Morning Backaches Part 2: Is It My Bed or Is It My Body?

Many of our patients at our clinic experience back and/or neck pain that is much worse in the morning upon arising from bed. This is a symptom that can be related to many different contributing factors, some of these are addressed below.

In order to discuss the varying factors involved in morning back or neck aches we will need to break down them down into these categories:

• The bed you sleep in
• The position(s) you sleep in
• The pillow you use
• Possible underlying mechanical back issues that need to be addressed

1. The Bed

During the years in which I’ve been practicing chiropractic, this is one of the most frequently asked questions that I’ve heard: “What bed should I be sleeping in?”

This question is also difficult to answer because, “one size does not fit all.” In other words, everyone has their own preferences in terms of the firmness, the temperature of the mattress, what type of material that they prefer the mattress be made of, how long is this mattress going to last, and also the price of the bed. Since we spend nearly 1/3 of any 24hr. period of time in bed it is important for us to sleep in a bed that gives our spine the support and the comfort it needs in order to recover from a day of physical and emotional stress. If we are frequently awakened during the night due to discomfort produced by a poor mattress, we become exhausted and increasingly suffer from “back fatigue”.

Below are some bed tips to be aware of when considering your mattress:

• Age of the mattress. Unfortunately, mattresses are made from materials that do eventually break down. Most chiropractors agree that you are doing well to get 7 years out of a mattress.

• Type of bed (mattress).“The better the quality of materials used in your mattress, the more support it will give and the longer it will last.” (1)In a conventional mattress, the greater number of innersprings will provide better comfort because these smaller springs will conform better to your shape. If the springs are bigger and firmer, they are unable to conform to your body type as well. Larger individuals also have to consider other factors in picking a mattress such as weight limits, edge support and the density of foam used in the mattress.

Foam, including memory foam, has improved in recent years, but it still tends to break down fairly quickly. There are now numerous types of foam combined into one mattress that has improved the longevity as well as “cooled” the mattress down so that it doesn’t sleep so hot. These are undoubtedly improvements, and I’m sure there will be many more innovative uses coming in the future concerning the many types of foam that can be used in mattresses.

Air bladders have one distinct advantage over the conventional mattress: sleep partners can utilize a different firmness setting for their particular side of the bed. Obviously, if sleep partners have significantly different body types and different weights this ability to “customized” the amount of air pressure in each bladder could be an important step in getting better sleep comfort. However, what advantage the air bladders have in the ability to customize comfort, they may lack in their ability to be supportive. Many users tend to be more interested in comfort than support. For this reason, air bed users can also complain of backaches especially if they do not have enough support from the amount of air pressure that they “like” in the mattress.

Water beds are not nearly as popular as in years past, but now and then we will have someone in the office who still prefers a baffled water bed over any other mattress. While discussing this with them further, the main reason most people who still use waterbeds prefer them is because of the heating element that warms up the water in the mattress making it more pleasant as you climb into bed. It’s important to note that, although the heated waterbed may be comfortable, water is not very supportive.

2. Sleep Positions

Sometimes it’s not the bed that is giving you morning back or neck aches. The positions that you spend most of your sleep time in may be creating a situation where your back or neck muscles may not be able to relax during the night. Often, we will see people in our clinic with severe back or neck pain that were pain-free the night before they went to bed. This can be a sign that sleep position may be a problem. Below are some helpful tips to remember when sleeping:

• Never sleep on your stomach. The lower back receives no support when we are on our stomach forcing the low back muscles to maintain a state of contraction in order to keep the lumbar spine from “sagging” into the organs during the night. Also, when stomach sleeping, the neck muscles become imbalanced for long periods of time due to the fact that we have to turn our heads to breath. These are the main reasons we try to get our patients to break the stomach sleeping habit.
• Try to sleep on your back. Research has found that this is the most stress-free sleep position for your back. Keep the arms down – do not extend them over your head. The main concern is to keep your pelvis and low back aligned when sleeping.
• Sometimes, especially if snoring is a problem, side-sleeping is a good alternative to back-sleeping as long as you use a thin pillow between the knees. This aids in keeping the spine and pelvis from twisting.
• Also, when back-sleeping, you can put a pillow under the legs or behind the knees to take some of the pressure off of the low back if you are experiencing some low back pain at night.

3. Pillow

• Try to use a pillow that maintains your head and neck at the same level as the mid back. In other words, height of the pillow really matters, especially while side-sleeping. A sign that your pillow is too short is if you find yourself placing your arm under your head or under your pillow when you sleep on your side in order to prop the head up. This will create imbalance of the neck muscles.
• When back-sleeping, I recommend using a contoured pillow with support for the neck as the head rests in a hollowed-out area in the center of the pillow. This pillow aids in supporting the neck posture curve as you sleep when on the back. This type of pillow is not needed if you spend most or your time on your side when sleeping.

4. Mechanical problems in the back or neck producing symptoms that can be worse in the morning

• Spinal alignment problems can be one of those conditions that seem to be more painful in the early morning when you assume weight bearing. If this persists more than one or two weeks, it is recommended that you see a chiropractor or physical therapist in order to check out the function and alignment of the spine and pelvis. When there is a problem in this area, many times the pain is non-existent or very mild during the daylight hours after you’ve loosened up, but then can become very debilitating in the mornings.
• Many types of arthritis can be much worse in the mornings than at any other time of the day. If these symptoms persist then x-rays can reveal the type and severity of the arthritis in many cases.
• Overuse or misuse injuries can become more painful in the mornings, especially the morning after the event that created the problem. In this case we will have the patient utilize short bouts of ice or heat in order to reduce inflammation and/or relax muscles for a couple of days. If this pain persists then there is a need to examine further.

A good night’s sleep is extremely important in order for us to restore and rejuvenate our bodies during the night so that we wake up refreshed and ready to tackle the day ahead. I hope the information above will be useful for you who have trouble with morning soreness. If you continue to have persistent morning back or neck aches, we recommend that you come in and talk to us about what could be the potential causes of this pain. We would be happy to help you explore the potential causes and the solutions for your morning backaches.