I am often asked questions about morning pain. If you have pain that is worse in the morning and seems to get better as the day goes on, before worsening again at the end of the day, then your pain is most likely discogenic pain – or pain that originates with the intervertebral disc.
The disc is like a jelly doughnut in that it is made up of two structures, the nucleus (the jelly) and the outer shell, called the annulus. The annulus is made up of repeating layers of tissue, similar to an onion, with the nucleus in the middle like the jelly in the doughnut. The natural history of the aging of the discs results in gradual failure of the annulus, so that by about age 25, the nucleus is starting to push out and create a bulge in the disc, that itself can be painful.
Now with that in mind, you can see how the bulge develops, and you now need to imagine that the nucleus grows and shrinks depending on the weight bearing status. I say this because the nucleus is made up of molecules that are hydrophylic, which means that it attracts water, it does more than attract water, it actually binds water and as such, grows in thickness. This happens in a non-weight bearing status which is usually at night.
Because the nucleus is under more pressure first thing in the morning, any bulge that occurs is more likely to cause pain since the pain sensitive structures will be under greater distress. The pain subsides as the day goes on though, because as your physical weight puts the disc under pressure, then nucleus loses water.
You might remember the SkyLab astronauts, who, when they returned from space, and to do so early because they out grew their space suits in that ant-gravity environment. This occurred because without weight bearing, the discs just got thicker and thicker as the nucleus continued to imbibe fluids.
Morning pain occurs then, because the disc starts out each day with greater intradiscal pressure after a night if absorbing water. If this is your experience, then you need to start out each day with greater caution.
- Use good mechanics
- Face what you are doing
- Avoid bending and lifting activities
- Be careful exerting pressure while on the potty
As the day goes on, and the pain subsides, you can relax a little, but you still need to be cautious because even though the pain is lessened, the disc is still susceptible to bulging. Just remember, that back pain is episodic, which means it comes and goes, and the best treatment is prevention.
The data says that you should stay active, use good biomechanics to do things like lift and carry objects, and avoid prolonged sitting.