If you’re searching the internet for “why does my back hurt when I wake up,” I think it’s safe to assume this isn’t a one-time event for you. Most people understand that morning back pain that lasts just a few days is probably from a new mattress, making room in your bed for a needy child (two- or four-legged), or overdoing it on the golf course.
If you can pinpoint an obvious inciting event, your pain is most likely temporary. In those cases, a little ibuprofen, ice or heat, and maybe sleeping a few nights in the guest bedroom will usually take away your pain. But if your back hurts when you wake up for more than a few days, it’s time to explore whether there is an underlying spine condition that needs medical care.
Here are a few symptoms to help decide if it’s time to make a doctor’s appointment:
- Your morning back pain doesn’t get better — and may even get worse — after you get up and move around.
- Your pain is severe and
- Your pain gets worse, not better, over time.
- You start to feel new symptoms with your morning back pain, such as pain that radiates into your arms or legs; numbness, tingling or weakness in your arms, legs, hands or feet; or bowel or bladder dysfunction. These are a few of what are known as “red flag” symptoms that should be seen by a medical provider right away. (Learn when you need to go to the ER for back pain in this blog.)
Spine Conditions That Can Cause Morning Back Pain
In general, pain that is limited to your back and goes away as you get up and stretch and start to move around isn’t something to worry about unless you have one of the symptoms I listed above. However, there are spinal conditions that tend to cause or worsen back pain specifically in the morning. These conditions can create pressure or stiffness in your spine joints or disc space at night when you’re not moving around that leads to an increase in pain in the morning.
These conditions include:
- Degenerative Disc Disease: The discs that cushion your vertebrae can deteriorate over time, causing pain, stiffness, and reduced mobility, particularly in the morning.
- Spondylolisthesis: This condition occurs when one vertebra slips forward over another, resulting in nerve compression and morning back pain.
- Spinal Stenosis: Narrowing of the spinal canal can lead to pressure on the nerves that can cause pain that is often worse after prolonged periods of rest, such as during sleep. (This can differ greatly depending on where the stenosis is located and your position during sleep.)
Ironically, sitting or laying down may relieve pain in the early stages of these conditions. But if that’s no longer the case, that tells us that you’re reaching the point where help is needed. Remember, most spinal conditions not caused by trauma like a car accident are cumulative. A herniated disc that doesn’t cause pain can suddenly start — and that’s when we need to see you.
Where to Get Medical Care for Back Pain
If it’s time to seek medical care for your pain, the next question is deciding what type of care to get. Here are some general guidelines you might find useful:
- If you are experiencing mild back pain in the morning that doesn’t get better with over-the-counter medication, stretching and moving around or if it seems like your pain is getting worse, call your primary care doctor. (Our physician assistants, such as myself, and nurse practitioners at Neurosurgery One’s Spine Center also see patients for initial back pain.)
- If you are having symptoms related to nerve irritation, such as pain that spreads into your arms or legs, or a tingling sensation along with your morning back pain, you probably have some nerve irritation and should make an appointment with a neurosurgery specialist.
- If you are experiencing debilitating pain — such as pain that prevents you from getting out of bed, pain that is causing weakness, or bladder and bowel changes — you should go to an emergency room. (Learn the other symptoms of needing emergency care.)
Remember, these are general guidelines. Trust your instincts and knowledge of your own body. Most people know when waking up with back pain is a result of overdoing something. They also know sudden, sharp pain that doesn’t let you get out of bed is not usual and, at a minimum, is worth a call to your primary care provider.
I can confidently say that I’ve never seen someone for back pain who didn’t need to be seen — even if the only treatment they needed was physical therapy. On the other hand, I have seen patients with back pain who should have come in earlier. Patients who experience a shooting pain down their leg, for instance, could be dealing with a pinched nerve. Pinched nerves can lead to numbness or weakness that at times can’t be restored even with surgery if it’s gone on too long, so in this instance, you shouldn’t “wait the pain out.”
Remember, it’s always better to err on the side of caution when it comes to your spine. Seeing a medical provider will help determine the cause of your morning back pain and the best course of action.
Tess O’Brien is a certified physician assistant who provides personalized, expert care to patients who are dealing with back and neck pain. She performs initial evaluations, oversees conservative treatments, and refers patients for spine surgery when appropriate. She also spends time helping patients before and after spine surgery to ensure they get the best outcome possible.
