Lower Back Pain When Lying Down Flat: Causes & Treatment

Lower back pain when lying down flat is one of the worst types of lower back pain you can deal with. You aren’t just dealing with the actual hurt – but most often, the inability to relax and fall asleep. When your ailment starts to affect your ability to sleep, that’s when its time to get serious about figuring out the root cause and coming up with a treatment regimen.

There are plenty of things that can cause this type of pain. In fact, it can be as simple as an old, beat up mattress. But, it can also be something as serious as degenerative back conditions, including arthritis or some sort of disc issue.

We’ll cover the most typical culprits behind lower back pain when lying down flat, along with recommended treatment options. Then we’ll share some tips to help you remedy the pain in the meantime, and get some much needed sleep!

Why Do I have Lower Back Pain When Lying Down Flat?

As we briefly touched on earlier, there are so many different causes of lower back pain when lying down flat. 

To figure out the exact cause, you need to have a good level of awareness. Did you recently do something to tweak your back? Have you felt the pain increasing over a period of time? Does it go away when you stand up, or is it only present when laying down on certain surfaces, like a specific couch or bed?

The answers to these questions, along with the presence of secondary symptoms, will be instrumental in figuring out the root cause of your ailment. Let’s start with some of the most typical, and easiest to fix.

The Surface You’re Lying On Is At Fault

A lot of the time, we get lower back pain when lying in bed or on our couch, because they are worn out and provide no real support! You should also find out the best sleeping positions for lower back pain.

Depending on the age of your couch or mattress, it’s very possible you could just be lying on springs, which is going to cause pain and discomfort.

So start by ruling that out. If you don’t believe that to be the case, it is very likely one of the conditions we’ll list below.

Tweaked, Pulled, or Strained Back Muscles

This is the most common cause of back issues – a tweaked or strained back muscle, ligament, or tendon.

This will also be the easiest to diagnose – as you’ll feel the pain immediately after moving incorrectly. Most often, these occur during sports or exercise.

The good news is, these heal on their own. Just rest, and while you’re recovering, do some research into proper lifting form and make sure it doesn’t happen again!

Arthritis or Spondylitis

General arthritis, and a specific type of arthritis referred to as ankylosing spondylitis, are common culprits for lower back pain in general.

These conditions can cause the back pain to worsen at night, when you’re less active. This is why you’ll notice it more when laying down at the end of the day.

The pain centralized in the lower back and pelvis area. Often, treatment consists of NSAIDs (non steroidal anti inflammatory drugs). Unfortunately, not much can be done to cure arthritis, but rather the treatment focuses on building up strength, mobility, and tolerance to the pain so you can live comfortably.

In severe cases, your doctor may recommend blockers and inhibitors. These are much more invasive and will require some serious thought on your end.

Degenerative Disc Conditions

If you are getting up there in age, the inevitable, unfortunate reality is that your spine is going to start breaking down.

This can lead to a host of degenerative disc conditions, all of which can cause severe lower back pain when lying down.

This is an issue that will come on slowly and get worse over time, rather than having a specific moment you notice the pain.

Similar to arthritis, there are no real cures for any sort of degenerative disc conditions. Instead, the focus is on restoring range of motion and mobility, increasing strength, and minimizing pain and discomfort.

In some cases, professional care options are your best bet. These include chiropractic care, physical therapy, acupuncture, massage, etc.

How Can I Stop My Lower Back From Hurting When I Lay Down?

If you aren’t exactly sure why your lower back is hurting when you lay down, but you know you want it to stop, there are some quick things you can do to lower your pain level.

Start by applying a heat pad to the area – this will increase blood flow and promote healing, plus it just feels good!

If necessary, take some sort of over the counter anti inflammatory – such as advil, ibuprofen, etc. Don’t rely on these for constant relief, but you can use these on your worst days as a crutch here and there.

Try to keep yourself moving, even if its just taking a walk around your house or backyard. Motion is lotion for the spine, and rest is only good protocol immediately following an injury. Often times, you can remedy much of the stiffness associated with the aforementioned back issues by just getting your body moving again.

Tricks To Fall Asleep With Lower Back Pain When Lying Down Flat

Lying on your back is one of the most common ways to fall asleep. It also happens to be a great sleeping position posture wise. But if you have lower back pain when lying down flat, it can be impossible.

So, try changing up your sleeping position if necessary. It’ll be tough for a few nights, but eventually, it will become your new normal.

Or, if you wish to continue sleeping on your back, try elevating your legs with a pillow. Place it right under your knees.

This will take much of the stress off your lower back, and can help you remain pain free so you can fall asleep.

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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