This is one of those “if I had a dollar for every time I’ve heard that” questions.This question is usually followed by frustrated statements like, “It’s not like I’m 800 years old,” “I didn’t have this pain a few years ago,” or “my back never hurts any other time than the morning.”
So why are so many of my patients experiencing low back stiffness in the morning, yet go about their days pain free? Is it normal to wake up with stiffness? What causes low back stiffness in the morning after sleeping?
Is there hope for this cranky, creaky crowd, or are they destined to suffer in stiffness for eternity (Dun dun dunnnn)? Better keep reading to find out!
YES. YES. YES. Now just because it’s “normal” doesn’t mean it’s optimal. The “normal” American diet consists of processed and fast foods, though we all know that those foods are not the best for us. Plenty of people wake up in the morning with stiffness in the neck and low back. In fact, I see it every day. Is it healthy for your body to wake up stiff and in pain? Not particularly. Does it mean there is something catastrophically and irreversibly wrong? No. Fortunately, just like our diets, we have control over the state of well-being in our bodies, and there ARE ways we can prevent this pesky morning back stiffness. But first, we must identify the causes…
While this is by no means a comprehensive list of all stiffness-triggers, (and not all of the things listed will definitely cause stiffness) here are some of the most common causes:
Below is a picture of a normal spine (left), and a spine of a person with lower crossed syndrome (right). Ideally, muscles are all used evenly and are balanced. Unfortunately, many people have lower crossed syndrome, and this usually results from lack of activity, prolonged sitting, poor posture, poor body composition (ie. large, heavy belly pulling the spine forward), and lack of core stability. As you can see in the picture below, someone with lower crossed syndrome will have weak and often protruding abs, tight hip flexors (thanks to sitting for long periods of time which shortens the hip flexors), tight erector muscles in the low back, and inhibited, weak glutes.
People who have muscle imbalances such as lower crossed syndrome have a greater likelihood of experiencing low back stiffness in the morning, as they spend their days (and nights) with abnormal stresses on their bodies. The already tightened muscles will tend to have greater tone than the weakened muscles- even while sleeping. The lack of movement during sleep makes the tight muscles feel even tighter (just like being stiff after sitting in a chair for a long period of time), as they aren’t as “warmed up” as they are during the day.
Similar to the previous example, sleeping on one’s back (especially if a muscle imbalance exists) can contribute to low back stiffness in the morning. The lower back has a natural curvature called a “lordosis,” and strong lower back muscles that pull and maintain the lordosis during every day life (see two pictures below).
Sleeping on your back with your legs flat on the bed causes anterior (forward) rotation of the hips, which arches the lower back (see picture below). This allows the strong lower back muscles to approximate (shorten), and stay in this position for hours while you sleep. After many hours in this tightened, shortened state, the low back will feel stiff upon wakening.
Many people overlook their old, unsupportive beds as a cause for back pain and stiffness. As illustrated below, a soft, sagging, unsupportive bed will cause certain muscles to tighten, while allowing others to stretch too much. At the end of the night, the end result is… you guessed it: back stiffness.
Very similar to the first cause (muscle tightness and imbalance), the spinal joints can undergo areas of tightness “hypomobility,” and laxity “hypermobility.” When we move, each of the joints in our spine move a little bit to create a larger global movement. I like to use the analogy of an assembly line- when all of the people on the assembly line are present, everyone is working the same. Everyone is happy and not stressed (in my perfect assembly line world, that is), and all of the work gets done. If you take away a few people and sit them in chairs to watch, there are less people remaining on the assembly line. The work still needs to get done, but there are less people to do the job at hand. This causes the remaining workers to become stressed and overworked, all while the people in chairs (the workers who aren’t working anymore) are sedentary and lazy. The spine works in a similar way. When all of the “workers” (joints) are doing their jobs (moving), everyone is happy and healthy. If a few joints stop moving appropriately (hypomobility), then the rest of the joints have to move excessively (hypermobility) to compensate for the “lazy” joints (hypomobile joints). This phenomena predisposes the joints that move too much (hypermobile) to premature degeneration due to over working, while the joints that don’t move enough (hypomobile) are at risk for degeneration too! Since the spine and joints receive nutrients from movement, the hypomobile joints (lazy ones that aren’t moving) don’t get the appropriate nutrition and will eventually start to break down as well.
If we combine the pain and stiffness associated with improper spinal biomechanics (how the joints in the spine move) with the hours of stillness associated with sleeping (which causes stiffness in general), one can see how likely having low back stiffness in the morning is. In addition, if there is any swelling surrounding any of the degenerating joints, the swelling will cause even greater stiffness the longer a person is still.
This might be easier said than done, and would go really well with number 4 (go see a chiropractor). I wouldn’t recommend that you self-diagnose your postural and muscular imbalances, so perhaps hold off on doing lots of corrective exercises until you know for sure you have an imbalance.
If you know you have lower crossed-type imbalances, consider trying the following routine before bed and in the morning:
-2 sets hip flexor stretch (30 seconds) on each leg (1st picture)
-Approx. 5 minutes low back release with foam roller or lacrosse balls
(maintain pressure on tender spots until they release) (2nd picture)
-2 sets of 10 reps per side of core activation: dead bug
(this is a complex exercise- I recommend looking for a video or an instructor to help with this one) (no picture shown)
– 2 sets of 10 reps per side of glute activation: donkey kicks (3rd and 4th pictures)
*note: there are many great exercises to help a lower crossed syndrome- don’t limit yourself to these! They are meant to be an example.
By placing a pillow under the knees while back-sleeping, you elevate the legs slightly (changing the angle of the hips). This change of angle at the hips creates a posterior pelvic tilt, which helps the muscles of the lower back to elongate (stretch out).
How can you tell if your bed is too old or too soft? For starters, if you try to avoid rolling into the “dent” that you’ve made over the years in your bed, you need a new bed. If you feel springs or lumps in your bed, this is also a sign that you may need a new bed. Also, if you sleep well while on vacation from your mattress (sleeping at a hotel, relatives house, or even camping), you may want to consider getting a new mattress.
As explained under the “Improper Motion in the Spinal Joints” heading, joints that aren’t moving properly can be predisposed to degeneration. When this happens, inflammation, swelling, and degeneration can occur, and will be exacerbated by prolonged hours of stillness (ie. sleeping). Going to see a chiropractor will help restore appropriate motion in the joints that aren’t moving well, which will help decrease inflammation and premature degeneration of the spine!