Sleeping with Lumbago:Often Humorous, Always Personal Stories

When a red flag is present, you should not delay in reporting your symptoms to your family physician. Here are some red flags that should be considered when back pain is severe, persistent, or associated with other symptoms. Although an x-ray exam is not often indicated depending upon your medical history when acute back pain occurs, your doctor might order an imaging study if symptoms persist longer than a month.

A plain x-ray image can be helpful in finding a structural problem, such as spondylolisthesis, that might be causing back pain; it might also detect bone disease, an abdominal aneurysm, or some other problem that might be causing non-musculoskeletal back pain. When there is a red flag involving spinal nerves, an MRI study might be needed to look for nerve root impingement or disc herniation. CT-myelography might be ordered in the case of spinal stenosis or cauda equina syndrome, and so on.

An appropriate specialist will order an appropriate testing procedure. In most cases, a good physical exam and a detailed case history by an astute clinician will provide a diagnosis that will often be confirmed by special studies. Generally, non-musculoskeletal back pain referred from an internal organ is characterized by pain that is not affected by movement, percussion, and other mechanical testing procedures. Back pain complicated by neurological symptoms, such as loss of reflexes, localized muscle weakness, muscle atrophy, and other signs of progressive nerve damage, may be an indication of massive herniation of an intervertebral disk.

Barring the medical emergency of a cauda equina syndrome, any recommendation for surgical excision of a herniated disk would warrant taking time for a second and third opinion. Surgery can often be avoided when time is combined with periodic evaluation by a physician who can watch for progressive neurological signs that indicate an unquestionable need for surgery. As an option, patients may be taught self-application of heat or cold to the back at home.

Here are some basic self-help measures that anyone can use safely and effectively to relieve symptoms and to buy the time needed for recovery. Cold constricts blood vessels and reduces swelling. When an injury is severe enough to cause swelling in deep tissues, early application of heat might increase pain and swelling by dilating blood vessels and drawing blood into the injured tissues. When back pain is not severe, it probably makes little difference whether you use heat or cold; you may try using brief applications of each and then use whichever feels best. Heat applied for 20 or 30 minutes will often provide soothing relief by relaxing spastic muscles.

If heat seems to increase pain or cause a throbbing sensation, you should discontinue use of heat and use cold applications for at least two days before trying heat again. A gel pack that can be cooled in a freezer or heated in a microwave oven can provide a convenient source of heat or cold. Such packs can be strapped to the back to permit movement around the house; they should always be wrapped in fabric to prevent tissue damage caused by excessive temperature.

When acute back pain occurs as a result of injury, you may have no choice other than to rest in bed the first day or two. But the sooner you begin moving around, the better. When you are resting in bed, placing a pillow under your knees will relieve strain on your lower back by taking tension off hip flexors psoas muscles that tug on the lumbar spine.

You can relieve tension on hip flexors and get the added effect of traction by lying on the floor and draping your legs over the arm of a sofa. Even though movement may be painful, the pain you feel will prevent excessive movement and will not worsen your injury.

Use a walker or a pair of crutches if necessary. A simple wrap-around velcro back support might help when standing or walking. A behind-the-back cushion to maintain the normal lumbar curve while sitting might also be helpful. Over-the-counter medication such as Tylenol acetaminophen will usually provide adequate pain relief. But do not continue use of such medication for longer than about a week at a time. Some people may have mattresses and pillows and other sleep gear that facilitate this.

Younger people are generally much less vulnerable to tissue stagnation they are better at maintaining their circulation despite stagnancy , and so they are better candidates for pain-free sleeping. There are many variables. If you get a few good ones lined up, you may have no problem with back pain at night.

Morning Back Pain

Awkward positions can be quite painful, even injurious. Sleeping often involves slightly awkward positions held for periods long enough to cause sustained compression, pinching, and oxygen starvation of tissues which may or may not have already been vulnerable or irritated. The dose makes the poison: We may also cause minor injuries in our sleep, or aggravate existing minor injuries and vulnerabilities like chronic minor back pain. Sometimes you just roll over and pinch something hard enough and quickly enough to hurt it — maybe not even enough to wake you up, but enough to feel the consequences when you do wake up.

Usually this is going to be an isolated incident, but what if you keep pissing off the same vulnerable tissue? For instance, suppose you already have minor intermittent back pain related to an old accident: And so you wake up in moderate pain. In other words, whatever is bothering your back in the first place can be easily and routinely aggravated — re-injured — by common sleeping positions. I have no personal experience with back pain like this, but I know exactly what this is like from trying to sleep with a shoulder injury.

Sleeping position is clearly a factor in some back pain. For most people, trying to work on sleeping position probably does not offer particularly good bang for buck. The most likely position to cause trouble is face down. I do not think that sleeping face down is a universally evil sleeping position — I am not on that bandwagon. But, based on years of anecdotal reports from clients and readers, I do think face-down sleeping does tend to bug lots of backs.

