Ever had back pain that left you feeling exhausted? That’s because persistent back pain is exhausting, as you probably know all too well. It can affect your physical activity habits, and stress levels, and it can be disruptive at night, affecting your ability to fall asleep and stay asleep. Experts refer to this as the pain-sleep cycle. 

The good news is: You don’t have to get stuck in this cycle. There’s a lot you can do to break it, simultaneously helping to reduce your back pain, improve your sleep, and feel better overall. One way to do this is by adding stretching into your bedtime routine to help you wake up feeling more refreshed and ready to take on the day. 

Here, learn what can contribute to back pain and poor sleep and, more importantly, how you can break the pain-sleep cycle, especially with exercises recommended by our physical therapists. 

Bedtime Stretching: How Your Back Benefits 

Your back has a very important job. In addition to housing some of the most important structures in your body (hi, spinal cord), it supports you while you move and go about your day. Every time you put on your shoes, play catch with your kids or sit in front of your computer, the muscles, bones (called vertebrae), discs, tendons, ligaments, nerves, and other structures in your back all work together to allow you to move.  

While that may sound like a big burden, your back is designed to handle and thrive on these responsibilities. It’s inherently strong and resilient, while also being flexible. “The most important thing to remember is that having back pain doesn’t automatically mean something is wrong with the spine,” says Heather Broach, PT, DPT, a physical therapist at Hinge Health. “The spine is often seen as fragile and delicate, so I always try to educate patients on the strength of the spine and demystify its relationship to back pain.” 

Despite its incredible strength, your back may benefit from some targeted stretches if you're prone to back pain (just like your muscles benefit from a little extra attention after a difficult workout). Many people with persistent back pain report worse symptoms in the evening, which is why stretching before bed can be especially therapeutic. Whether you are very active or have to sit a lot during the day, stretching before bed can help: 

• Release tension. Stretching helps your body relax and release tension that often builds up from stress during the day. This helps relax your muscles, which reverses the cycle of tension and resulting pain. It also helps you stay asleep because calm and relaxed muscles are less likely to disrupt you during the night, says Lori Walter, PT, DPT, a physical therapist at Hinge Health. 

• Reset your posture. Many people perform repetitive motions each day. Whether you drive a lot, sit at a desk, stock shelves at a grocery store, or crawl on the ground with toddlers, our days often involve repetitive activities. While this isn’t necessarily a bad thing (or something you can always control), that repetition can contribute to changes in your body’s natural posture. Stretching at the end of the day can be an effective way to incorporate variety and lengthen your back muscles to get relief from your usual position. 

• Increase blood flow. Stretching your back improves blood flow to that entire area, which means your back muscles get a fresh supply of oxygen and nutrients. This helps relax your muscles, reduce stiffness, and promote overall flexibility and comfort, which can help you sleep better. 

• Enhance range of motion. Exercise programs that incorporate flexibility help relieve back pain because increased flexibility leads to improvements in range of motion and functional movement, according to a review published in the journal Healthcare. This can also help reduce the risk of back sprains and strains and help you sleep better.  

• Reduce stress. Yep, stress can definitely affect back pain — and sleep — because it triggers a cascade of events in your body by releasing hormones such as adrenaline and cortisol. These increase your heart rate, blood pressure, blood glucose, and energy supplies and contribute to nerve sensitivity, muscle tension, and anxiety. Try not to let all this stress you out even more, though. Stretching has been shown to increase serotonin levels, which is the “feel-good” hormone that helps stabilize mood, reduce stress, and increase feelings of calm. 

“These stretches involve both large and small muscle groups that directly attach to the spine,” says Dr. Broach. “By incorporating movements that target many different areas of your back, you are more likely to get to the source of the pain and get relief from stretching,” she says. As you do these stretches, focus on your breathing. Slow and concentrated breathing can be meditative and ensure that your stretches feel good and help you wind down for the night. 

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.

More Tips for Better Sleep

In addition to doing calming stretches before bed, here are some additional ways to help improve your sleep quality, especially if your back pain is disrupting your sleep at night. 

• Sip a calming tea. Herbal teas that include calming ingredients such as chamomile or lavender can help you fall asleep. For an added benefit, try drinking your tea after doing your stretches before bed. 

