Of all the topics that we cover at Tulsa Spine and Rehab, the number one topic we get questions about back pain upon waking up in the morning. What causes it, what can you do about it? And to get answers to those questions and many more, we’re joined by Dr. Sean Riley from Tulsa Spine and Rehab. And by the way, they’re a team of specialists under one roof with one mission and that is to help you get moving. Dr. Riley, let’s jump right into this. Why does your back hurt more in the morning than later in the day?
Yeah. Hey Charlie. So let’s break it down. Number one, it’s the position you sleep in. Number two, it’s going to be your environment, what type of bed or pillow you’re using. And then lastly, let’s touch on a little bit of physiology. And so we’ll talk about literally what’s going on with the joints and those types of things and the disc. So position-wise okay, Charlie, when you sleep at night, what position are you in typically?
See, it’s not fair because I know the answer because you and I’ve talked about this. I sleep on my back.
Okay, perfect. So it’s a discussion that I have with most of my patients throughout the day and it’s a challenging discussion that I have. This one number one is very challenging and number two related to the environment or the bed, because I ask patients, what position do you sleep in?
And they kind of look at me like, hell, I don’t know. I mean, I go to sleep on my right side and I wake up on my stomach.
Mm-hmm (affirmative).
I really don’t know what’s going on there. And I say, listen, we’re not going to put too much stress on this. Awareness is 80% right, Charlie?
Mm-hmm (affirmative).
What position should you sleep in?
I mean it’s knowing what to do and then we can make some changes from there. It’s really important that we stay on our side or our back when we sleep. And ideally if I could say, Charlie, I’m going to position you and I don’t want you to move all night, I would put you on your side with your knees bent at about a 45 degree angle. I would probably put some type of pillow or some type of bolster between your knees. I want your head in a relatively neutral position with the rest of the body.
It’s so funny you say that because when I broke the habit of sleeping on my stomach, that’s exactly what I did. I slept with a 45 degree angle, put a pillow between my legs and that stopped me from making that roll in the middle of the night to go back to my stomach.
Yeah. Is that reasonable? Probably not for most people, but I just wanted to get it out there that how should I sleep? There’s how you should sleep or getting on your back on your back. Knees once again in a 45 degree angle, get a bolster or some form of pillow underneath your knees. What that’s doing, it’s reducing some of the stress and pressure off your low back. Because what happens when we lie down with our legs flat or extended out, it actually has a tendency to put our back into a little bit of hyperextension or more extended meaning increasing that curve in your low back and that potentially can increase stress and pressure on those joints as we sleep at night.
The one thing that I would ask that you’d not do is stay off of your belly and that is a big, big no no. And it’s challenging and I had the discussion with patients like, I don’t know how to stay off my belly, and I’m like, listen, it takes effort. It takes time. Most of us are creatures of habit. You get in bed, you’re not thinking about your chiropractor or your therapist or whatnot. You just want to go to sleep. You’re tired, but over time, what does it say? Repetition creates new experiences, that you can create a new experience through repetition and just putting forth some effort. What happens though when you’re on your belly, Charlie, is that pelvis kind of will move forward or anterior or front and it creates, once again that hyperextension or increased curve in your low back.
Just imagine if you were sitting in your chair or if you were standing and then you extend back through like you go backwards or you really work hard on increasing your curve. For most of us, it feels kind of uncomfortable just even being in that position. Could you imagine staying in that fixed position for eight hours or six hours whatever the case may be? Not a good spot to be in because it’s putting a lot of stress on the back side of the spine, the facet joints more specifically, and as there’s increased stress and pressure on those facet joints, you develop inflammation and some of those types of things that we’re going to touch on here on number three. So position-wise you need to stay on your side, knees at a 45 degree angle, alternatively on your back, once again, knees bent, something underneath your knees. At all costs stay off of your belly. So position number one is so very important.
Number two, environment or bed gets a little tricky. It’s easy for me to make recommendations on Dr. Riley, what kind of mattress do I need. And there’s a lot of stuff that goes into that. Most specifically or the one that comes to mind is resources. I mean, money. Beds are not cheap. Mattresses are not cheap. And so many of us have the ability to spend different amounts of money on different types of mattresses. I mean, there are mattresses that are 15 $16,000 I mean, it’s nuts. It’s like twice as much, three times as much, four times as much as my first car when I was 16, maybe six times as much as your first car, Charlie. But anyway, money comes into play. But to dumb it down a little bit, I would say that we need to start with a very firm mattress.
