Why Does My Back Hurt in the Morning? 

  • Lower back pain felt by older people after sleeping may be caused by underlying medical conditions, such as disc degeneration, spinal stenosis (narrowing of the spaces in the spine), or herniated discs.
  • Other non-medical factors that cause lower back pain include bad mattress quality or sleeping positions(1).
  • Non-pharmacological treatment options, including simple exercises, stretching, and physical therapy, may help with back pain in the morning.
  • If low back pain is severe, seniors may seek medical advice from their physicians about over-the-counter pain medications or nonsteroidal anti-inflammatory drugs (NSAIDs)(2).
  • Older people may prevent the onset of back pain after sleeping by using the best bed position for lower back pain, exercising, or reducing stress, tension, and anxiety(3-4).

Lower back pain after sleeping is a common struggle among older people(5). However, it may be challenging to find a solution to their pain problems, especially if they do not know the cause of their pain and discomfort.

Health Report aims to help older people manage chronic back pain by providing relevant information and possible health solutions. Through these solutions, seniors can manage their back problems and start their day positive and pain-free. 

Causes of Lower Back Pain After Sleeping

Early morning back pain or morning stiffness may be caused by an underlying medical condition or non-medical reasons(6). 

Here are the possible causes that explain why an older person’s back may hurt after sleeping:

Degenerative Disc Disease 

According to Mayo Clinic, disc degeneration occurs as people grow older. The condition is characterized by the drying out and shrinking of the discs between the vertebrae(7).

The spinal discs function as shock absorbers for the spine. These discs provide flexibility while resisting forces in various angles and planes of motion(8). 

Each spinal disc has two parts: the annulus fibrosus and the nucleus pulposus(9). The disc’s outer portion is the annulus fibrosus, made up of firm and tough material that can induce pain when damaged.

The nucleus pulposus is a soft, jellylike core that contains proteins, which may cause inflammation to the tissues they touch.

The proteins in the nucleus pulposus may leak out to the nerves of the spinal disc’s outer layer, resulting in painful sensations(10).

Because of low blood supply, discs cannot repair themselves once they are injured. Then, disc degeneration follows in a span of 20 to 30 years(11). 

Acute pain caused by the condition makes normal back movement difficult. The bone where a disc injury occurred becomes relatively unstable over time(12).

Disc degeneration affects sleep as it narrows the space between the vertebrae, making the spine less stable and flexible. The narrowing of the spaces may cause pain, numbness, or weakness(13). 

A patient with degenerative disc disease should see a physical therapist for treatment.

Below are the symptoms of degenerative disc disease(14):

  • Feeling pain that worsens when lifting, bending, or twisting.
  • Experiencing lower back pain when sitting. Lower back discs have three times more load on them when sitting than when standing.
  • Feeling reduced back pain while walking or running than while sitting or standing.
  • Suffering from periods of intense pain that range from nagging pain to disabling pain. This pain may be felt on the lower back, buttocks, thighs, or neck.
  • Numbness and tingling in the extremities.
  • Feeling weak, particularly in the leg or foot muscles.

Spinal Stenosis

Spinal stenosis is the narrowing of the spaces within the spine. The action puts pressure on the nerves traveling through the spinal column(15). 

The most common reason for spinal stenosis is wear and tear in the spine, a symptom associated with osteoarthritis. The condition may also be caused by the following(16):

Below are the symptoms of degenerative disc disease(14):

  • Feeling pain that worsens when lifting, bending, or twisting.
  • Experiencing lower back pain when sitting. Lower back discs have three times more load on them when sitting than when standing.
  • Feeling reduced back pain while walking or running than while sitting or standing.
  • Suffering from periods of intense pain that range from nagging pain to disabling pain. This pain may be felt on the lower back, buttocks, thighs, or neck.
  • Numbness and tingling in the extremities.
  • Feeling weak, particularly in the leg or foot muscles.

Herniated Discs

A slipped or a herniated disc occurs when the nucleus pulposus pushes out through a tear in the disc’s outer layer. 

A herniated disc can irritate surrounding nerves and cause pain, numbness, or weakness in an arm or leg(20). 

