Why do I get low back pain first thing in the morning?
Have you ever got up in the morning and done either of the following;
- bent forward to put on shoes or socks…..
- leant forward over a wash basin to shave or brush your teeth….
and then felt a sudden surge of low back pain leaving you unable to straighten or move for the rest of the day? All the while wondering why this back pain has come on out of the blue.
This is a classic sign of lumbar disc pain, caused when a disc has bulged or protruded beyond its normal area. And while it seems to come on for no apparent reason it is often associated with activity from the previous day.
Classic activities would be;
- working in the garden
- repeatedly bending to look after a small child
- a heavy gym workout involving deadlifts or squats
Any activity where there is repeated or sustained bending, particularly when under load as in the case of lifting a child or pushing weights.
So why does this happen?
The ‘discs’ of the spine are fibrocartilaginous, meaning that while they are solid structure they can deform accordingly to pressure being applied to them. This is what makes them so good at doing their job of providing cushioning to the spine, and allowing flexibility to the spine. So when we bend they will temporarily deform, and then revert back to their normal shape when we straighten up.
The exception to this is when repeated or sustained loading of the disc occurs, causing tearing and stretching of some of the tougher outer structure of the disc. This is what can lead to a permanent deformity – a bulge/prolapse/herniation or simply ‘slipped disc’.
If force applied to the disc is strong enough pain will be instant, but in the examples given above often pain will be delayed. And here’s what happens:
The disc contains water as part of its make up. In the daytime when we are upright and the discs are under load water will disperse into the vertebrae above and below. In the night time when we are resting and not in an upright position, pressure relationships change between the vertebrae and the disc causing water to transfer back into the disc from the bony vertebrae causing the disc to become turgid (causing us to be taller in the morning than in the evening)
So in the morning one of the first movements to place pressure on the disc (bending) will cause strain at the area of weakened tissue, leading to a bulge in the disc. This state of injury will cause pain through inflammation, and if the disc bulges sufficiently it can place pressure on surrounding structures – usually nerve, with an associated pain referral pattern into the leg.
How can this be prevented?
After strenuous activity it is best to avoid just sitting down afterwards. Standing and walking can help to redistribute fluid evenly in the disc and avoid a build up of pressure in one place.
Lying face down can help reverse the effects of the sustained bent position. And repeatedly bending backwards in standing (extension movement) can do the same.
In the morning it is best to ease into movement before springing out of bed. This can be done by bending the hips and knees and gently rolling the knees side to side. This movement can give an indication if any further caution is required before getting up. If so it is best to roll on to the side and push up from that position rather than sitting straight up out of bed.
Then when in standing repeating a few extension movements. This helps to reduce natural morning stiffness, redistribute fluid on the disc, and avoid pressure accumulating at any area of weakness in the disc. So while it’s not natural to think about these things first thing in the morning, any past experience of low back pain usually serves as a good reminder of what can happen following a day of vigorous activity.
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