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What Causes Morning Back Pain? The Ultimate Guide

What Causes Morning Back Pain? What Causes Morning Back Pain?

Waking up in the morning with lower back pain, neck stiffness or a headache is an all-too-common experience for many people.

For some, back pain even serves as a sort of “alarm clock”, waking them up at a particular time and making it impossible for them to get back to sleep. Others find that their back pain is significantly worse in the morning than at any other time throughout the day.

What causes this phenomenon?

In this article we discuss some of the key factors that might be causing you to wake up in the morning with back pain, along with some tips and tricks on how to combat it.  

It’s important for us to note that this article is not primarily for people who wake up with a crick in their neck every now and again. If that sounds like you, it’s likely due to poor sleeping position and will probably heal itself within a couple of days. Rather, this post is meant to help shed some light on what might be causing you to wake up virtually every day with back pain that seems particularly worse in the morning.

What causes morning back pain?  

There are several different reasons why people can wake up in the morning with back pain or stiffness:

1. Inflammatory back pain - This is probably the least common, but most serious cause of chronic back pain in the morning. It’s often caused by pathological inflammation from an autoimmune disease.

2. Chronic inflammation (inflammaging) - Inflammaging is the steadily increase of chronic inflammation we experience as we age.

3. Myofascial pain syndrome and/or fibromyalgia - This is likely one of the most common causes of back pain in the morning, but there is some controversy and mystery behind why.

4. Poor sleeping posture - Many people attribute their morning pain and stiffness to poor sleeping posture and while it’s the most obvious culprit, it could be also do more damage than you suspect.

We’ll discuss each of these conditions in detail below.

How Inflammatory Back Pain Causes Pain in the Morning

Inflammatory back pain (IBP), also known as spondyloarthritis, is an umbrella term for several rheumatic (inflammatory) diseases that cause arthritis and one of the most serious causes of back pain in the morning. It’s a condition caused by pathological inflammation that attacks the spine and, in some, the joints in the arms and the legs. It typically manifests itself by causing pain and stiffness, specifically in the spine and causing bone destruction and deformities.  

While the condition is somewhat well-known, no one is really sure why IBP causes back pain specifically in the morning. This could be because it can often escape diagnosis or that it can manifest itself in many different forms. In truth, it’s just something that that inflammatory back pain does.

Spondyloarthritis Symptoms

However, it’s important for us to note that waking up in the morning with back pain does not mean that you have IBP. While it’s true that most people with the condition experience pain in the morning, research has shown that the connection is far from exclusive. As a matter of fact, one study of over 700 people who experienced chronic back pain found that 82% experienced pain or stiffness in the morning, while only 11% actually had IBP.1  

In other words, people who are diagnosed with spondyloarthritis will almost always experience morning back pain and stiffness, but those symptoms don’t necessarily mean that you have the condition.

IBP is a serious, but relatively rare condition, so the chances aren’t great that it’s causing your morning back pain. Unfortunately, it’s also commonly misdiagnosed. So, if you’re experiencing any of the following symptoms, you should ask your spinal specialist if IBP is a possibility.

Symptoms of inflammatory back pain include:

  • Signs of inflammation in parts of the body apart from the spine, including tendons (especially where they attach to the bone), arms, legs, fingers, toes and more.

  • A family history of BPI or other autoimmune diseases. Spondyloarthritis is primarily passed genetically and is found most commonly in males. The condition gets fairly severe as you age, so the chances are pretty high that you’ll know if a family member has it.

  • You find relief from back pain with anti-inflammatory drugs.

  • You had an infection in the weeks leading up to the start of your morning back pain.  

Finally, it should be noted that IBP typically causes pain during the night, not the morning. What people feel when they wake up in the morning is likely just a “leftover” of what was happening while they slept. In more severe cases, IBP can actually start waking up people who suffer from the condition through the night. Thus, if you’re sleeping soundly at night and only waking up with back pain, you probably don’t have IBP, or it’s relatively minor.