We can do a little to minimize the chances of an awkward position, mainly by starting out as comfortably as we can, and adding a little bracing with pillows to discourage too much rolling around.

Using a knee pillow is the best example of this: This reduces rotation in the spine, and rolling face down. Unfortunately, most people who toss and turn can make short work of any pillow arrangement in their sleep. Testing pillows is more feasible, but not much.

There is a bit of evidence that a new mattress can improve back pain. The difference was not dramatic, but worth noting, and undoubtedly worthwhile. Just like you need breaks from long stretches of sitting, you may need to take a break from sleeping. Or if you are sleeping, set an alarm! Or ignore your back and do something pleasant. If you were in an awkward position when the alarm went off, you may really be doing yourself a favour by interrupting it.

Few people have ever thought of trying this, let alone taken it seriously, or tried it consistently for a few nights. Stranger still, it may even be unhealthy as well as painful to try to sleep all the way through every night. But I think that author is indulging in a simplistic mind-body connection theory. This is one of the classic theories about why people seem to be more vulnerable to back pain in the morning.

Between every pair of vertebrae is a bit of padding, the infamous disc. They probably swell up a wee bit overnight. There are two studies that suggest this 26 27 although one of them was a study of long term bed rest, and only barely applicable here. A paper speculates that disc swelling is why astronauts probably suffer from more disc herniations than they should.

For all we know, problems with discs might be much more aggravated by postural stress … or it could be a complicated combination, such as swelling that is exaggerated by postural stress but still only hurting when other problems are present. A hot bath is one of the oldest medicines. While most people appreciate a nice hot bath, few people think of it as a serious treatment for back pain — just something that takes the edge off.

I am 73 with assorted age-related issues, but this low back pain every morning is new. Here is what I do: I run a hot bath, and jump in and immediately the pain goes away, all of it.

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Why would that be, and what does it mean? This may be more pronounced with some kinds of pain that are aggravated by gravity, so the partial floatation might be directly relieving. And then, by the time you get out of the bath, the relatively transient phenomenon of morning back pain is already retreating … and perhaps even faster because of some thermal effects getting the blood flowing, etc.

No one really knows! Believe or not, I actually have an entire, surprisingly large article about bathing tips. Tips for getting the most benefit from a hot soak, the oldest form of therapy. I am a science writer, former massage therapist, and I was the assistant editor at ScienceBasedMedicine. I have had my share of injuries and pain challenges as a runner and ultimate player. My wife and I live in downtown Vancouver, Canada.

Complete Guide to Low Back Pain ()

See my full bio and qualifications , or my blog, Writerly. You might run into me on Facebook or Twitter. Fifteen updates have been logged for this article since publication Like good footnotes, this sets PainScience.

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Although footnotes are more useful , the update logs are important. I log any change to articles that might be of interest to a keen reader. Complete update logging of all noteworthy improvements to all articles started in Prior to that, I only logged major updates for the most popular and controversial articles. November — Significant science update: October — New section: Miscellaneous improvements, mainly to the introduction and about fibromyalgia.

More information about the vulnerability of the paraspinals to trigger points. New image of a messy bed. Modernization of trigger point information as well.

Everything you ever wanted to know about back pain (but were afraid to ask)

Its absence in previous versions of the article was a major oversight. This study of triggers for episodes of back pain concluded that the "brief exposure to a range of physical and psychosocial factors," mainly being distracted during an activity and awkward postures, can "considerably increase the risk of an episode of acute back pain. Mornings were the most frequent time of day for back pain onset, with An MRI can also help diagnose this kind of inflammation. An excellent explanation for professionals of the changes in diagnostic criteria for fibromyalgia. Does it hurt to be heavy?

For instance, several other pain problems were also more likely: Clearly that typical assumption is not a safe one, and indeed the apparent connection between weight and pain weakened when the data were adjusted for common denominators like depression, a strongly confirmed risk factor for low back pain. In other words, if you factored out the depressed cases, the remaining subjects were not all that likely to have back pain.

Given such complexity, the researchers made it clear that more and different research is needed to figure out what, exactly, is causing what. The claim that large proportions of North American and other populations are deficient in vitamin D is based on misinterpretation and misapplication of the Institute of Medicine reference values for nutrients — misunderstandings that can adversely affect patient care. You probably do not know that nature has provided an automatic manipulator to correct most spinal and peripheral joint lesions in primates. In common with millions of other so called civilised people you suffer unnecessarily from musculoskeletal problems and are discouraged about how to treat the exponential rise in low back pain throughout the developed world.

All you have to do is sleep on the ground, and all your body pain will be solved!