Several people with a herniated disc experience no symptoms. Surgery is not always needed to relieve the problem(21).

Although most herniated discs commonly occur in the lower back, slipped discs may also occur in the neck. The condition’s symptoms depend on where the herniated disc is situated and whether the disc is pressing on a spinal nerve(22).  

Below are some of the symptoms of herniated discs(23):

Numbness or Tingling

People with a herniated disc often experience radiating numbness or tingling in the body part near the affected nerves.

Arm or Leg Pain

If the slipped disc is located in the lower back, the patient may feel pain in the buttocks, calf, and thigh. Pain may also radiate to the foot.

However, if the herniated disc is in the neck, typically, the patient feels the most pain in their shoulder and arm. The pain may be felt when the patient moves their arm, coughs, or sneezes.


Muscles near the affected nerves tend to weaken, causing the individual with a herniated disc to stumble or struggle when holding objects.

Fibromyalgia is a musculoskeletal medical condition characterized by widespread pain and fatigue. Problems in sleep, memory, and mood are also associated with the condition(24). 


Researchers suggested that the condition may amplify painful sensations by affecting how the brain and spinal cord process painful and non-painful signals(25).

Fibromyalgia’s primary symptoms include(26):

Widespread Pain

Patients with fibromyalgia experience a constant dull ache that lasts for roughly three months. Discomfort associated with fibromyalgia is felt on both sides of the body and above and below the waist.


Fibromyalgia patients feel tired after waking even though they slept for a long time. Sleep in patients with the condition is also often disrupted by pain.

Cognitive Difficulties

Another symptom of fibromyalgia includes “fibro fog,” which impairs the patient’s ability to focus on mental activities.


Fibromyalgia also causes stiffness which may be most severe when the patient has been in the same position for a long time. This sleeping position issue may cause pain and discomfort in patients when they first wake up in the morning(27).

Vitamin D Deficiency

According to a 2019 study found in The Permanente Journal, vitamin D deficiency and insufficiency may cause and exacerbate neck and back pain(28).

The authors noted that the condition may also trigger and worsen muscle spasms(29). 

The 2019 study suggested that vitamin D played a crucial role in managing musculoskeletal system chronic pain. The authors noted that treating vitamin D deficiency and insufficiency improved the subjects’ symptoms(30). 

Poor Sleeping Positions

Back pain after sleeping may also be caused by poor sleeping posture. Poor sleeping positions add pressure on the spine, causing its natural curve to flatten(31).

Experts stated that sleeping on the stomach may cause body pain since it pushes on the muscles and joints and flattens the body’s natural curve. The position also forces a person to turn their neck while sleeping, which may cause neck and upper back discomfort(32).

To address this issue, older people may change their sleeping position to help them get better sleep and improve their spine health and overall wellness.

Bad Mattress

If an older person’s lower back pain does not go away even after they fix their sleeping posture, the pain may be caused by their mattress’ poor quality. 

Replacing their old mattress may provide them with pain relief and a good night’s sleep.

According to a 2009 study about back pain published in the Journal of Chiropractic Medicine, authors noted that replacing mattresses over nine years old may improve sleep quality and reduce stress and pain in the back muscles(33).

When choosing a new mattress, older adults should look for an adjustable bed and a medium-firm mattress with enough back support.

To know more about the other possible causes of lower back pain in the mornings, seniors may visit the National Institutes of Health (NIH) website, where they may read more about the condition and its causes.

Lower Back Pain Treatment Options


A 2016 study published in the Scientifica journal noted that strengthening exercises relieve lower back pain and improve body functions in elderly people(34).

The authors noted that physiotherapists may recommend strengthening exercises to prevent disability and improve physical functions(35).

Regular exercise throughout the day may help alleviate back pain. Anything that gets seniors moving and off their feet, such as walking, may help strengthen their back. 

If an older person wakes up with back pain, they may try doing light exercises to alleviate discomfort throughout the day.


One way to reduce back pain is to perform lower back stretches for older adults.

Begin by doing a stretch before getting out of bed.

