Q. I have low back pain which is more in the morning and less in the evening. Why does this pattern occur?

Hello,

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You have mentioned persistent low back pain for 5 years as your main problem. It is a known scientific fact that when you go to bed, the muscles in the body relax subconsciously, due to which any inflammatory pain is felt more. When you start with some activity, then that protective muscle spasm comes again and prevents the pain perception. Also after overnight inactivity, the disc pressures have been found to be very high in the mornings. So there are very high chances of prolapse early in the morning. Hence, I always advise my patients not to bend acutely forwards, or lift something very heavy, especially in the early morning time.

Your pain could be due to multiple reasons - muscular, mechanical, discal in origin, etc. If you have a localized backache, with no associated neurological symptoms like radiation of pain to legs, numbness, paresthesias, electric shock-like sensations in legs and there are no systemic symptoms like swelling, fever, loss of appetite or weight, etc., my advice to you for the initial 2 to 3 weeks will be:

1. To maintain a proper posture of lower back while working and sleeping.
2. If the pain is more, then you can take a short course of an anti-inflammatory medication which suits you.
3. Physical therapy initially under the supervision of a trained physiotherapist and then to continue at home, mainly concentrating on lower back strengthening, abdominal strengthening, and general conditioning exercises.
4. Adequate calcium and vitamin D intake if their levels are low in the body.
5. Ice packs can be applied if your pain is acute, then hot fomentation can be done at home.
6. Analgesic spray for local application can be used and is easily available.
7. Avoid lifting heavyweight and acute forward bending in the mornings.

If your condition does not improve after 2 to 3 weeks of this conservative management, then you need to undergo some investigations.