Nocturnal, or Sleep related Back Pain – Should you change your mattress?.

Back pain is a common issue that can significantly affect your quality of life – especially when it interrupts your sleep. One of the main reasons a person may decide to see a doctor or a physiotherapist for their back pain is because they are awake at night due to the pain, or they have difficulty getting out of bed in the morning due to stiffness and discomfort.

Here is one of the most common questions we are asked on a regular basis – you may find the answer helpful too!

Should I change my mattress?

Many people who experience nocturnal back pain feel that changing their mattress would improve their sleep quality and that a new or firmer mattress would help their spinal alignment. From a physiotherapist’s perspective, spines undergo most loading ‘axial loading’ when we are in an upright position, during the day. When we are standing and sitting in sustained postures over a long period of time, this causes load or ‘deformation’ of the tissues such as ligaments, discs, muscles and fascia or connective tissue. If the tissue can’t cope with the load being applied, it triggers pain sensitive tissues, or can initiate inflammation in these tissues. Overnight, when we are at rest several hours later, the inflammatory process takes place, in which the body tries to start healing itself with the formation of new tissue, a rudimentary type of scar tissue. When you turn during the night or load the spine as you move into sitting or standing in the morning time, this is when you feel the effects of the previous day’s load or activity – the result of the inflammatory process.

There are times when eg a large disc protrusion can directly affect your sleep position and keep you awake at night, but usually pain in the early hours of the morning is more related to low grade inflammation of the soft tissues of the spine from persistent loading the day before.

Our advice?

Try to move your spine and change position more regularly during the day and observe if this makes a difference to your nighttime or early morning back pain before changing your mattress which can be an expensive option with no guarantee of success. A suggestion would be to do some simple pelvic tilts in your chair at work every 15-20 minutes to begin and reach down to touch your toes and then raise your arms overhead.

‘Motion is lotion’ is a key concept in maintaining a healthy, pain-free spine, and backs not only love to move – they need to move.

Find reasons to get up and move from your desk to walk around the office or house during the day,  -getting a glass of water is a simple and often overlooked mini-task - try to avoid getting engrossed in a task to the detriment of movement and keeping up your hydration. Dehydrated tissues are more likely to become painful tissues.

 Our next blog will continue the focus on Nocturnal or Sleep related back pain, where will we suggest some mattress choices and explore good options for those who are due a mattress change.

*Please note that nocturnal back pain is sometimes associated with underlying medical issues, and in particular if it is persistent over a number of weeks with no improvement, or associated with night sweats, unexplained weight loss or bladder and bowel changes or any new symptoms of concern it is important to seek assessment from your doctor or physiotherapist.

From ‘pain’ to ‘chronic pain’

At Physiofusion we see many patients who seek treatment for pain that is persistent or chronic, despite taking rest from their usual activities to allow time for the tissues to heal. This can be the case for pain in almost any part of the body, but most commonly we see it as chronic back pain, neck pain and buttock pain.

So why do some aches and pains go away by themselves, and other aches and pains persist?

Most muscle and joint pains (‘musculoskeletal pains’) occur as a result of us increasing our activity levels by doing too much too soon, with insufficient recovery time. Our muscles, tendons and joints need to be strong enough to cope with the loads and demands we place on them every day. When we apply too much load or we do it over too short a time, our tissues react to this and send signals to our brain to tell us that something may be wrong – our brain perceives this as a ‘threat’, and our brain also then acts to produce the sensation of ‘pain’ so that we pay attention to the ‘threat’.

All pain is produced by our brain!

It is true to say that all pain is produced in our brain– even though we feel it in the injured areas of our arms, legs or spine etc.

Usually, we will pay attention to the ‘threat’ or the pain sensation that the threat has produced, and we make a decision of how to react based on a number of influencing factors – whether we have had this pain before and if so what we did to resolve it; maybe we heard that our friend who had the same pain rested for 2 weeks from football and so we choose to copy that as it sounds sensible; or maybe we decide to take pain medications to mask it as it is too inconvenient to rest from sport or work that week, or we decide to continue as normal and to take no action, if we consider that this pain does not represent a strong threat to our wellbeing overall. This might be the case in back pain for example, if we frequently experience a similar type of pain and if we rationalise that it has usually resolved by itself in the past and so no further action may be required.

On the other hand, we are also influenced by other factors as we make our ‘what to do’ decision, and these can escalate the significance of the perceived threat… For example if we know of a neighbour with back pain who went on to be diagnosed as a spinal tumour, our brain might pay more attention to the ‘threat’ of our own back pain and we may then worry that we may also have a tumour and then pay more and more attention to the back pain. If we have other stressful issues going on in our lives at the time the pain starts, this can have an effect on how our brain interprets and deals with the pain also – and our brain can magnify the pain sensation or ‘output’ it produces if we perceive this threat to be significant. A pianist with a sore finger pain may report higher levels of pain for the same injury that a footballer would be expected to report, as the personal and financial significance of the injury is different for both individuals.

So our brain is capable of escalating the level of pain we experience for a given injury or ‘threat’, and this influences the decisions we make as we decide how to protect our injured area. Both conscious an unconscious decisions can drive the course of the recovery – ie the persistence of the pain. Studies show that poor sleep quality, work dissatisfaction and overall stress levels are important predictors of pain outcomes.

“Learning about how your body works, and how it generates and responds to pain signals can help with recovery”.

Knowing this, how can we identify which pain may become ‘chronic pain’?

As physiotherapists, it is important for us to gain a sense of your ‘whole person’ during our initial assessment so that we can create a better understanding of how ‘your’ pain is affecting ‘you’. In acute or ‘recent’ pain or injury, we will take a thorough history and listen to your description of the onset and behaviour of the pain, and how it affects your ability to walk/play sport etc. On another level, we are listening to the words that you might use to describe your pain, and we try to uncover any underlying ‘pain beliefs’ or past experiences of pain which might help us to determine the best approach for us to take when managing your pain.

In pain that has been present for longer duration, we are trying to identify how much of a ‘threat’ you may perceive their pain to be, and we implement strategies that will help to address these issues also.

The best time to intervene in the pain system is within the first three months. Our bodies do their best healing of ‘actual’ tissue damage within the first three months after the injury/onset of the pain.

Pain that persists beyond three (and in particular six months) is less likely to be coming from the tissues themselves, and more likely to involve changes in our pain processing system. This means that chronic or longstanding pain will most likely need a broader approach to treatment than massage or hands-on treatment alone. This is not always the case, but we need to consider it when we treat chronic pain.

At Physiofusion our team of physiotherapists are all senior physiotherapists with over ten years of experience in the diagnosis and treatment of chronic persistent pain. This is particularly valuable when assessing and helping patients who have tried various forms of treatment in the past without results. We take an individualised approach to each patient which involves a thorough initial assessment from your first visit so that you can be assured you of a high quality treatment plan towards a successful recovery.

Watch out for our next blog on the strategies that we use at Physiofusion as we work together with our patients to treat chronic pain.

Please contact us if you wish to speak to one of our physiotherapists to discuss if we can help you with persistent or chronic pain.