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Why Does My Back Hurt When I Lie Down? Common Causes and When to See a Doctor
Short answer: Back pain when you lie down has many possible causes. Often it is linked to the muscles, to a position that strains your back, or to a mattress that does not suit you. But it can also come from a disc, an irritated nerve, narrowing of the spinal canal, or inflammation of the spine. Only a doctor who examines you can say which. Pain that wakes you at night, does not ease with rest, or comes with warning signs such as weakness in the legs, fever or changes in bladder or bowel control should be checked promptly.
Key takeaways
- The pattern of your pain, meaning when it starts, what eases it and what makes it worse, gives your doctor clues about the cause.
- Position, pillows and mattress can make a difference for some people, and are worth trying.
- Pain that is worse after rest and at night, and better once you move around, can be a sign of an inflammatory condition and is worth raising with a doctor.
- Staying gently active is usually advised. Long bed rest is not [1].
- Some symptoms need urgent care. See the warning signs below.
Why can lying down make back pain worse?
There is no single reason. Some people notice pain as soon as they lie down, others wake in the night, and some feel it only in one position. The pattern is useful because different causes tend to behave differently. The sections below describe the most common ones. They overlap, and many people have more than one.
Common causes of back pain when lying down
Muscle strain, stiffness and the way you lie
Muscles that are strained or tight after a day of work, lifting or sitting can ache when you lie still. Your position matters too. NHS hospital leaflets suggest lying on your back with a pillow or two under your knees, or on your side with a pillow between your knees, and say that a rolled-up towel at the waist helps some people [2][3].
A mattress that does not suit you
A mattress can contribute to back pain, although the research is limited. In a 2003 trial published in The Lancet, adults with long-lasting, non-specific low back pain who were given a medium-firm mattress did better than those given a firm one [4]. If your mattress sags or feels very hard or very soft, it may be worth changing. You can also read our guide to sleeping positions for lower back pain.
A disc problem or an irritated nerve (sciatica)
A bulging or herniated disc, or wear-and-tear changes in the spine (spondylosis), can press on or irritate a nerve. This can cause pain that travels from the back down the leg, sometimes with tingling or numbness [1]. If this sounds like you, see our pages on L4-L5 disc bulge and lumbar spondylosis.
Narrowing of the spinal canal (spinal stenosis)
In lumbar spinal stenosis, the space for the nerves in the lower spine is narrowed. The typical pattern is back and leg symptoms such as pain, heaviness, numbness or weakness that come on with standing or walking and ease when you sit or bend forward [7][8]. Some people also find a curled-up side position more comfortable [9]. NHS hospital leaflets say stenosis is not usually serious or an emergency, but that new weakness, numbness or bladder or bowel changes need urgent attention [7].
Inflammatory back pain
Some back pain is caused by inflammation, for example in axial spondyloarthritis, which includes ankylosing spondylitis. It behaves differently from the pain of a strained muscle. The NHS describes pain that gets better with exercise but not with rest, and that is worse in the morning and at night, sometimes waking you [5]. A patient charity adds that it usually starts slowly, often before the age of 40, and lasts at least three months [6]. If your pain fits this pattern, ask a doctor about it.
Less common causes
Serious causes of back pain, such as a fracture, pressure on the spinal cord or nerves, infection or problems with the blood vessels, are uncommon [1]. They are the reason doctors ask about the warning signs in the section below.
What your pattern may suggest
What you notice | What it may point to |
Pain that eases when you change position, and that is linked to a day of activity or to your mattress | A muscle, joint or position problem |
Pain going down one leg, with tingling or numbness | An irritated nerve, for example from a disc [1] |
Leg pain or heaviness when standing or walking that eases when you sit or bend forward | Spinal stenosis [7][8] |
Pain that is worse after rest and at night, eases once you move, and began slowly | Inflammatory back pain [5][6] |
Constant pain that does not ease with rest, or that wakes you, or comes with fever, weight loss or leg weakness | Something to have checked soon [10] |
This table is only a guide. It cannot diagnose you, and the patterns overlap.
What may help
These are general measures. If your pain is severe, getting worse or worrying you, see a doctor.
- Try a different position. Lie on your back with a pillow or two under your knees, or on your side with a pillow between your knees [2][3].
- Get in and out of bed carefully. Roll onto your side, bend your knees, drop your feet over the edge and push up with your arms [14].
- Stay gently active in the day. Long bed rest may make symptoms worse [1].
- Look at your mattress and pillows. A mattress that sags or no longer supports you may be worth replacing [4].
- Keep a short pain diary. Note when the pain starts, what eases or worsens it and any other symptoms. It helps your doctor.
- Ask a pharmacist or doctor about pain relief. Do not take painkillers regularly for a long time without advice.
