Struggling with back pain at night? Here's what could be causing it, plus how to treat it

Suffering from back pain at night? You're not alone. Eight out of ten people suffer from back pain at some point in their life, and for many, it can become more obvious when they lie down in bed at night. 

While taking pain medication might help ease tension, it’s important to establish the root cause of your pain so you can take the right steps toward treatment. There are many simple explanations for back pain, and treatment could be as easy as investing in the best pillow and mattress (see our guide to the best pillows for back pain) or introducing some gentle movement into your routine such as bedtime yoga.  

With the help of our experts, it's time to stop suffering in silence and get to know what's causing your back pain, and how you can prevent it. 

What causes back pain?

There are a number of possible causes of back pain generally, but the most common causes include: 

1. Inactivity 
2. Injury 
3. Medical conditions  

1. Inactivity

Chronic back pain is often caused by an inactive lifestyle, and moving a little bit more each day could help relieve back pain at night. Research published by the American physiological society even shows our ancestors were much more active than we are now, as they moved in search of food and shelter with limited time to rest. As we moved from hunter-gatherer to a more industrialized society, our bodies haven’t caught up to our more sedentary lifestyle and in comparison, we spend more time sitting, lying, and relaxing than ever before. 

“Our backs are designed to move, and when they are in a position for long periods, this can result in pain,” says Hollie Maskell, physiotherapist and fitness expert for Meglio.

It should come as no surprise that NIAMS finds obesity and low physical activity as high-risk factors for back pain. And, as Maskell points out, long days in front of the computer or at a desk can contribute to back pain at night.  

2. Injury

In other cases, back pain can be caused by injuries—such as a slipped disk, broken bone, or sprain. Injuries can be caused by anything from lifting a heavy box incorrectly, to performing weight lifting exercises with incorrect form.  

If you think this might be the reason you're in pain, you should seek medical attention immediately.

3. Medical conditions

It's also possible that back pain is down to other medical conditions. "Back pain can also be caused by inflammatory disorders such as ankylosing spondylitis or arthritis which can flare at night when the body is at rest," explains Juliet Slade. "Once diagnosed, medication can be prescribed for this to help minimize symptoms."

Pregnancy, endometriosis and PMDD can also cause lower back pain. If you think this is the cause, speak with your doctor for medical advice. 

Why do you feel more back pain at night? 

"As our lifestyles become more sedentary with desk jobs limiting our daily step count, our backs become stiff and our bodies generally decondition. Therefore, when we try to rest at night our bodies find it hard to relax into a soft mattress," explains Slade. 

It's also possible we experience stress to our back throughout the day, but only notice it when we lie down at night. In these moments, you might feel the effects of bad posture sitting in one place. 

“People might have the back pain throughout the whole day, but they just don't happen to realize it until night when everything is quiet, and they don't have anything else to focus on except themselves,” says Jasmine Marcus, a physical therapist and certified strength and conditioning specialist.

If you're concerned about your back pain and are unsure what is causing it, it’s important you speak with your doctor to rule out any underlying health conditions.

How to treat back pain at night

Knowing what triggers back pain at night is half the battle, the other is treatment and prevention. 

How to treat it

• Use home remedies—when back pain strikes at night, there are steps you can take to relieve the pressure. Slade suggests anti-inflammatory pain medication or a heat pack to encourage stiff muscles to relax (a hot water bottle can be used as a substitute here, and make sure to follow the instruction of both heat packs and hot water bottles, using them only for the suggested period of time).
• Change up your sleeping position—investing in a pillow and mattress that supports your sleeping position is a must if you suffer from back pain. A physiotherapist can help you determine what's causing your back pain, and recommend the best type of pillow or mattress for you. During the night, Juliet suggests, "avoid sleeping on your front and try using pillows between or under knees or back to help relieve pressure." 
• Practice gentle stretches—you don't have to do a full yoga routine at 2 am, but try getting out of bed and stretching your body, focusing on positions that take the pressure off your back such as child's pose, cat-cow, and seated twists. See our guide to yoga for back pain for more tips. 

How to prevent it

• Walk more—movement is key when it comes to relieving back pain and preventing it. When back pain strikes at night, take a few minutes to move, stretch and massage to relieve tension. In an effort to prevent pain, Slade advises aiming to hit the World Health Organisation's daily goal of 10,000 steps. 
• Try different exercises—adding low impact, strengthening exercises into your fitness regime will strengthen your muscles and keep your bones strong, which is particularly important to combat the natural loss of bone density as we age. "Exercises that involve upright postures are great for taking pressure off the back," says Slade. She suggests swimming or Pilates three times a week (see our guide to Pilates for beginners to get you started). 
• Take breaks—if you're often desk-bound, taking regular breaks can make a huge difference to your back pain at night. "When you work, you should try to take a break every half hour. When you do, get up, move around and change positions,” advises Marcus.
• Have an ergonomic assessment—ask your employer for an assessment of your work set up to determine if this is contributing to your back pain, and find out what other options are available. "Many people sit poorly at work, either due to weakness in postural muscles or poor set-up that encourages further stiffness and puts pressure on the spin," says Slade. "Simple changes to chair, desk, and screen positions can make a huge difference in comfort levels." 

When you should see a doctor about back pain at night

While it’s common to experience back pain every now and again, it should not affect your daily life and interfere with your everyday routine. 

“If you're finding that you can't sit at work, aren’t able to ride a bike as you normally would, or the pain is changing the way you live your life, I would say that's a good point to go see a medical professional for further advice,” says Marcus.

Listening to your body is the best tell-tale sign of when to see a doctor. If you feel abnormally high pain and don’t know what’s causing it—your body is sending you a signal to seek further advice. 

w&h thanks Hollie Maskell, physiotherapist and fitness expert for Meglio, Juliet Slade, consultant physiotherapist and clinical Pilates instructor specializing in injury rehabilitation and prevention, and Jasmine Marcus, a physical therapist and certified strength and conditioning specialist.