This episode is entitled “Low back pain / sciatica worsens when we wake”, and you will learn the 3 main causes for this:

• Inflammation
• Position worsens low back pain / sciatica
• Disc swelling

and also:

• What to do if low back pain / sciatica worsens when you wake

Why is my pain worse when I wake up? People think we have pain receptors, but we don’t. We have nociceptors, little nerve endings distributed throughout your body. They detect noxious events like inflammation or extreme temperatures, and send a message into the central nervous system. Let’s focus on these nociceptors and the 3 things that can affect their activity.

Inflammation

Inflammation often builds up. When you sleep, you move every half hour or so, but you’re mostly still for prolonged periods of time. Nociception is aggravated or triggered by inflammation or anything that causes ongoing inflammation in your system. That inflammation will build up and you will be worse when you wake up. There are a bunch of inflammatory disorders that can cause low back pain / sciatica. The longer you stay still, the more the inflammation builds up. If there is an inflammatory component, you will experience more pain when you wake up. Don’t be terribly concerned about inflammation, but take some action.

Position worsens low back pain / sciatica

If you’ve been asleep, you’ve been in one position for a prolonged period of time, so you have exerted sustained load on a tissue. When you’re asleep, you will not perceive that nociceptive input consciously. If you get into a strange position, slightly twisted off to one side, over half an hour, an hour at a time, it leads to the sustained loading effect, which will cause the nociceptors to fire. That will lead you to have more pain, more nociceptive input, due to a prolonged position leading to more low back pain when you wake up.

Disc swelling

Disc problems can be successfully rehabilitated. Discs absorb fluid overnight. If you have a disc bulge in your low back, that disc is irritating the nerve of the spinal nerve that exits at that level, leading to sciatic pain. And if you have a sciatic radiation, the disc bulge is likely to be bigger when you wake up, because when you lie down for a prolonged period, the disc is decompressed and absorbs more fluid, swelling. This is only likely when it comes to sciatica. If you only have low back pain, and it’s worse in the morning, it’s not known how much of a factor disc swelling can be.

What to do if low back pain / sciatica worsens when you wake

If the first thing you do when you wake up is focus on the body part that usually hurts, you’re much more likely to notice pain. Try not to do this. Focus your attention on another body part, like your hands, and move them. Clench, open and feel them. Be aware of the fact that you can do that. Straighten and bend your elbows up and down. Roll your head from side to side. Focus on whichever parts of your body you can move without pain, and move them. Ignore your low back.

Incorporate some gratitude in a meditation. Feel grateful that you have these body parts and you can move them. Focus on feeling gratitude for that capacity, for the freedom to be able to do things, so that eventually, you’re thinking about how you’re going to get up out of that bed. Not focusing on your low back, but on what you can do. Practice abdominal bracing, tightening and releasing your abdominal muscles, greasing them up. Slowly move from bracing to gently rolling to one side. Brace and gradually move upwards, get yourself up from a lying down position and ultimately get up from sitting and stand fully erect.

That may seem like a very prolonged way of getting out of bed, but getting up from bed takes many people 15 to 30 minutes, because of their pain. Take the time to prepare yourself in a positive way, so that when you go to get up, you’re geared for ability and not for disability. Move all the different bits of your body that you can before even thinking about getting up, feel grateful for all the things that you can do and then lightly brace your abdominal muscles so that you can get up and be active for the day.