Lower back pain when lying down: causes, treatments, exercises

At the end of a long day, most of us can’t wait to lie down and rest. But for some, lying down to rest or sleep  doesn’t bring relief — it actually contributes to low back pain, or makes it worse. Whether the back pain is  a dull ache that keeps you from falling asleep or a sharp pain that wakes you up in the middle of the night, back pain when lying down can disrupt your sleep and reinforce the pain-sleep cycle. (This is where pain prevents you from sleeping well, and poor sleep makes you more sensitive to pain, making pain feel worse).

While it can be frustrating to lose sleep over this type of discomfort, back pain while lying down can be managed with a combination of approaches, including gentle exercises, evaluating your mattress, and even adjusting your sleep position.

"There is no single 'right' way to lie down when you have back pain," says Tyler Boyd, PT, DPT, a physical therapist at Hinge Health. "For some people, lying on their back relieves pain, but for others, this sleeping position increases stiffness or discomfort. This is why a one-size-fits-all approach to treatment often doesn't work."

Ahead, learn more about what factors contribute to lower back pain when lying down and how to treat it — especially with exercises recommended by Hinge Health physical therapists.

Causes of lower back pain when lying down

There isn't just one reason why your back might hurt when you lie down. It can be due to a mix of muscle tension, your position when lying down, and daily habits. Here are some common causes:

• Muscle stiffness. If you have done a lot with your back muscles during the day, they may tighten up when you finally stop moving. "When you sleep, you go seven or eight hours without moving," says Dr. Boyd. "If you come off eight hours of sleep and then sit at a desk for another eight hours, that’s 16 hours of minimal movement." This lack of movement can cause muscles to stiffen, leading to pain when you lie down or try to get comfortable.

• Disc issues. Discs are strong spacers between the vertebrae in your spine. Sometimes, they can become sensitive in certain sleep positions. "If you have a sensitive disc, staying in one position too long might feel uncomfortable," explains Dr. Boyd. "Gentle movement helps calm the area, whereas lying still in certain positions might increase pain sensitivity."

• Spinal stenosis. This condition involves a narrowing of the spinal canal, which can put pressure on nerves. People with this condition often feel better when bending forward (like sitting) and notice more discomfort when standing straight or lying flat. Finding a position that slightly bends the spine, like sleeping at an incline usually provides relief. 

• Arthritis in the back (osteoarthritis). This condition refers to normal changes in the spinal joints — associated with aging — that can contribute to stiffness when lying down. "Movement is crucial for conditions like osteoarthritis because it acts as lubrication for the joints," says Dr. Boyd. Lying still for long periods can temporarily increase stiffness.

• Sleep position and mattress. Sometimes, it comes down to simple comfort. If your mattress isn’t comfortable for you, or a sleep position doesn’t feel right, your muscles might tense up. “Some people need a firm surface, while others need soft support,” says Dr. Boyd. “Everyone’s preferences are different — you often have to experiment to find what works for you.” And experimenting doesn’t have to mean buying an expensive new mattress. When possible, starting with a slightly firmer mattress can give you more flexibility, since you can always make it feel softer with a mattress topper or extra padding, but it’s much harder to make a very soft mattress feel firmer.

Symptoms of lower back pain when lying down

Symptoms can vary widely depending on the factors contributing to your back pain and your body and lifestyle. The most common symptoms include:

• Localized dull ache. You might feel a persistent, throbbing ache in the lower back that sets in once you stop moving for the day.

• Sharp, shooting pain. This can occur with certain movements, like rolling over in bed.

• Radiating pain. Pain that travels from the back into the buttocks or legs (sciatica) can sometimes worsen when lying down. "If you lie down and start to feel numbness or tingling traveling down your leg, that’s often a sign to modify your position," says Dr. Boyd.

• Morning stiffness. Many people experience "start-up pain" or significant stiffness immediately after waking up, but improves as they get moving.

Practicing these gentle exercises in your bed regularly can help ease stiffness and improve mobility. Moves like knee rocking and pelvic tilts help gently loosen up the spine, while bridges and marches build the strength needed to support you during the day. "The above movements can reduce discomfort from all kinds of different back conditions," says Dr. Boyd. "They help desensitize the area and get blood flow to the muscles to promote healing."

