Is your low back pain worse at night?  If it is, read on, this could be vitally important information for you.  As an Edinburgh osteopath, I’ve been specialising in low back pain for 29 years. Aside from writing more than one book on low back pain, I have a great online course for low back pain / sciatica too. I’ll deal with “should I worry?” first.

Should I worry?

If your low back pain is worse at night AND you answer “yes” to one of the below questions, I recommend you get your doctor to check you over.

  • Have you lost any great amount of weight without meaning to over the last year?
  • Have you been diagnosed with Cancer at any time?
  • Have you had lower back surgery in the last 2 years?
  • Do you have any weakness (rather than pain) in any of the following?
  1. When standing, lifting either big toe up
  2. When standing, pushing up onto the toes of one foot (compared with the other, or compared with what you would expect is your normal)
  3. Squatting
  • Do you have any numbness (lack of sensation) or pins and needles in your pelvic floor area (up between your upper thighs, the area you would sit on if on a saddle)?
  • Have you had any recent change in sexual function?  Loss of feeling, erection or ability to orgasm?
  • Do you have any difficulty urinating or defecating (using the toilet)?  e.g. trouble starting or stopping, or not aware of your bladder filling
  • Have you suffered any significant trauma recently, which in any way could impact on your lower back?
  • Have you been on a prolonged course of oral corticosteroids in the past or now?
  • Have you had a persistent high temperature recently?

If you’ve answered “no” to all of the above, you’re probably not sporting a “nasty” cause of back pain at night.

Why is my low back pain worse at night?

There are many possible reasons for this.  Let’s cover some of them.

Sustained loading

When you lie still in bed, you may think your low back is relieved of load-bearing.  You’re right – it is relieved of vertical load-bearing.  But it’s exposed to side-ways shearing forces for a sustained period of time.  Sustained loading can lead to back pain.  Try pulling one of your fingers back as far as it will go (not past that point).  Hold it there.  After a few minutes it will start to hurt.  This is due to sustained loading leading to fatigue and then pain

Inflammation build up

When you lie still, your circulation slows down and inflammation builds up.  It doesn’t matter whether we’re talking back pain, knee pain, shoulder pain or whatever.  If you stay still for a while, the pain will build up.

Discs absorb fluid

If your pain is at all related to a disc problem, you are likely to feel worse if you stay still for a while. Discs absorb fluid when you lie down.  If the disc has a bulge (herniation) in it, this will get bigger when you lie still.  This is often why disc-related pain is worse over night and first-thing in the morning.

The mattress isn’t right

I’ve written a guide to choosing a mattress before.  It’s certainly true that if your mattress doesn’t support you well, it could be contributing to your back pain.

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