We’ve all been there at one point or another. Waking up first thing in the morning only to be faced with troublesome back pain. And while the lion’s share of us can put this down to a bad night’s sleep, poor posture, muscle tension caused by stress or even a heavy day at the gym, others are living with an underlying medical condition that needs addressing. In this article, we’re going to help you identify several possible causes of morning back pain, with insights into the different treatments available.
In the UK, an estimated 2.5 million people experience back pain every day. That’s a pretty big number. It can be highly debilitating and disruptive, making it harder to complete daily tasks and do the things you enjoy the most. So, where does this pain originate and why does it appear to be worse in the morning?
What causes morning back pain?
Back pain is particularly challenging to diagnose. It takes time and requires collaboration between different medical experts, including your GP, physical therapists and specialist physicians. There are a handful of conditions that may be responsible. Some of the main culprits are ankylosing spondylitis, a slipped disc, degenerative disc disease, myofascial pain syndrome, and vitamin D deficiency.
Ankylosing spondylitis (Axial Spondyloarthritis, axial SpA or AS) is a progressive form of inflammatory arthritis distinguished by swelling around the spine, where the ligaments or tendons attach to the bone. According to the National Axial Spondyloarthritis Society (NASS), 1 in 200 UK adults have AS, but they see an average delay of 8.5 years to properly diagnose this chronic condition, which often leads to irreversible damage to the spine.
AS inflammation causes high levels of fatigue, along with back pain and stiffness that’s usually worse in the morning but improves with movement throughout the day. Flare-ups are common, with most sufferers describing the pain as varying from one day to the next.
To manage your AS, it’s not enough to solely rely on medication. Exercise is also an important factor. You can explore:
- Physiotherapy: A physiotherapist will help you get through your flare-ups of pain and improve your mobility and flexibility. They will create an individual treatment programme that’s designed specifically for your needs. It will commonly factor in gentle exercise, joint mobilisation techniques, ultrasound therapy or even acupuncture.
- Swimming and hydrotherapy: Exercising in water has been proven to help with stiffness, pain, fatigue and the risk of developing a stooped posture. The warmth and buoyancy make stretches more effective and enjoyable.
- Cycling: Cycling is a great form of low-impact cardiovascular exercise if you have AS or any other form of arthritis. It limits impact stress on weight-bearing joints and the movement helps lubricate the joints, which reduces pain and stiffness.
- Exercise classes: Good low-impact options to explore include yoga, pilates, spinning, HIT (High-Intensity Interval Training) and circuit training.
- NASS offers regular physiotherapy and hydrotherapy supervised by qualified physiotherapists in over 90 locations across the UK.
Always speak to your doctor or physiotherapist for advice before undertaking any form of new exercise. It needs to be the right fit for you and you don’t want to risk causing any further damage.
A slipped disc, also known as a prolapsed or herniated disc, occurs if the spinal disc tissue pushes out between the vertebra – the series of individual bones that form the spinal column. This can be incredibly distressing if it puts pressure on the nerves. It can cause sudden, severe shooting pain in the lower back region, along with numbness or tingling in your shoulders, back, buttocks, hips, arms, hands, legs or feet. The pain from a slipped disc can be worse in the morning, due to long periods of inactivity during sleep.
Slipped discs are fairly common – usually the result of wear and tear as we age. Over time, our spinal discs gradually lose their flexibility. Fluid leaks out of them and they become brittle and cracked. A disc can also slip out of place as a result of an accident or injury – for example, as you twist and turn your body to lift a large, heavy object.
With enough rest, gentle exercise and over-the-counter painkillers such as ibuprofen or paracetamol, a slipped disc will usually heal within six weeks. Physical therapist Doctor Jo recommends the following exercises, which can be used as morning stretches for back pain when recovering:
- Pelvic tilt
- Clamshell exercises
- Bridge with ball squeeze
- Prone bent leg lift
You can watch the YouTube demonstration video here. Please be sure to never push yourself or your body and stop exercising if you feel uncomfortable.
While a herniated or slipped disc is a short-term problem, degenerative disc disease can present long-lasting chronic pain. The good news is that most cases of the condition can be managed using non-surgical treatment methods – namely physical therapy.
Myofascial pain syndrome (MPS)
With MPS, sensitive points in your muscles (trigger points) are stimulated enough to cause discomfort in various, “localised” parts of the body, including the back.
Do you find that you get the full brunt of your MPS back pain first thing in the morning? One possible reason for this is the fact that our muscles are less active at night, and this leads to reduced circulation. Tossing and turning while you sleep may also place added stress on trigger points.
Morning back pain associated with myofascial pain syndrome can be managed using a combination of medication, lifestyle changes and alternative therapies. Try:
- Staying active during the day by walking, cooking and performing work-related activities.
- Undertaking regular exercise that targets core muscle groups. This could be anything from cycling or swimming through to yoga or pilates.
- Putting some steps in place to achieve better sleep habits. A sleep schedule, mindfulness meditation and vitamin D supplements could all help with this.
- Having regular therapeutic massages, which promote relaxation and wellbeing.
- Heat therapy, which works by improving circulation and blood flow to the affected area to soothe muscle discomfort and increase flexibility. A hot bath, hot water bottle, heat pad or even Tiger Balm may work wonders for you.
Vitamin D deficiency
Vitamin D is essential to every individual’s general wellbeing. The main source is sunshine, but it also naturally occurs in some foods – namely fish liver oils and fatty fish such as trout, salmon, tuna, and mackerel. It may come as a surprise to hear that across the UK population, approximately 1 in 5 people have low vitamin D levels. A deficiency of this type has the potential to induce various conditions that are linked to poor bone and muscle health, which may result in symptoms such as morning back pain.
Vitamin D deficiency can occur for a number of reasons. It could be because you aren’t exposed to enough sunlight. Perhaps you’re missing vital nutrients from certain foods, such as fish or dairy? Your vitamin D metabolism can also be impacted by another medical condition or certain medications. These are all things to think about if you suspect you have low levels of vitamin D.
Aside from getting out in the sun a bit more (don’t forget your sunscreen), oral supplements are an efficient way of getting vitamin d into your body. You can easily visit your GP to get tested for vitamin d deficiency, which we highly recommend. Also eating foods that are rich in vitamin D is a great way to stay healthy and safely maintain your vitamin d levels and you can find some recipe inspiration here.
For any of the above conditions, you can explore To Better Days active patches. Cleverly designed to offer fast-acting localised relief, they provide vitamin D through the skin – like you would get from the sun – and are safe to use alongside supplements.
We hope some of the morning back pain treatment suggestions listed are helpful! If you have any concerns, always contact a qualified health professional for advice.
Are you keen to share your thoughts, experiences and advice on morning back pain relief? Join the conversation by visiting our Facebook page group Together for Better Days.