Why Does My Back Hurt When Lying Down?

Lower back pain when lying down is a symptom associated with several causes, from a common back sprain or strain to more chronic conditions like arthritis or sciatica.

Lower back pain can be mild, but it can also be severe enough to interfere with your sleep when dealing with nighttime back pain. It can lead to muscle stiffness and a limited range of motion that affects your daily life.

This article examines some possible causes of lower back pain when lying down. It also explains how the cause can be diagnosed and treated.

Causes of Lower Back Pain When Lying Down

Nighttime back pain usually isn't a sign of a serious health condition. Note that there are two types of back pain:

• Acute pain is short-term—lasting a few days or weeks. It often happens after an injury or specific event. 
• Chronic pain is longer-term. It may last for several months or more. In many cases, it isn't from an injury.

Here are some of the most common causes of lower back pain when lying down.

Strains or Sprains

Lumbar (lower back) strain or sprain occurs when muscles or ligaments are stretched too far. Injuries like these are very common.

A sprain or strain is usually considered acute rather than chronic, so the symptoms should last a few days or weeks.

Ankylosing Spondylitis

Ankylosing spondylitis (AS) is a rare form of arthritis. It causes persistent neck and back inflammation. Symptoms can be worse at night. People living with AS also appear to have a higher risk of spinal fractures.

It is known to occur in people also diagnosed with osteoporosis (thinning of bones) or psoriasis, among other conditions. AS symptoms tend to get better with physical therapy.

Spine Osteoarthritis

Osteoarthritis (OA) is a common cause of joint pain, often called degenerative, because it occurs due to the wear and tear on cartilage tissue across your lifetime. OA affects at least 32.5 million people in the United States.

The lower back is one of the most commonly affected sites with OA. Spine osteoarthritis due to wear and tear on the spine may spur more intense pain at night. That could be because you're less active.

Sciatica

Sciatica is nerve pain that often radiates from the back through the hip and down the leg.

Certain sleeping positions can aggravate the sciatic nerve, which runs from your spine to the foot on either side of your body. This can cause pain that shoots down your legs.

Sciatica typically affects one side at a time but can occur on both sides of your body (bilateral). Sciatica pain usually flares up and resolves on its own within six weeks for about 80% of people.

Spinal Tumor

People diagnosed with cancer of all types have difficulty sleeping at much higher rates than the general population. While tumors or growths on the spine are rare, they can cause worse pain when lying down if the growth puts pressure on the back.

Researchers who study spinal tumors find that compression on the spine results in pain that disrupts sleep, but surgery can lead to improvement.

Spinal Stenosis

Spinal stenosis is a condition that leads to narrowing of the spinal column and compression of nerves. The stenosis can affect different parts of your back, with lumbar stenosis and thoracic stenosis affecting the lower back.

As the stenosis becomes more advanced, sitting or lying down does not help as much to relieve the pain. This chronic condition can sometimes lead to severe impacts, including paralysis.

Osteomyelitis

Osteomyelitis is a bone disease due to bacterial infection. The Staphylococcus aureus bacteria is a common cause of these infections, which can spread throughout the body or recur at the same site.

Back pain is the most common symptom of osteomyelitis that affects the vertebral bones in the spine. You also may experience fever and other symptoms of an infection. Antibiotics and pain medication are used to treat osteomyelitis, but it can be difficult to manage.

Other Causes

Lower back pain when lying down can also be related to a condition that causes pain at other times of the day. Sometimes, we don't notice pain when busy throughout the day, which becomes more apparent when we go to bed.

Other possible causes of nighttime back pain include:

• Endometriosis
  
• Kidney stones,
• Other forms of arthritis
• Pregnancy
• Uterine fibroids

When to See a Healthcare Provider

Everybody handles pain differently. Still, it's a good idea to talk to your healthcare provider right away if your pain:

• Began with a specific injury, like an auto accident
• Wakes you up at night or keeps you from sleeping
• Travels to other parts of the body, like your legs
• Lasts more than a week
• Comes with weakness, numbness, or tingling in your lower body

Also, contact your healthcare provider if the pain feels severe or if signs of infection, like redness, warmth, swelling, or fever, are present. You may want to start with your primary care provider, who can treat or refer you to a rheumatologist or other specialist.

Diagnosis

To find the cause, your healthcare provider will start with a physical exam. Be prepared to talk about your medical history to help identify or rule out health conditions.

Your healthcare provider will ask you to describe your pain. You may want to note:

• When it started
• What makes it worse or better
• Its quality (e.g., aching, burning, throbbing)
• The intensity (how strong it is)
• Whether you have other symptoms like numbness or tingling

You may also need other tests to help with the diagnosis:

• Neurologic tests measure muscle strength and skin sensation to see if the pain is spine or nerve-related.
• Imaging tests, such as an MRI or CT scan, can help rule out cancer, infection, or fracture. 
• Lab tests like a complete blood count may be helpful if you have an infection or unexplained weight loss, which may suggest cancer or inflammatory arthritis.

Treatment

Your treatment will depend on what's causing your pain. Healthcare providers often start with pain remedies such as:

• Heat or ice
• Over-the-counter (OTC) pain relievers
• Gentle stretches or light exercise
• Physical therapy to strengthen core muscles that support the lower back
• Corticosteroids to reduce inflammation
• An epidural, which is pain medication injected into the spine

Because the pain happens at night, your healthcare provider will probably want to improve your sleep environment. You may need to change your sleeping position, pillows, or mattress.

Your treatment plan could also include complementary remedies, like:

• Acupuncture
• Chiropractic care
• Gentle exercises like yoga and tai chi
• Hydrotherapy
• Massage therapy
• Stress reduction programs

If your pain is severe or isn't improving with these methods, your healthcare provider may recommend surgery. Surgery may be a good option for degenerative disc disease, sciatica, and spinal osteoarthritis. It sometimes helps with AS.

Coping

Some risk factors increase the chance of having chronic low back pain. These include:

• Excess body weight
• Physically demanding occupation (e.g., lifting heavy objects)
• Difficult work positions (frequent bending or twisting of the lower back)
• A history of smoking

Some studies suggest anxiety and depression also may contribute to the risk. While not all conditions that cause nighttime lower back pain can be prevented, you can try to keep your back healthy and pain-free by maintaining a healthy weight, exercising, and not smoking. In addition:

• Use good posture.
• Avoid movements or heavy lifting that can strain the back.
• Use ergonomic chairs (designed to maximize comfort) at home and work.
• Switch sitting positions and take frequent breaks to walk or stretch during the day.
• Wear comfortable, low-heeled, supportive shoes.

Summary

Back pain when you lie down can have a wide range of causes. Some are serious, and others are less so. It's important to find the cause, especially if you experience lower back pain when lying down.

Muscle strains are the most common cause. Different types of arthritis, sciatica, and spinal changes can also lead to nighttime back pain.

Your back pain may respond to OTC pain medications, heat, ice, or gentle stretching. A new pillow or mattress may help, but your healthcare provider will need to diagnose and treat your pain if it continues.

A Word From Verywell

For lower back pain when lying down, I tell my patients to think about it in an A.B.C. format. "A" is for antecedent (what you did during the day before lying down), "B" is for behavior (what you are doing while lying down), and "C" is for consequence (the pain that is experienced). Antecedent examples include the activity or inactivity that occurs during the day, the position your body is in during work, and the firmness of your chair and mattress, while behavior may include sleep position and mental health. This way of thinking can help stimulate conversations with healthcare providers toward an individualized action plan for what is causing the pain, leading to a greater sense of control.

— FOREST MILLER, OTR/L, MEDICAL EXPERT BOARD