Back pain and stiffness in the morning is a common complaint I see in my practice, most people will state they wake up with pain and stiffness, get moving and have a hot shower then it will subside and then by the end of the day the pain and stiffness will return, it may also be the case it specifically is only felt for the first 30-60 minutes then completely fine for the rest of the day until the next morning. There are two main reasons why back pain first thing in the morning occurs, a more serious but less common cause and a less serious but much more common cause.
Serious But Less Common Cause
Inflammatory back pain (IBP) which is usually a result of auto-immune arthritis (not to be confused with osteo-arthritis) such as rheumatoid arthritis can include symptom of morning back pain and stiffness. This type of pain will usually wake the person up rather than feeling pain and stiffness once you are up and moving. The reason why pain is felt in the morning is not very clear but may have something to do with the body’s natural inflammatory circadian rhythm.
Other indications of IBP include more widespread pain in other joints such as hands, wrist feet, a family history of auto-immune arthritis, a recent infection and respond well to anti-inflammatories. Imaging such as x-rays, MRI and blood tests are required to confirm.
Not Serious but Much More Common
Myofascial or muscle pain is by far the most common reason for morning back pain and stiffness. It is usually a result of deep tightness and trigger points that run a good portion of the lower and lower mid back namely the erector spinae muscles. Typically the is no pain until you actually get up and start moving and putting on your shoe’s and socks can be a chore and it usually settles down fairly quickly, especially after having a hot shower as this increases blood circulation which allows the muscles to relax. Typically the trigger points are still there so as the muscles are being used throughout the day they can fatigue and tire quicker and the stiffness and tension will return later in the day.
I have treated hundreds of these over the years and assuming it hasn’t become too chronic or the muscles are not too deconditioned it is a very easy fix and usually only takes a couple of sessions. As the trigger points can be quite deep in the muscles a strong, deep tissue massage to the erector spinae muscles is what is usually required. Also doing self treatment/trigger point release using a tennis or lacrosse ball will greatly speed up the process and make sure it doesn’t come back anytime soon.