Here’s a helpful inflammatory back pain quiz if you want to do a little more research. Of course, it doesn’t need to be said that an online quiz or a symptom checklist is not a diagnosis. They’re helpful for learning more about the condition and educating yourself, but if you think you may have IBP, you need to contact your spinal specialist.

How Chronic Inflammation Can Cause Morning Back Pain

As we age, we naturally tend to experience more inflammation throughout our bodies. This process is called chronic low-grade inflammation, but is also commonly known as inflammaging, and affects just about everyone over the age of 40.2  

Typically, most chronic inflammation is a result of poor lifestyle choices like an unhealthy diet, lack of exercise, long-term stress, excessive weight and more. This is known as metabolic syndrome and typically is identified by a little bit of inflammation appearing all throughout your body. On the contrary, inflammaging can affect anyone regardless of their physical health as they start to grow older.

The research isn’t exactly firm on why inflammation, chronic or otherwise, tends to affect people so much in the morning apart from the fact that inflammatory conditions simply seem to be more apparent during that time.

One cause of this could be the fact that our body stops, or significantly slows, repressing inflammation in the morning. Research has found that, while we sleep, our brains use their circadian rhythm to deliver a protein called cryptochrome to help suppress inflammation throughout the night hours.3 As these effects wear off, it can lead to the stiffness and pain that is commonly felt in the morning.

But why does chronic inflammation or inflammaging cause back pain specifically?

Once again, the research isn’t particularly clear on the subject. However, we know that inflammaging doesn’t seem to target the nerve endings in the spine specifically, rather it appears and affects structures all throughout the body. Nevertheless, it still seems to cause back pain primarily. This would suggest that the nerve endings in the spine are more sensitive to the damage caused by inflammation or, perhaps, the brain is simply more protective of those nerves and more likely to alert you of a problem that’s occurring.

Inflammaging Morning Back Pain

There’s not a whole lot you can do to reverse the aging process in your body and inflammaging will likely catch up with everyone sooner or later. Nevertheless, you can do your part to help fight inflammation and keep your body healthy throughout the aging process.

Here are some ways:

Stay active

We say this time and time again, but being physically active is one of the best ways that you can protect yourself against spine pain. Not only does it help strengthen the muscles and structures supporting the back, but it also encourages blood flow to areas that might be inflamed, promoting healing, and nourishes spinal structures. Here are some of our favorite low-impact exercises that can help you ward off pain.

Eat healthy

Research has shown repeatedly that diet has a direct impact on the amount of inflammation that can occur throughout the body. Foods that are high in sugar and fat are much more likely to cause you trouble.

Get sleep and fight stress

We’ve discussed in detail how stress and a consistent lack of sleep are common sources of back pain, so we won’t belabor the point. However, it’s important to note that if you’re not giving your body enough time to recover from the day (sleeping) or giving it too much stress, you’re setting yourself up for pain.

These steps are simple and should be something you do regardless of whether you struggle with back pain or not.

How Myofascial Pain Syndrome and/or Fibromyalgia Can Cause Morning Back Pain

Two of the most common reasons for consistent morning back pain are conditions called Myofascial pain syndrome and Fibromyalgia. While these are two seperate disorders, they do share quite a few commonalities and are often used interchangeably among physicians.

  • Myofascial pain syndrome (MPS): This condition is caused when pressure is placed on sensitive points in muscles and it causes pain in a seemingly unrelated part of the body.
     

  • Fibromyalgia: This chronic disorder causes muscle pain and tenderness all throughout the body and is known for affecting sleep and causing fatigue.

Fibromyalgia and its connection to morning back pain

First off, it’s important to note that Fibromyalgia is a condition that simply is not well-understood by science. We know the symptoms that it typically causes, but don’t have a great understanding on why it occurs, how it functions or how to effectively treat it. There are no doctors who specialize specifically in the condition, though there are some who take particular interest in it, and the good research on the topic is thin at best.

Here’s what we do know about the condition:

Fibromyalgia is typically classified as a neurological disorder, which is its primary differentiator from MPS and it seems to amplify the way our brains perceive and process pain signals.

