Lower back pain has a range of possible causes. It can flare up in different positions depending on the cause. Some people may have lower back pain, especially while lying down.

Lower back pain is very common. A person may get relief after shifting sleeping positions or stretching out the back. However, lower back pain may persist in some people.

Pain in the lower back when lying down can occur for various reasons, including a lumpy mattress, strained muscles, or conditions that require medical treatment, such as arthritis.

It is important to contact a healthcare professional if back pain worsens when lying down. It could indicate a more serious condition, even though strains and sprains are common causes of lower back pain.

This article explores the causes of lower back pain when lying down and how to manage them.

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Several conditions can cause lower back pain when lying down.

However, although a doctor may need to rule out underlying chronic conditions, around 90% of back pain results from a mechanical cause, such as an injury while lifting at work or overstretching during exercise.

Muscle strains or sprains

Muscle strains or sprains are known as mechanical injuries. They involve direct damage or injury of the spine or muscles around the lower back.

Strains or sprains of the lower back are the most common causes of lower back pain. The lower back supports the weight of the upper body. It plays a key role in twisting and moving, making it particularly prone to strains and sprains.

Strains involve excessive stretching or tearing of muscle fibers. Sprains occur when ligaments are overstretched or tear from their attachments. Both injuries can lead to muscle spasms and discomfort, whether at rest or moving.

Learn more about the difference between sprains and strains.

Ankylosing spondylitis

Ankylosing spondylitis (AS) is a form of arthritis that develops in the back. It usually starts in the joints where the lower back meets the hips.

AS can cause stiffness and back pain after periods of inactivity. People with AS often wake up at night due to pain while lying down.

Most people begin to experience symptoms of AS before age 45. However, it can also develop in childhood or adolescence.

AS can develop from the immune system attacking healthy joints and ligament tissues in the spine.

Learn more about ankylosing spondylitis.

Spinal stenosis

Spinal stenosis involves the narrowing of the spaces between vertebrae (disks) of the spine. It is the most common cause of spinal surgery in people ages 65 years and over.

Being in a position that involves extending the spine, such as lying down, can worsen symptoms in some people.

Learn more about spinal stenosis.

Spinal tumors

There are several types of spinal tumors. Not all are cancerous.

Cancerous spinal tumors can develop in the spine or spread there from other parts of the body. However, some may be noncancerous. Regardless of the type, growths in the spine can cause lower back pain while lying down.

Learn more about spinal tumors.

Other conditions that cause lower back pain

Some other conditions that can cause lower back pain include:

However, the pain may not always worsen when lying down.

Treatment varies depending on the condition causing lower back pain when lying down.

Treatment for muscle strains and sprains

A few home remedies can help relieve back pain and provide temporary comfort. Muscle strains and sprains tend to self-repair over time.

Home remedies for muscle strains and sprains might include:

  • Cold and heat therapy: Applying cold compresses may help numb pain in the area. Applying a heated pad or hot-water bottle might improve blood flow to the area, supporting the healing process. Heat therapy may not be helpful after the first week.
  • Staying mobile and limiting bed rest: If it also hurts to stand or sit, bed rest might be helpful. Ideally, though, moving around can help prevent muscle stiffness.
  • Being as active as possible: Exercise can help the healing process and improve function. A qualified healthcare professional, such as a physical therapist, can provide the best exercises for back pain. Movement and stretching practices, such as yoga and tai chi, are gentle while stretching the back muscles.

Complementary treatments might help with lower back strains and sprains, such as:

  • acupuncture
  • chiropractic spinal manipulation
  • therapeutic massage

Treatments for AS

AS is an inflammatory condition. Treatment aims to manage pain and reduce inflammation.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are available over the counter to reduce pain and swelling. In some cases, a doctor may prescribe stronger NSAIDs.

Other medications that may help manage AS symptoms include:

  • Biologic medications: These medications work by targeting certain immune system messages and interrupting the signals. This can help stop or reduce inflammation.
  • Corticosteroids: These are typically injected into the affected joint. Corticosteroids can help reduce inflammation and provide some relief from pain.
  • Janus kinase (JAK) inhibitors: These medications are generally only prescribed if other treatments are not effective. They send messages to certain cells to stop inflammation from inside the cells.

Physical therapy can also help improve core strength, relieve pain, and maintain flexibility. A physical therapist may also recommend the best sleeping positions. Surgery may be necessary to repair or replace joints in certain cases.

Treatment for spinal stenosis

Doctors generally first treat spinal stenosis with nonsurgical measures, including:

  • NSAIDs and other pain relief medications
  • physical therapy
  • a brace to provide support and improve mobility

Depending on pain level, other health conditions, the level of relief from nonsurgical treatment, and overall health, a doctor may recommend surgery to reduce spinal cord and nerve pressure.

Treating spinal tumors

Imaging scans and a biopsy may be necessary to determine the type of tumor. Treatment may then involve a combination of:

  • chemotherapy
  • radiation therapy
  • surgery to remove the tumor

A team of spinal surgeons, oncologists, and other specialists can recommend the best course of treatment.

Lower back pain when lying down can be uncomfortable and interfere with sleep. It can be tempting to self-manage back pain.

However, if back pain is at its worst when lying down, it is important to speak with a doctor. They can rule out more serious spinal problems.

Other symptoms can point to severe infections or tumors that require urgent attention if they occur along with lower back pain, such as:

  • fever
  • unexplained weight loss
  • a loss of bowel or bladder control

Lower back pain when lying down can occur due to sprains and strains or more systemic conditions, such as ankylosing spondylitis. It can also be due to spinal stenosis or spinal tumors.

Many treatments are available to make lower back pain more comfortable or treat underlying conditions. It is important to speak with a doctor if back pain worsens in a particular position or when lying down.