Back pain....after lying down.

[JumboBeef]

My OH gets very bad lower back pain first thing in the morning. She cannot bend without pain. Once up and about for an hour or two it eases off. She is 45 and walks/swims without issue.

Any ideas please?

[Escort2dr]

I have something similar and put it down to a change of matress, not for the better.

[drdc1971]

Hi. Obviously lots of possibilities but if she is better with activity and worse with rest then it could be inflammatory back pain (IBP) and related to a spondyloarthropathy. The most common of these would be Ankylosing Spondylitis (AS). It is more common in men but does occur in women when it often presents a bit later (in men it usually presents in the mid-twenties).
Response to non-steroidal anti-inflammatories (eg Ibuprofen) can be helpful to assess the chance of IBP so if she has previously been OK with Ibuprofen it is worth trying to see if it shortens her symptoms in the am. If Ibuprofen makes a big difference it would be worth seeing her GP for a better NSAID and to consider referral to a rheumatologist. The Arthritis Research website has some useful info (http://www.arthritisresearchuk.org/) HTH. David

[douglasr]

This happened to me for 3-4 weeks, then it disappeared and my back "went". I had a prolapsed disk. I'm not saying this is what's happened, but get her to go to her GP - most just prescribe some medication, but ger her to try and get an appointment with a physio / orthopeadic surgeon.

If you have access to private cover through work, then use it, it will save you weeks/months.

[JumboBeef]

Thanks. It is a worry.

She is seeing her GP next week.

[goldblum]

Sounds muscle related.Change the mattress,but watch out - it can be an expensive business!

[E21_Ross]

drdc1971 said:

Hi. Obviously lots of possibilities but if she is better with activity and worse with rest then it could be inflammatory back pain (IBP) and related to a spondyloarthropathy. The most common of these would be Ankylosing Spondylitis (AS). It is more common in men but does occur in women when it often presents a bit later (in men it usually presents in the mid-twenties).
Response to non-steroidal anti-inflammatories (eg Ibuprofen) can be helpful to assess the chance of IBP so if she has previously been OK with Ibuprofen it is worth trying to see if it shortens her symptoms in the am. If Ibuprofen makes a big difference it would be worth seeing her GP for a better NSAID and to consider referral to a rheumatologist. The Arthritis Research website has some useful info (http://www.arthritisresearchuk.org/) HTH. David

not in that age group for a female it's not. more likely from purely an inflammatory arthropathy point of view is probably osteitis condensans ilii, which can have very similar symptoms, but even then, onset of that past 40 is quite rare, ever rarer for AS.

goldblum said:

Sounds muscle related.Change the mattress,but watch out - it can be an expensive business!

wouldn't jump to that just yet. we don't know enough about the history, she may have only been having it for the last 2 weeks for all we know, yet the mattress may only be 3 years old and it's never caused her any problems.... the OP (presumably!) sleeps on the same mattress too, is he ok? has she recently changed activity levels (how long has she been walking swimming), had previous back injuries? how long has the pain been coming, is it only in the mornings, what does she do for a living etc etc.

if i were OP i'd be looking to see chiro/physio/osteo before the GP.

Edited by E21_Ross on Wednesday 8th December 11:09

[JumboBeef]

Thanks for the reply.

The mattress is a good one, albeit about 5 years old. I sleep on it without issues: more importantly, when we stay away, she still gets the pain.

It is worse first thing in the morning and lasts for maybe an hour or two. She has had the pain for maybe a year, but it has been a gradual thing, going from a little bit of stiffness back then to bad pain now. No old back injuries.

She spends a few hours at her desk each day, walks the dogs twice a day and is out and about a lot. The only time she gets pain is after sleeping or if she has to stand around for a long time (like waiting for a train a few weeks ago, after 20 minutes she was suffering).

Edited by JumboBeef on Wednesday 8th December 12:44

[goldblum]

Whether YOU sleep on the mattress without issues or not is irrelevant.

The fact that when you are away her back is still painful upon rising STILL suggests a position related problem.

Some mattresses last for years,some for weeks.I know of one person who changed mattresses 4 times before her backpain eased

and the process took 2 years.