The problem is that there really doesn’t seem to be a source or any particular damage that’s causing the pain.

Traditionally in science there are two classified types of pain, nociceptive and neuropathic. Nociceptive pain is probably what we experience most often and involves your nerves reporting tissue or structure damage to your brain. A good example of nociceptive pain is stubbing your toe. You’ve caused some damage to your foot structure and the nerves surrounding the affected area report to your brain that something is amiss.

Neuropathic pain, on the other hand, typically comes as a result of the nerves themselves being damaged; a pinched nerve in the spine is a good example.

The problem is that Fibromyalgia pain doesn’t really fit well into either of these classifications. In most cases there hasn’t been muscle damage, despite the fact that patients typically feel pain at certain points throughout their body, so it can’t be nociceptive. Additionally, Fibromyalgia doesn’t seem to cause any damage to the central nervous system, therefore it can’t be classified as neuropathic.

Fibromyalgia Morning Back Pain

So what is it?

The truth is that we don’t really know as of right now. Some theories suggest that Fibromyalgia creates small lesions which cause subtle damage to the central nervous system that’s virtually imperceptible. While this is certainly possible, the research simply doesn’t back it up at this point.

All we really know for certain is that there is pain at certain points and that pain, whether caused by damage or a neurological dysfunction, is very real.

Now, it’s important to note that only 1-2% of the population is currently diagnosed with Fibromyalgia, so it’s a relatively rare disease. However, it’s steadily becoming a more popular diagnosis, simply because it seems to fit a wide range of potential symptoms. These include:

  • Chronic, widespread pain that has lasted for more than three months

  • Fatigue, trouble sleeping

  • Irritable bowel syndrome

  • Mood disorders (depression, anxiety, mood swings)

  • Mental fog (also commonly known as “fibrofog)

As a patient, it’s important for you to remember that there are no tests that can prove you have Fibromyalgia. Your symptoms may make it apparent, but not always. People with the condition often experience pain from mild to severe, so it’s important that you do your research and make sure you’re being diagnosed properly.

Now to the back pain.

For people suffering from Fibromyalgia, back pain is particularly common. As a matter of fact, studies have shown that as many as 49% of people with the condition also experience back pain, likely because so many muscles in the neck, shoulders, back and legs play a role in supporting the spine.

Unfortunately, one of the main components of Fibromyalgia is virtually constant muscle pain which means that people are likely going to experience the symptoms of this disorder throughout the day and night.

Since the pain of the condition is relentless, it has an uncanny ability to affect sleep and cause daily fatigue, which is one of the main reasons why the pain may be worse in the morning. Research has shown that, when sleep deprived, we’re far more likely to experience an increased amount of pain perception and, at few other times throughout the day, are we more tired than we are in the morning.4 There’s no specific reason why we perceive more pain in the morning apart from the fact that we don’t have many other distractions. Throughout the day, pain can be steadily dulled by other distractions like family, work, driving, cooking, etc. but those first few minutes you’re laying in bed after you wake up simply don’t have that and you can feel the full brunt of your pain.   

Myofascial pain syndrome and its connection to morning back pain

There’s still a lot to be learned about Myofascial pain syndrome (or MPS). While hotly debated in the medical field, it’s currently believed that the condition is caused when a particular muscle is overworked for long periods of time, or severely damaged, it can develop what are known as trigger points.

The trigger points associated with MPS are essentially knots in the muscle that, unlike common knots, so tight that they cut off the capillaries and do not receive the nutrient and oxygen filled blood that they need to heal. Thus, they persist. Since there is no blood flow to or from the affected muscle fibers, they are also unable to extract waste products like lactic acid and the muscle continues to hurt and deteriorate.   

Eventually, the muscles simply won’t release and develops into a trigger point. This can be a source of chronic pain and, depending on the location of the affected muscle, can even affect the spine.

