© 2019 by Spinal Symmetry Pty Ltd


Why do I have Low Back Pain when I first wake up?

June 26, 2019

Here at Spinal Symmetry a common symptom people present with is low back pain that is worse when they first wake up and then feels better as they start moving or after they have a hot shower. 


This month we thought we would look at why this is, how it occurs and what can be done to help it. 



The list of reasons for this can be quite large but the most common cause for this presentation is actually lumbar disc pain. 


The lumbar discs are the shock absorbers that lie between the lumbar spine vertebrae. They are made of material called annulus fibrosus and a nucleus pulposus. The nucleus pulpous is the part of the disc that has the most fluid in it. And this is the area of the disc which can vary in the actual amount of fluid throughout the day.  


When you sleep your body undertakes a process called osmosiswhere the fluid that lies in the interstitial fluid around all structures in the body slowly moves back into the tissues that need the fluid. In other words, the fluid moves from outside the disc moves back into the centre of the disc (the nucleus pulposus). 
This happens when you are sleeping because you are lying down out of gravity, with no pressure on the structures- so the fluid/water can easily flow into the tissue. When you are standing and moving, the gravitationally forces are loading the structures which forces the fluid out.
When you first wake up in the morning you are actually the tallest you are in the day. By the time you go to bed you are actually the shortest!! 
The reason you may be complaining that the pain is the worse in the morning and then gets better as you start moving around or have a hot shower, is that this is the time when the disc is the most swollen in the day. 
However, this process has been happening since the day you were born- so why are you only complaining of this now? 
Disc injuries can occur from trauma such as lifting and twisting incorrectly, which can tear the fibres of the disc. The most common cause that we see in practice is a buildup effect of stress from other parts of the body slowly loading the disc. Over time this can slowly cause the disc to become more and more irritated until it gets to a point where you become aware of it from no known mechanism or injury. 
This process generally occurs when you have a hip imbalance. 
The hips determine the stability of the primary foundation of your entire body.Their job is to direct the gravitational force that is being placed on your body so that it is balanced. This allows the spine to sit symmetrically and stable upon the pelvis so that it is able to function as it is built to.


When you have an imbalance in these hip angles, it causes your centre of gravity to shift which creates an uneven load on the spine. Over time, this puts greater pressure on the discs as each individual disc will be incrementally loaded unevenly causing inflammation in the discs because they have to work hard to act as the shock absorber of the spine. 


When the natural process of osmosis occurs during the night, the fluid flowing into the disc plus the inflammation from being over worked, leads to too much fluid in the disc. This activates the pain receptors in the disc to cause the pain and stiffness that you are feeling in the morning. 



As you get up and move the fluid dissipates and your body is able to manage the level of fluid in the disc. 
It is important to resolve this as quickly as possible to prevent further irritation. The spinal nerves exit the spine next to the disc, so if there is any swelling in the disc, it may start to irritate these nerves which can lead to nerve referral pain in the legs or other neural symptoms such as tingling or numbness down the legs. 
The take home message is that if you start feeling pain in the morning and it improves as the day progresses, it is most likely from a dysfunction in the hip and pelvic joints leading to an imbalance in your skeletal system. 
Over time this will cause increased loading on the rest of your spine- particularly the discs which may become irritated and inflamed leading to other symptoms. 
By addressing these dysfunctional joints quickly can prevent further progression of dysfunction in your skeletal system which may lead to something more severe.


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