Does your OH stretch? A lot of lower back pain can be caused by tight hamstrings..

Of course I may be barking up the wrong tree on both counts! Good luck sorting it out.

Edited by goldblum on Wednesday 8th December 14:19

Edited by goldblum on Wednesday 8th December 14:20

[DownUnder.]

You sure you haven't left the t.v. remote under her back?

[CatherineJ]

I have suffered similar symptoms in the past, indeed i've had it this morning but i'm putting it down to the flu bug I currently have as i'm aching all over.

In my case I moved over to a memory foam mattress and it seamed to help. I was told by the doctor to sleep in the foetal position as it opens up the discs.

[Bill]

The chances are she strained something minor that hasn't fully recovered and seizes up with immobility over night.

Go see a physio etc.

[duchess]

i suspect you need to change your bed..it worked for me

[996 sps]

Some of the reason behind this is the intervertebral discs are mainly formed from water and protein (they have 2 portions but not relevant). As you sleep they hydrate with the water content hence you are at your tallest first thing in the morning.

As you become mobile the discs lessen in thickness as compression from gravity and body weight is placed on the discs.

This can contribute if there is a muscle or skeletal problem. Hydro as you mentioned is a great mobility relief.

Edited to add this could be some of the problem not is the problem and your wife should see a good physio.

Edited by 996 sps on Thursday 9th December 21:40

[TheFlatSixer]

Could be rheumatoid arthritis, which is generally worse in the morning.

Do NOT go near osteo/chiro etc without a diagnosis, this is utter madness.

This should be investigated straight away.

[E21_Ross]

TheFlatSixer said:

Could be rheumatoid arthritis, which is generally worse in the morning.

Do NOT go near osteo/chiro etc without a diagnosis, this is utter madness.

This should be investigated straight away.

although RA rare affects the SI joints, it does not affect the lumbar spine so is extremely rarely a cause of low back pain, particlarly with no wrist/hand pain preceding it. therefore, RA must be extremely low on the list of differential diagnoses for this. so it's rather absurd to suggest that IMO.

[missdiane]

This happens to me when I go through stages of a bad back, just getting over another spell now and it's still very stiff in the morning and when I am driving- as soon as I start work it works itself loose and I am fine by mid morning
if previous problems have been anything to go by I will be stiff in the morning for a few more weeks then it will start to get better
We have changed the mattress before and it made no difference
Position is a big thing for me, if I lay on my front or back for too long then I suffer more, if on side it is much better, but I have no control over how I turn when I am asleep, so not sure how to fix it

[TheFlatSixer]

E21_Ross said:

TheFlatSixer said:

Could be rheumatoid arthritis, which is generally worse in the morning.

Do NOT go near osteo/chiro etc without a diagnosis, this is utter madness.

This should be investigated straight away.

although RA rare affects the SI joints, it does not affect the lumbar spine so is extremely rarely a cause of low back pain, particlarly with no wrist/hand pain preceding it. therefore, RA must be extremely low on the list of differential diagnoses for this. so it's rather absurd to suggest that IMO.

Bullst. Firstly, RA does not necessarily just affect SI joints. Further, SI joint pain can cause referred pain in the lumbar spine. Secondly, Arthritis in it's many variants can affect any spinal segment, independently of wrist/hand pain or sequence of joints affected. Incidentally, you assumed wrist/hand pain is not a feature in this case, but did not conduct any fact finding. Ask, don't assume.

Rheumatoid arthritis typically manifests with signs of inflammation, with the affected joints being painful and stiff, particularly early in the morning on waking or following prolonged inactivity. Increased stiffness early in the morning is often a prominent feature of the disease and typically lasts for more than an hour. Gentle movements may relieve symptoms in early stages of the disease. These signs help distinguish rheumatoid from non-inflammatory problems of the joints, often referred to as osteoarthritis or "wear-and-tear" arthritis. In arthritis of non-inflammatory causes, signs of inflammation and early morning stiffness are less prominent with stiffness typically less than 1 hour, and movements induce pain caused by mechanical arthritis. In RA, the joints are often affected in a fairly symmetrical fashion, although this is not specific, and the initial presentation may be asymmetrical. Where a spinal joint is affected is not necessarily where a patient will complain of pain.