• Drink enough water during the day. Dehydration during the day can contribute to back spasms at night. Try to drink half your body weight in ounces of water each day. “This encourages the flow of nutrients such as blood and oxygen to the tissues in your back,” says Dr. Broach. “It also plumps up the discs in your vertebrae so that they can better support your back and spine.” If you find that you wake up in the middle of the night to empty your bladder, cut off fluids about two hours before bedtime to minimize sleep disruptions. 

• Use heat. Try doing your stretches before bed with a heat pack for added relief. Heat increases blood flow and promotes muscle relaxation, and it also increases strength and flexibility among patients with chronic back pain, according to a 2018 study in the journal Clinical Biomechanics. “I am a big fan of heat — most people tend to respond well to it,” explains Dr. Broach. It’s a very effective way to help muscles heal and prevent stiffness, reducing your risk of disruptive back pain as you sleep. 

PT Tip: Sleep with Support 

If you have back pain that keeps you up at night or affects your energy during the day, you may need more support when you sleep, explains Dr. Broach. “For example, something as simple as placing a pillow under your knees can provide extra support for your back, making you more comfortable and helping to reduce pain or discomfort that wakes you up at night,” she says. 

“It’s also worth making sure your mattress is working for you, and not against you,” Dr. Broach adds. Some people with back pain do better with a firmer mattress, and others with a softer mattress. If you want to experiment with something firmer than what you’re currently using, try putting a plywood board under your mattress, or placing your mattress on the floor. If you want to experiment with something softer than what you’re currently using, try adding a soft mattress topper. If you notice an improvement in pain or comfort, you can stick with the experiment or consider whether it's possible and worthwhile to shop for a new mattress.

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. Back Pain: Causes, Prevention, Treatment, and Best Exercises. (2023, February 9). Hinge Health. https://www.hingehealth.com/resources/articles/back-pain/ 

2. Low Back Pain When Sleeping: What Causes It and How to Treat It. (2023, January 20). Hinge Health. https://www.hingehealth.com/resources/articles/how-to-sleep-with-low-back-pain/ 

3. Deshmukh, V. Y. (2019). Health Benefits Of Stretching. Aayushi International Interdisciplinary Research Journal, 6(5), 123-126. 

4. Gordon, R., & Bloxham, S. (2016). A Systematic Review of the Effects of Exercise and Physical Activity on Non-Specific Chronic Low Back Pain. Healthcare, 4(2), 22. doi:10.3390/healthcare4020022

5. Bae, H.-I., Kim, D.-Y., & Sung, Y.-H. (2017). Effects of a static stretch using a load on low back pain patients with shortened tensor fascia lata. Journal of Exercise Rehabilitation, 13(2), 227–231. doi:10.12965/jer.1734910.455

6. Wipfli, B., Landers, D., Nagoshi, C., & Ringenbach, S. (2009). An examination of serotonin and psychological variables in the relationship between exercise and mental health. Scandinavian Journal of Medicine & Science in Sports, 21(3), 474–481. doi:10.1111/j.1600-0838.2009.01049.x

7. Ice or Heat for Back Pain: What Should You Use? (2022, December 4). Hinge Health. https://www.hingehealth.com/resources/articles/back-pain-heat-or-ice/ 

8. Freiwald, J., Hoppe, M. W., Beermann, W., Krajewski, J., & Baumgart, C. (2018). Effects of supplemental heat therapy in multimodal treated chronic low back pain patients on strength and flexibility. Clinical Biomechanics, 57, 107–113. doi:10.1016/j.clinbiomech.2018.06.008

9. Hester, J., & Tang, N. K. Y. (2008). Insomnia Co-Occurring with Chronic Pain: Clinical Features, Interaction, Assessments and Possible Interventions. Reviews in Pain, 2(1), 2–7. doi:10.1177/204946370800200102

10. Back Muscles. (2021, July 23). Cleveland Clinic. https://my.clevelandclinic.org/health/body/21632-back-muscles

11. Williams, C. (2020, April 27). Can Stress Cause Lower Back Pain? Interventional Orthopedics of Atlanta. https://ioaregenerative.com/blog/can-stress-cause-lower-back-pain