Getting out of bed in the morning can be the scariest part of the day for patients with lower back pain, herniated disc or sciatica. During the first moments in the morning, the rollover can be jarring and immediately increase back and leg pain. In many cases, lower back pain and sciatica are related to a bulging or herniated disc in the lumbar spine. One of the most common complaints from a patient with this condition is significant pain in the first one or two hours of the morning. One of the main contributors to lower back pain and sciatica is a disruption in the disc segment in the lower lumbar most commonly the L4 L5 disc and L5 S1 disc.
Looking at the anatomy of the disc, there is a central nucleus pulposus and outer annular rings. One of the theories is that the new global pulses (which is kind of like the center of a jelly donut) increase because of excess fluids being absorbed throughout the night. Unfortunately, with bulging or herniated discs, their outer annular rings are weakened. The disc is actually slightly larger or taller upon waking up in the morning. (That is one of the reasons why we are slightly taller in the morning as compared to the evening.)
As soon as one gets out of the bed and sits up or stands, there is greater pressure to the disc segment until it equalizes, within one to two hours after waking. People report that they actually are stiffer in the morning and have less range of motion and this is partly related to this disc having less of a capacity to handle the extra fluid that it takes in during the nighttime.
Here’s how you can get up with less pain and discomfort in the morning if you have a herniated disc, bulging disc, back pain or sciatica.
The first strategy is: lying on your back, bend both of your knees to lessen the pressure on the back and roll as a unit (this is often referred to as logrolling into sidelying). At this point, you can attempt to let your feet and lower leg drop off the side of the bed as you try and maintain your trunk and hips to move as one, as you use your hands to push off the bed. As you do this, I encourage you to keep your back in a neutral position or indent your lower back just above the belt line. At this point, we attempt to stand while maintaining a neutral lumbar lordosis.
Another strategy is to move yourself into position, lying on your stomach or prone. Perform a lumbar prop or prone pressup as you slowly lower your left or right leg off the bed, trying to maintain hips and trunk and alignment. The goal is to make that transition from essentially a nonweightbearing position for the herniated or bulging disc without flexing or twisting, which puts the disc in a weakened position when it has more fluid in it during the morning hours. This is by no means a guarantee of zero pain, but it often decreases the pain and allows for a more comfortable transition in the first one to two hours in the morning. Anatomically, when the lumbar spine is flexed and rotated, that often occurs when getting out of bed; it is in a weaker position and more prone to injury.
Another tip for the morning time is to be careful when leaning forward to brush your teeth, going to the bathroom (especially on a low toilet) or putting on socks and shoes. In the early periods, we’re simply attempting to let the disc heal and, depending on the severity, it can take upwards of two to three months.