throughout the day.
• Spinal Stenosis: The narrowing of the spinal canal can put pressure on nerves, and is often irritated when you sleep. While it’s more common in older adults, it can affect younger patients, particularly those who suffered a spinal injury.

Morning back pain might be subtle, but it’s important to take it seriously. If you wake up with back pain for an extended period of time or the back pain is increasing in severity, you should click here to request an appointment from an OCR Spine Specialist before your morning stiffness worsens.

The specialists at OCR’s Physical Medicine and Rehabilitation department can help diagnose the source of your morning back pain and develop a comprehensive treatment plan. Physical therapy often provides significant relief through targeted exercises and manual therapy techniques.

About Orthopaedic & Spine Center of the Rockies Spine Care Specialists

At Orthopaedic & Spine Center of the Rockies, our dedicated team of spine care specialists is committed to helping you find relief from morning back pain and various spine-related issues. With a wealth of expertise, our specialists offer personalized solutions to address your unique spine health needs. Whether it’s chronic discomfort or specific conditions like scoliosis, our spine care physicians are here to guide you toward a pain-free life. To learn more about our spine care specialists and how they can assist you, visit our website today. Your journey to a healthier, pain-free spine starts here.