While lying on their back, seniors should stretch their arms up above their head as far as they can. At the same time, they must stretch their feet out in the opposite direction.

They can bring their knees to their chest and hold for a few seconds for a lower back stretch.

After sitting up, older adults should plant both feet on the ground, shoulder-width apart. They can stretch by raising their arms over their head, then stretching from side to side. l


Physical activities beneficial for older adults include planking, push-ups, pull-ups, squats, and lunges(36).

A plank stretches the entire body, especially the core muscles. Strengthening the abdominal muscles puts less strain on the back(37).

Doing a plank may prevent a person’s core from weakening and avoid the occurrence of neck, shoulder, and lower back pain(38).

To properly do a plank, the senior should lie facedown on the floor. Curl the toes and keep the elbows and forearms in line with the wrists.

As they lift off the floor, they must push themselves to their upper back and keep their chin close to the neck.

Stay in the position for up to 30 seconds, crunching the abdomen tight as if bracing for a punch in the stomach. As the person holds the pose, they must also contract their glutes and thighs.

Pharmacological Treatment


In some cases, physicians may recommend pharmaceuticals to relieve severe back pain in need of immediate relief.

The doctors may prescribe NSAIDs, such as ibuprofen, to manage pain. NSAIDs are pain relievers and anti-inflammatory medications that reduce inflammation contributing to the patient’s discomfort.

Acetaminophen, a painkiller and fever medication, may also be an option to reduce occasional back pain if the patient cannot take NSAIDs.

Another treatment to consider is the use of a transcutaneous electrical nerve stimulation (TENS) machine.

According to a 2008 study in the Current Rheumatology Reports, TENS may relieve severe chronic musculoskeletal pain. However, patients must first need to build up a tolerance to the electrical currents(39).

Seniors must first ask their doctors if using a TENS machine may be the best solution for their back pain.

Topical Remedies

Older adults may also try topical remedies to relieve pain. They may apply natural and essential oils, such as turmeric and peppermint, infused in carrier oils to the affected area.

However, before trying alternative treatment options, seniors must first consult their doctor to avoid worsening their pain or other adverse reactions.

Tips to Prevent Back Pain After Sleeping

The onset of lower back pain in the mornings is preventable by making simple changes in a person’s sleeping habits. Having a good sleeping posture may protect a person’s back(40). 

Below are some recommendations on how to improve a person’s sleeping habits, regardless of the position they sleep in(41):

If a person is a side sleeper, they may draw their legs up towards their chest and place a pillow between their legs to put less strain on their backs.

Meanwhile, if an individual sleeps on their back, they may place a rolled towel under their neck and a pillow underneath their knees to help maintain their lower back’s natural curve.

They may also use a rolled towel under the small of their back for additional lower abdomen support.  

Sleeping on the stomach may strain the back. If an older adult cannot sleep any other way, they may reduce the strain on their back by placing a pillow under their pelvis and lower abdomen. 

They must also use a pillow that does not place excessive strain on the back. If changing the pillow does not relieve back pain after sleeping, they may try sleeping without a pillow under their head.

Below are other helpful tips to keep in mind to prevent experiencing lower back pain in the morning(42):

  • Stay active and exercise regularly
  • Reduce extreme stresses and strains on the back
  • Be careful when lifting objects
  • Strengthen back muscles
  • Lose excess weight; older people may use a body mass index (BMI) calculator to determine whether they have the appropriate weight for their height
  • Try not to sit for long periods
  • Wear flat footwear with cushioned soles to reduce the stress on the back
  • Avoid muscle strain or sudden movements
  • Make sure to have a good-quality mattress that provides enough back support
  • Fix back posture when watching television or using computers or phones
  • Try to reduce any tension, stress, and anxiety

Sean Byers, MD

Sean Byers, MD

Sean Byers is currently a Resident in the Internal Medicine program at UTMB. He studied at the University of Queensland School of Medicine as well as received his Master’s in Public Health with a focus in epidemiology and biostatistics at the University of Southern California. His background is in biology, computer science, public health, and internal medicine.

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