When to see a doctor
Go to a hospital emergency department now if back pain comes with any of the following:
- new difficulty controlling your bladder or bowels, or difficulty passing urine;
- numbness or tingling around your genitals, buttocks or inner thighs;
- weakness, numbness or tingling in both legs, or difficulty walking;
- chest pain or breathlessness;
- a serious accident or fall.
These signs are described in more detail in our guide to back pain red flags [10][11].
See a doctor soon if:
- pain wakes you at night or is constant and does not ease when you lie down [10];
- you have a fever, unexplained weight loss or feel generally unwell [10];
- pain began after a fall or injury [10];
- pain, numbness or weakness in a leg is getting worse [10];
- the pain is getting worse or has not improved after about six weeks [12].
You do not need to have one of these symptoms to see a doctor. If something feels wrong to you, get it checked. You can also read our page on which doctor to consult for lower back pain.
Frequently Asked Questions
Why does my back hurt when I lay down? There are many possible causes, including strained muscles, your position, your mattress, a disc or nerve problem, narrowing of the spinal canal, and inflammation of the spine. The pattern of your pain gives clues, and a doctor can examine you to find the cause.
Why does my back hurt more at night? Possible reasons include your position and mattress, and spine conditions such as nerve irritation. Pain that is worse in the morning and at night and eases with movement can be a sign of inflammatory back pain [5]. If pain wakes you regularly, have it checked.
Why does my lower back hurt when I lie on my back? This can relate to your position or mattress, or to a spine condition. Some people are more comfortable with a pillow or two under the knees [2][3]. If the pain persists, see a doctor.
Why does my middle or upper back hurt when I lie down? There are many possible causes, and a doctor needs to examine you. The warning signs that apply to the lower back also apply to the middle of the back, including weakness or numbness in both legs, difficulty walking, numbness around the genitals or buttocks, and bladder or bowel problems [13]. Back pain with chest pain or breathlessness needs urgent medical attention [11].
What is the best position to lie in with back pain? There is no single best position for everyone. NHS hospital leaflets suggest lying on your back with pillows under your knees, or on your side with a pillow between your knees [2][3]. If a position makes your pain or leg symptoms worse, change it.
Should I lie down all day if my back hurts? Long periods of bed rest are not recommended and may make symptoms worse [1]. Short rests are fine. Gentle activity is usually advised unless a doctor tells you otherwise.
How The Spine Foundation can help
If your back pain keeps returning, wakes you at night or comes with leg symptoms, a proper assessment can help. The Spine Foundation provides spine care and runs camps across India. Find a spine care centre near you or contact our team to ask about upcoming camps.
Our camps are not an emergency service. If you have any of the emergency signs listed above, go to the nearest hospital emergency department now.
This article is for general information only and is not a substitute for medical advice, diagnosis or treatment. Always speak to a qualified doctor about your own condition.
Lower back pain is grouped by duration (acute, subacute, chronic) and by source (mechanical, nerve-related, referred, degenerative, stenosis-related, inflammatory).
A dull ache that eases with rest is usually mechanical. Sharp pain that travels down the leg is usually nerve-related.
Pain relieved by sitting or leaning forward can point to stenosis, and morning stiffness that eases with movement can point to degenerative or inflammatory causes.
Most acute pain improves with gentle activity, but leg weakness, numbness or loss of bladder or bowel control is an emergency.
References
- Sikina M, Kiel J. Re-evaluating red flags for back pain. American College of Emergency Physicians, Sports Medicine Section; August 2022. acep.org
- Sherwood Forest Hospitals NHS Foundation Trust. Managing back pain (patient information). sfh-tr.nhs.uk (PDF)
- Oxford University Hospitals NHS Foundation Trust. Back pain (patient information). ouh.nhs.uk (PDF)
- Kovacs FM, Abraira V, Pena A, et al. Effect of firmness of mattress on chronic non-specific low-back pain: randomised, double-blind, controlled, multicentre trial. The Lancet. 2003;362(9396):1599-1604. PubMed
- NHS. Ankylosing spondylitis: symptoms. nhs.uk
- National Axial Spondyloarthritis Society (NASS). Patient information. nass.co.uk (PDF)
- Sherwood Forest Hospitals NHS Foundation Trust. Lumbar spine stenosis (patient information). sfh-tr.nhs.uk
- South Tees Hospitals NHS Foundation Trust. Ten lumbar spinal stenosis facts. southtees.nhs.uk
- Baylor Scott & White Health. Back pain: is your mattress to blame? bswhealth.com
- Gloucestershire Hospitals NHS Foundation Trust. Red flags in back pain. gloshospitals.org.uk
- NHS. Check if this is the right service for you (back and joint problems). nhs.uk
- CISSS de la Côte-Nord (Québec). Back pain: health fact sheet. cisss-cotenord.gouv.qc.ca (PDF)
- Berkshire Healthcare NHS Foundation Trust. Mid-back pain. berkshirehealthcare.nhs.uk
- PeaceHealth. Sleeping with back pain. peacehealth.org