The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.

Treatments for lower back pain when lying down

Finding back pain relief often involves a mix of movement, lifestyle adjustments, and calming therapies. Here are top treatments recommended by Hinge Health physical therapists:

• Try physical therapy and targeted exercises. Targeted exercises and stretches, like the ones above, can help ease muscle tension and stiffness in your joints. You can do exercise therapy at home or work with a physical therapist who can guide you through movements tailored to your needs. You can see a physical therapist in person or use a program like Hinge Health, where you may access a PT via telehealth/video visit.

• Stay active. Targeted lower back exercises are designed to help with recovery, but any type of movement — like walking, stretching, swimming, or even household chores — can improve circulation and reduce stiffness. Finding your movement sweet spot is key — it’s the amount of movement that feels challenging but not like you’re overdoing it.

• Take over-the-counter (OTC) medication. Pain relievers such as ibuprofen (Advil, Motrin), naproxen (Aleve), and acetaminophen (Tylenol) can help ease pain so you can do your targeted exercises and stay active when you have back pain. Other options are topical NSAIDs or pain relief creams. If you have a medical condition or take other medications, check in with your provider to make sure these OTC options are ‌safe to take.

• Adjust your sleep position. “Your next position is your best position," says Dr. Boyd. If lying on your back hurts, try lying on your side with a pillow between your knees, for example. If you prefer lying on your back, placing a pillow under your knees can help your lower back relax, especially if you have conditions like spinal stenosis.

• Apply heat and ice. "If you have pain laying on your back, try using a heating pad or ice pack to see if that helps alleviate symptoms before bed," says Dr. Boyd. Heat can help relax tight muscles, while ice can reduce inflammation. Try both methods, or stick to the one that works best for you.

• Consider lifestyle modifications. Factors like sleep, stress, nutrition, and certain activities can all play a role in how you feel. In fact, many people are surprised to learn that pain isn’t just about what’s happening physically — your daily habits and overall well-being can have a real impact, too. Staying curious about how your routines affect your muscles and joints can help you identify where small changes might help reduce pain. For example, you might notice your pain is less noticeable on low-stress days.

• Try complementary treatments. Talk to your provider if you’re interested in trying alternative treatments for back pain relief, such as massage, acupuncture, or chiropractic care.

• Ask about TENS therapy. TENS, or transcutaneous electrical nerve stimulation, uses gentle pulses to quiet your pain response and help reduce back pain. One option is the wearable device Enso, available through Hinge Health. It’s small, wireless, and portable.

Physical therapy for lower back pain

Physical therapy is a key treatment for back pain, focusing on movement, exercise therapy, and stretches to improve mobility and reduce sensitivity. The goal is to desensitize the painful area and build resilience in the spine and back. Targeted exercises and stretches can help lubricate joints and improve blood flow to tight low back muscles.

A physical therapist (PT) can assess your symptoms and movement to design a customized program to help you sleep and move better. They can also provide tips to modify everyday activities to make them more comfortable. "Everyone's symptoms are different," says Dr. Boyd. "A PT can help determine if you need more stability exercises, mobility work, or specific modifications to your sleep setup."

You can see a physical therapist in person or use a program like Hinge Health, where you may access a PT via telehealth/video visit.

How to sleep better with back pain

Getting a good night's sleep is essential for managing back pain. Finding a comfortable way to sleep with low back pain and updating your mattress are just two ways you can ease discomfort. Other practical tips from Hinge Health physical therapists to help ease pain and improve your sleep include:

• Move your body during the day. Research shows that just 30 minutes of moderate exercise three times a week can enhance your quality of sleep (though it may be best to avoid strenuous activity within two hours of bedtime as this can actually disrupt sleep for some people). Even taking small movement snack breaks throughout the day, like walking, stretching, or anything that gets you moving can help. If you can get your exercise outside, it’s even better. Exposure to natural sunlight (or bright light) during the day helps keep your circadian rhythm — or sleep cycle — on track.