Contrary to your assertion of "absurd" differential diagnosis, whilst reactive or osteo arthritis are also possibilities, early morning stiffness is a hallmark feature of RA and is one of the key diagnostic differentiators.

New onset back pain in a lady of this age warrants investigation, therefore your suggestion of seeing osteo/chiro before a GP is simply ludicrous nonsense.

[E21_Ross]

TheFlatSixer said:

E21_Ross said:

TheFlatSixer said:

Could be rheumatoid arthritis, which is generally worse in the morning.

Do NOT go near osteo/chiro etc without a diagnosis, this is utter madness.

This should be investigated straight away.

although RA rare affects the SI joints, it does not affect the lumbar spine so is extremely rarely a cause of low back pain, particlarly with no wrist/hand pain preceding it. therefore, RA must be extremely low on the list of differential diagnoses for this. so it's rather absurd to suggest that IMO.

Bullst. Firstly, RA does not necessarily just affect SI joints. Further, SI joint pain can cause referred pain in the lumbar spine. Secondly, Arthritis in it's many variants can affect any spinal segment, independently of wrist/hand pain or sequence of joints affected. Incidentally, you assumed wrist/hand pain is not a feature in this case, but did not conduct any fact finding. Ask, don't assume.

Rheumatoid arthritis typically manifests with signs of inflammation, with the affected joints being painful and stiff, particularly early in the morning on waking or following prolonged inactivity. Increased stiffness early in the morning is often a prominent feature of the disease and typically lasts for more than an hour. Gentle movements may relieve symptoms in early stages of the disease. These signs help distinguish rheumatoid from non-inflammatory problems of the joints, often referred to as osteoarthritis or "wear-and-tear" arthritis. In arthritis of non-inflammatory causes, signs of inflammation and early morning stiffness are less prominent with stiffness typically less than 1 hour, and movements induce pain caused by mechanical arthritis. In RA, the joints are often affected in a fairly symmetrical fashion, although this is not specific, and the initial presentation may be asymmetrical. Where a spinal joint is affected is not necessarily where a patient will complain of pain.

Contrary to your assertion of "absurd" differential diagnosis, whilst reactive or osteo arthritis are also possibilities, early morning stiffness is a hallmark feature of RA and is one of the key diagnostic differentiators.

New onset back pain in a lady of this age warrants investigation, therefore your suggestion of seeing osteo/chiro before a GP is simply ludicrous nonsense.

whilst i agree with the majority of your post, RA itself does not affect the lumbar spine (essentials of skeletal radiology - yochum and rowe). secondly, i did not say it only affects the SI joints, i said it RARELY affects the SI joints. most common joints are MCP's and PIPs of hand, C-spine, GH joint, ankle, and hip. rare areas are SI, knees and elbows. RA is possible IF the OP's wife has at least 2 areas of stiffness with pain, swellings and possibly nodules, the more areas affected the more likely. if the OP's wife has no other areas of stiffness then yes, RA is highly unlikely. it does most commonly affect the hands first. many other conditions and arthritides give rise to morning stffness. IF she has no swellings, no other joints involved then it's extremely unlikely to be RA. i agree, it's wrong to assume she has no other symptoms, but from what we have, RA would be pretty low on a diagnosis so far, however, yes, she's in the right age group.

DJD often gives morning pain, and is far more common in lumbosacral region than RA also. many arthritides lead to morning stiffness. as plenty of other musculoskeletal problems. as bill said, could just be muscular problem among plenty of other things. i'd doubt RA on what we've got. blood test would be handy though

Edited by E21_Ross on Sunday 12th December 10:28

[JumboBeef]

Thanks again for the replies. She has had a MRI now and is seeing the Dr tomorrow to get the results.

No other symptoms, and her hands/wrists (and everything else actually) is pain-free at all times.

History: she did take a very heavy fall about three/four years ago, on to one hip. Nothing broken but she was in pain for a long time after that. Other than that, nothing that really comes to mind. This current lower back pain has been coming on slowly for about 12 months now.