Okay. First off, I want to avoid any type of a pillow top. Man, pillow tops feel great in the showroom and for some reason they’re very, very popular. And you know what I’m talking about. It’s got the mattress and now they’re termed as this is Tempur-Pedic and we’ve got this memory foam pillow top. They feel really good when you’re lying down on them. But what happens is those things have a tendency to break down and what I mean by breakdown is the more you’re in that bed, the longer you have the that mattress, that pillow top can have the potential to crater or start to kind of dip. And then man, there’s just no turning back. When that thing starts to break down, it breaks down more. It’s actually exactly opposite of what we need. We need a lot of support to our back and our joints and it’s doing the exactly opposite.
We’ve created a kind of environment that’s even difficult to move out of. So I would suggest that we at all costs, stay away from pillow top type mattresses. Firm mattress, firm is the better. Firm is the best and it’s going to provide the most support to our back and our joints and our neck.
What about those dial mattresses where you can dial in the way you want the mattress? What are those? Sleep Number mattresses or…
Is Sleep Number a good mattress?
Sleep Number, I like them a lot. I like them for the simple fact that you’re not just locked into one thing. Obviously many of us, our spouses may need a little something different than what we need. So I might like something ultimately very, very firm and my wife, she might… I continue to preach that firm is good and maybe just not as firm for her, but she’s still getting the amount of support.
A couple of things to consider here. They’re very, very expensive. Okay. The positive is though that like I said, you can do the dual type setup where you can control your side. She can control the other side. So, I like them that you’re not locked into a certain type of firmness yet they can be very, very expensive. I’m a big fan of Tempur-Pedic mattresses. That’s personally what my wife and I own and we’ve had one for the last six years. And what’s great about it when you take the sheet off that, you can’t tell anyone’s been sleeping in that bed. What I mean by that, it’s not started to break down or crater. I’ve been really, really pleased. Let me quickly touch on… I don’t know if I’ve mentioned this in the past, Charlie, that patients like when do I need a new mattress?
It’s hard just to give you a just one answer, but I would say across the board, if you’ve had your mattress for 10 years, it’s likely time to start shopping for a new mattress. And it’s the one thing… It’s tough to spend money on a mattress, but we spend a fair amount. Think about it. Hopefully we’re in that thing six to eight hours a night and it’s so vital for health. If we’re not sleeping properly, you’re not going to recover and without recovery, you tend to have more problems and just not even touching on insomnia and those types of things. But so, so very important that we’re getting a good night’s rest. So I would say stay away from pillow tops. You want a firm mattress. I am a fan of the Sleep Number and the Tempur-Pedic’s and then once it starts to break down or crater, we need to start looking. And then 10 years is kind of that timeline of it’s time to get a new mattress.
And then lastly, I talked about physiology. We’ll touch on this here briefly. So what happens when we sleep, we develop more hydrostatic pressure, hydrostatic, hydro water. What it means is our body has a tendency to kind of rehydrate and as we recover at night when we’re sleeping and things have a tendency to rehydrate, there’s also the possibility of increased swelling. So imagine a disc is like a balloon. The disc is between the vertebra. Imagine that you’ve got a little disc bulge, okay and at night that thing has a tendency to kind of rehydrate. It’s going to actually swell more. The joints will have a tendency to increase inflammation. And so that’s why many times when we wake up, we’re just really stiff. Luckily as we move and shower and get on with our day, a lot of that inflammation and swelling starts to work itself out of the joint.
Not much we can do. Some of that obviously staying very active and exercising and living a generally healthy lifestyle can be helpful. Position can help as well, so we want to reduce those variables that might contribute to increased swelling. But, there is a bit of physiology that’s tough to control. I think obviously number one and two, we have some ownership over that. Number three, that’s just kind of the way we’re wired as humans and you really can affect the physiology, but take your time in the morning, take a warm shower. I wouldn’t suggest a lot of bending, lifting first thing in the morning. Just give yourself your body a chance to get warmed up and slowly get moving.
And consider a new mattress.
Absolutely. So when you’re asking yourself, why am I more sore in the morning, just think about it. Three things, what position that I sleep in last night? Is it time that I rethink or take a look at my sleeping environment or my mattress. Things re-hydrated last night, the physiology of my body, things, there was a little bit of increased swelling. So those are typically the, the three factors that contribute to why you have morning back pain.
three great steps to help you handle back pain. And it’s the kind of advice you can count on from Tulsa Spine and Rehab. And you can find lots of tips like that by visiting and exploring our website at tulsaspineandrehab.com. Dr. Riley, thanks for helping us out.
Thanks Charlie.
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