• Prioritize comfort. There is no single "correct" way to sleep. "It doesn’t matter what position you sleep in as long as you get a restorative rest," says Dr. Boyd. "If sleeping on your stomach makes your symptoms go away and you can sleep through the night, then do it. It’s about what works for you." 

• Use pillows strategically. If you feel most comfortable sleeping on your back, consider placing a pillow under your knees to slightly flex the hips and reduce the curve in your lower back to ease pressure. If you’re a side-sleeper, try placing a pillow between your knees to keep your hips aligned and reduce rotation in the spine, Dr. Boyd says.

• Evaluate your mattress. While there’s no perfect mattress for back pain, if your mattress is old or sagging, it might not be providing enough support. "Some people do better with a firm mattress, while others need softness," says Dr. Boyd. "If you find you sleep better on the couch or in a recliner, that might be a clue that your bed isn't offering the support you need right now."

• Adopt sleep hygiene skills. Simple habits can help regulate your sleep cycle. Try getting natural light during the day, limiting caffeine and alcohol before bed, and creating a calming wind-down routine like reading, dimming the lights, and doing soothing stretches to help your body prepare for rest.

When to see a doctor

Lower back pain when lying down often improves on its own with simple, at-home treatments. But if your pain is severe, getting worse, or causing difficulty with daily activities, see a healthcare provider. It's also a good idea to get care if you have:

• Pain that is constant and does not change with position (hurts when standing, sitting, and lying down)

• Pain accompanied by numbness, tingling, or weakness in both legs

• Loss of bladder or bowel control 

• Numbness in the groin region

• Unsteadiness when walking

PT tip: Trust the process

"It’s important to remember that most of the time, this pain is just a flare-up and it will get better," says Dr. Boyd. "It might take a little time, but trust the process. Listen to your body, modify your sleep positions when you need to, and know that your back is resilient."

How Hinge Health can help you

If you have joint or muscle pain that makes it hard to move, you can get the relief you’ve been looking for with Hinge Health’s online exercise therapy program.

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app when and where it works for you.

Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you.

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References 

1. Saini, Y., Rai, A., & Sen, S. (2025). Relationship Between Sleep Posture and Low Back Pain: A Systematic Review. Musculoskeletal Care, 23(2), e70114. doi:10.1002/msc.70114

2. Ylinen, J., Arja Häkkinen, Hannu Kautiainen, & Juhani Multanen. (2024). Preferences and Avoidance of Sleeping Positions Among Patients With Chronic Low Back Pain: A Cross-Sectional Study. Curēus, 16(5). doi:10.7759/cureus.59772

3. Cary, D., Briffa, K., & McKenna, L. (2019). Identifying relationships between sleep posture and non-specific spinal symptoms in adults: A scoping review. BMJ Open, 9(6). doi:10.1136/bmjopen-2018-027633

4. Alnawwar, M. A., Alraddadi, M. I., Algethmi, R. A., Salem, G. A., Salem, M. A., & Alharbi, A. A. (2023). The effect of physical activity on sleep quality and sleep disorder: A systematic review. Cureus, 15(8). doi:10.7759/cureus.43595

5. Anderson, B. E., & Bliven, K. C. H. (2017). The Use of Breathing Exercises in the Treatment of Chronic, Nonspecific Low Back Pain. Journal of Sport Rehabilitation, 26(5), 452–458. doi:10.1123/jsr.2015-0199

6. Gooley, J. J., Chamberlain, K., Smith, K. A., Khalsa, S. B., Rajaratnam, S. M., Van Reen, E., Zeitzer, J. M., Czeisler, C. A., & Lockley, S. W. (2011). Exposure to room light before bedtime suppresses melatonin onset and shortens melatonin duration in humans. The Journal of Clinical Endocrinology & Metabolism, 96(3). doi:10.1210/jc.2010-2098

7. Caggiari, G., Talesa, G. R., Toro, G., Jannelli, E., Monteleone, G., & Puddu, L. (2021). What type of mattress should be chosen to avoid back pain and improve sleep quality? Review of the literature. Journal of Orthopaedics and Traumatology, 22(1). doi:10.1186/s10195-021-00616-5