Trigger points can cause back pain in general, simply because there are so many muscles throughout the body that are responsible for supporting the spine. Though, there is some research to suggest that trigger points occur in back muscles more than anywhere else. If even one of these muscles is tight or strained it can cause inflammation, destabilization and pain in the spine, even if the condition doesn’t affect it specifically.

Myofascial pain syndrome morning back pain

However, people with MPS, often report feeling more back pain in the morning as opposed to other points during the day. There can be a couple of reasons for this:

The first, and most likely reason, is that tissue stagnancy and muscle strain seem to play a major factor in trigger point pain; both of which occur commonly at night. When you’re stagnant, there is very little blood flowing to an area that already has a very limited blood supply, thus there is even less keeping the pain at bay. Additionally, we often toss and turn ourselves into awkward positions throughout the night that can put additional strain on trigger points. Both of these things can cause morning back pain.

How can you address morning back pain caused by Fibromyalgia or Myofascial pain syndrome?

This is an incredibly broad topic, well beyond the scope of this post and, in reality, there are many different treatment paths you can take depending on the severity and location of your pain.

However, some good rules of thumb when dealing with Fibromyalgia or MPS pain are:

Massage and heating therapy

Both of these treatments you can do at home with a heating pad and your own two hands. Heat and massages help encourage oxygen and nutrient-filled blood flow to muscles, which is absolutely vital in helping combat, and potentially healing, trigger points. It can also help bring some relief to pain that’s caused by Fibromyalgia.    

Exercise

If you’re struggling with trigger points or Fibromyalgia, it’s likely that you won’t be able to do any strenuous exercise; that’s okay. As a matter of fact, we recommend that you keep it light, but consistent. As we’ve mentioned before, exercise is absolutely vital to helping encourage blood flow to your muscles which helps remove toxic chemicals and heal damaged tissue.

Sleep

One of the biggest impacts of Fibromyalgia is the effect it has on your sleep. Unfortunately, the less you sleep, the more likely you are to experience pain, mood disorders and the “fog-like” symptoms that come along with the condition. That’s why it’s vitally important that you figure out how to make sleep improvements.   

How Poor Sleeping Posture Can Cause Morning Back Pain

Many people assume that poor sleeping posture is what causes most morning back pain and, for people who experience it intermittently, they’re probably right.

Most of the conditions that we’ve addressed above start occurring as you grow older and happening on a consistent basis. So, if you’re waking up every now and again with a crick in your neck or some back pain, your problem likely has less to do with inflammation and chronic conditions and more to do with your sleeping posture throughout the previous night.

Here’s the deal: Sleep is absolutely vital for life and, when it’s done well, plays a major role in regenerating your body and preparing it for the onslaught of the next day, some studies even suggest that it can help you address your back pain. However, the problem with sleep is that it lasts a long time, typically about 6-8 hours.

While sleeping for that long is necessary and recommended, our bodies don’t particularly like being still for such an extending period of time. On the contrary, we were built to move and be active which is why being still, whether you’re sitting or lying down, becomes inherently uncomfortable after a while. You’ve probably felt this on long car trips or after spending a lazy Sunday on the couch.

Well it turns out this inherent uncomfortableness of staying still continues to occur while we sleep and we naturally respond by adjusting our sleeping positions throughout the night. This helps keep blood flowing, muscles moving and oxygen flowing, so typically it isn’t a problem, but it can be if you work your way into an awkward position.

Sleeping Posture Morning Back Pain

The interesting thing about sleeping posture is that it doesn’t need to be incredibly bad for us to feel pain in the morning. We often conjure up images of our bodies twisted and pretzels into crazy positions as we sleep, but the reality is that even a slightly awkward position can cause problems if you hold it long enough, which tends to happen in your sleep.

So what can you do to help avoid back pain in the morning that’s a result of bad sleeping posture?

Well, the first thing you can do is figure out what “bad posture” is for you. You know your sleeping habits better than virtually anyone else (except your spouse, perhaps) so you know if you tend to toss and turn a lot throughout the night, the position you’re most comfortable in, etc.

