What to do when you wake up with back pain?

Waking up with back pain can be frustrating and compromise your well-being throughout the day. But don't worry: there are simple strategies for preventing back pain during sleep, understanding the causes behind the discomfort and adjusting your nighttime routine to have easier mornings. It is important to know when it indicates something more serious and which treatments can help.

Why do we wake up with back pain?

Before eliminating this discomfort from your routine, it is worth understanding what usually causes morning pain. Among the main reasons are:

1. Prolonged pressure on muscles and joints

Spending 6 to 8 hours in the same position can overload the back muscles, especially if the mattress or pillow do not provide adequate support.

2. Posture and misalignment of the spine

Sleeping with the spine outside the neutral position (arched or very straight) generates tension in specific areas, such as the lumbar and cervical regions.

3. Tension accumulated during the day

Stress and poor posture at work cause muscle contractions that manifest themselves when we relax during sleep.

4. Underlying health problems

Herniated discs, osteoarthritis and scoliosis can cause pain that becomes more evident after rest (National Institute of Neurological Disorders and Stroke)¹.

Did you know that up to 80% of the world's population will experience back pain at least once in their lives².

How to avoid back pain before bed

1. Light stretching at night

Dedicate 5–10 minutes to simple movements, such as the yoga “cat-cow” or hamstring stretch. This reduces muscle tension and improves circulation.

2. Sleep hygiene

Avoid coffee and stimulants after 5 pm and turn off electronic screens 1 hour before bed. Quality sleep speeds up muscle recovery.

3. Choosing a mattress and pillow

• A medium-firm mattress: supports the spine without being too hard³.

• Anatomical pillow: keeps the neck aligned, preventing twisting.

4. Relaxing routine

A warm bath or deep breathing techniques help to reduce stress levels, preparing the body for a restful sleep.

Main causes of back pain when waking up

1. Worn mattress

Mattresses that are more than 7–8 years old lose support. If you notice that yours has exceeded this age, consider replacing it with a high-density foam or pocket spring model.

2. Inadequate pillow

Pillows that are too high or too low force the cervical curvature. An orthopedic pillow, for example, can reduce morning neck pain by 30%.

3. Incorrect positioning

Sleeping on your stomach puts pressure on the lower back and neck. Ideally, try:

• Lateral decubitus (on your side), with a pillow between your knees.

• Supine decubitus (on your back), with a pillow under your knees.

4. Lifestyle factors

A sedentary lifestyle weakens the core and back muscles. According to the World Health Organization, 25% of adults do not get enough physical activity⁵, which contributes to back pain. Poor posture throughout the day puts strain on the lower back, resulting in nighttime pain. Accumulated stress causes muscle tension and affects relaxation during sleep. Healthy habits promote more restful sleep and pain-free mornings.

How sleeping position influences back pain

The way you sleep directly affects the alignment of your spine and weight distribution. See the options:

• Side position: keeps your spine aligned and reduces gastric reflux. It is recommended to use a pillow between your knees.

• Supine position: distributes weight evenly and relieves pressure on your lower back. It is recommended to place a pillow under your knees to maintain the natural curve.

• sleep on your stomach: can reduce snoring. However, it is not recommended, as it forces the cervical and lumbar curvature.

Tip: try a small pillow under your abdomen if sleeping on your stomach is unavoidable, reducing the arching of your lower back.

What about neck pain?

In addition to back pain, many people also report neck pain when waking up, which can be equally uncomfortable and affect your well-being throughout the day. Most of the time, this pain is related to an inadequate sleeping position, using a pillow that is too high, too low or lacking adequate support, and even muscle tension accumulated due to stress or excessive screen time before bed. Sleeping on your stomach, for example, forces your neck to remain twisted for hours, which can result in stiffness and discomfort.

To alleviate and avoid this type of pain, it is important to invest in a pillow that keeps your cervical spine aligned, prefer to sleep on your side or back, and do light stretching in the morning. In persistent or very intense cases, it is best to seek medical or physical therapy advice to assess the cause more accurately.

Occasional pain vs. more serious problem

Not all morning pain requires doctors or invasive treatments. Know how to differentiate.

Occasional back pain usually improves in about 30 to 60 minutes after you stretch or move around a little. Its intensity is usually mild to moderate, located in a specific region of the back, and does not radiate to other parts of the body. In these cases, the stiffness is brief and is not usually accompanied by other worrying symptoms.

On the other hand, it is important to be aware of signs that the pain may be something more serious. Back pain considered a warning sign tends to persist for more than two weeks, can be intense enough to make it difficult or impossible to perform daily activities, and often radiates to the leg or arm or is accompanied by tingling. In addition, symptoms such as loss of muscle strength, fever or weight loss for no apparent reason are indications that you should seek medical evaluation as soon as possible.

If you identify two or more warning signs, see a spine specialist or orthopedist.

Appropriate treatments for morning back pain

1. Strengthening and stretching exercises

Pilates or hypopressive gymnastics programs increase the resistance of the core muscles, reducing the recurrence of lower back pain by up to 40%⁶.

2. Physiotherapy

Techniques such as manual therapy, electrostimulation and therapeutic exercises promote postural re-education and relax trigger points.

3. Complementary therapies

• Therapeutic massage: relieves muscle tension.

• Acupuncture: studies show a 60% reduction in pain after 6 sessions⁷.

4. Medications (occasional use)

Simple analgesics (paracetamol) or non-steroidal anti-inflammatory drugs (ibuprofen) may be prescribed by the doctor in acute crises.

5. Changing habits

• Weight control: each extra kilo generates up to 4 kg of extra load on the lumbar spine.

• Regular physical activity: walking, swimming and stretching daily.

A good walk for well-being

Remember: small changes in your sleep routine and lifestyle have a big impact on your quality of life. Start implementing these tips today and notice the difference in the next few mornings. If the pain persists, do not hesitate to seek professional help. You are on the right track to waking up pain-free and enjoying each day with more energy!

Sources

1. National Institute of Neurological Disorders and Stroke. “Low Back Pain Fact Sheet.” Available at: https://www.ninds.nih.gov/low-back-pain

2. Global Burden of Disease Study. “Global prevalence of lower back pain.” 2017.

3. Brazilian Association of Sleep. “Mattress selection guide.” 2020.

4. Smith, J. et al. “Effectiveness of Orthopedic Pillows in Cervical Pain.” Journal of Orthopedic Research, 2019.

5. World Health Organization. “Physical inactivity: A global public health problem.” 2020.

6. Costa, L. et al. “Pilates and chronic low back pain: randomized controlled trial.” Brazilian Journal of Physical Therapy, 2018.

7. Lee, H. et al. “Acupuncture for low back pain: systematic review.” Pain Medicine, 2021.