Traditionally, sleeping on your stomach seems to have the most impact on your back throughout the night. This isn’t to say that it will cause damage or that you shouldn’t do it, but if you’re a stomach-sleeper and having daily back pain, you may want to try adjusting your position to something a little more neutral and seeing if that helps.

Additionally, you can set up some “boundaries” to help you avoid any potentially awkward positions throughout the night. For example, if you know that you toss and turn a lot, you can try placing a pillow between your knees while you sleep on your back. This can help keep you from rolling over too significantly, if you don’t eventually kick it out of the way.

The truth is that adjusting your sleeping posture is pretty difficult simply because we don’t have a lot of control over it. We may be able to set ourselves up for success, but it probably won’t do too much to change the natural course of events that occur during the night.

Fortunately, while sleeping position definitely is a factor in back pain, it probably doesn’t play as large a role as many people think. In fact, a study done on the issue found that when people with back pain slept in a neutral position (laying flat on your back with, if necessary, a pillow placed under your knees), they experienced a small improvement in their daily pain.5 This isn’t to downplay the importance of good sleeping posture, to anyone who struggles with daily back pain, even a minor improvement can be extraordinary.

The Anti-Nap: A Practical Way To Help Morning Back Pain

For people struggling with back pain in the morning, Paul Ingraham, from PainScience.com recommends taking what he calls an “anti-nap”.  

As we’ve mentioned before, being stagnant for long periods of time becomes inherently uncomfortable. When we’re awake, we can simply stand up, walk around for a little bit and help combat the feeling. However, when we’re asleep, we don’t get that option. Rather, we’re left to the mercy of our in-sleep movements, which are inconsistent and can do more harm than good.

The Anti-Nap trick seeks to solve this dilemma. If you’re struggling with bad back pain in the morning, we suggest trying to wake yourself up at consistent intervals throughout the night so you can get up and take care of your back. This might involve a little heat therapy, a self-message or even just movement to help get blood flowing into your back and the muscles that are causing your trouble.

Getting up and moving during the night is a great way to help you avoid muscle stagnation and it could also potentially protect you from spending too much time in an awkward position, which can save you pain in the morning.

You don’t need to stay up long, as a matter of fact you shouldn’t even turn on your lights, just long enough to take care of your back and help prevent pain.

In conclusion, there are a number of factors that can cause you to wake up in the morning with back pain and, in some cases, it can be a telling sign of the condition that’s affecting you.

Remember, daily back pain of any kind at any time is not normal. If you’re experiencing frequent back pain, even if it isn’t severe, you should speak to your spinal specialist and discuss your treatment options.

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1. Arnbak B, Hendricks O, Hørslev-Petersen K, Jurik AG, Pedersen SJ, Østergaard M, Hermansen LT, Loft AG, Jensen TS, Manniche C. The discriminative value of inflammatory back pain in patients with persistent low back pain. Scand J Rheumatol. 2016 Mar:1–8. PubMed #26982485.

2. Franceschi C, Campisi J. Chronic inflammation (inflammaging) and its potential contribution to age-associated diseases. J Gerontol A Biol Sci Med Sci. 2014 Jun;69 Suppl 1:S4–9. PubMed #24833586.

3. Hand LE, Hopwood TW, Dickson SH, et al. The circadian clock regulates inflammatory arthritis. FASEB J. 2016 Aug. PubMed #27488122.

4. Schrimpf M, Liegl G, Boeckle M, Leitner A, Geisler P, Pieh C. The effect of sleep deprivation on pain perception in healthy subjects: a meta-analysis. Sleep Med. 2015;16(11):1313-20.

5.  Desouzart G, Matos R, Melo F, Filgueiras E. Effects of sleeping position on back pain in physically active seniors: A controlled pilot study. Work. 2015;53(2):235–40. PubMed #26835867.

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Atlantic Brain and Spine A graduate of both Yale and Stanford, Dr. Jae Lim is a board-certified spine surgeon who specializes in minimally invasive spine surgery and robotic spine surgery, significantly reducing surgical impact and recovery times. (703) 876-4270
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Jae Y. Lim Ben L. Nguyen