This episode is entitled “How to turn over in bed with back pain”. You will learn:
- The most common cause of pain turning in bed
- How to test it clinically (don’t try this at home)
- What to do about it (how to turn over in bed using the brace)
The most common cause of pain turning over in bed
One of the most common causes of pain turning over in bed is instability. This is where at least one of the joints in your lower back is excessively mobile compared with its neighbors, and that you have poor control over that mobility. In technical terms, we often refer to motor control, which simply means how your muscles control your movement. For many people, they don’t control it very well. And specifically, sometimes around one spinal segment. That would be referred to as instability.
At the extreme end of the spectrum, people with hypermobility syndrome are excessively mobile in many of their joints, and consequently more at risk of instability. But you can certainly have instability in one spinal joint in an otherwise stiff person.
How to test it clinically (don’t try this at home)
I don’t recommend doing this at home, but it’s possible, with the help of a friend who has experience of manual therapy. It could be a massage therapist. You don’t want someone heavy handed doing this technique to you, as it could make you feel worse for a short while afterwards. You can use a dining table or the kitchen bar unit. It needs to be something solid that can support your weight. Our treatment table is about two feet across and we have people lying across it rather than along the length of it.
Stand facing the table and lower yourself onto it, such that your head is over the other side and your legs are hanging off the other side. Drape yourself over so that your hips are mostly on the bench and your legs are relaxed at the knees. As soon as you lay in that position and relax, it will hurt. Getting into that position and relaxing fully causes pain, because you’re tractioning through the lumber joints. As you relax into it, it stops being painful.
That’s just the start position to get into that position. Then your friend simply places the heel of the palm of their hand at the base of your back. For some people just the weight of the hand resting on their back is enough to increase the pain. If that isn’t sore, then you can continue with the rest of the test, but if it is, lightly lean through the joints in the lower back. The person leaning through would lean through very gently through the joints on your back. If that’s painless, go up to the next one. Work your way up the lumbar spine, the bottom five knobbly bits. As soon as you feel pain, stop and relax. Then try again on that particular vertebra. Gently lift one leg straight up behind you. Just lift it off the floor so that you’re taking the weight of that leg.
Then repeat the test. If the pain magically vanishes, you have instability. If you have pain when you’re relaxed, and you don’t have pain when the leg is off the floor, you have used their muscles to stabilize the spine. As you lift your leg up off the floor that stabilizes the joint, such that when I lean through it, it doesn’t hurt anymore. However, if lifting the leg up doesn’t make a difference to the pain, or if it increases it, you may not have instability. This is not an absolute test, it’s just an indication. I would still diagnose instability. And some people sometimes when they don’t test positive in this classical way, but you need a trained clinician for that evaluation, but this is how we typically do it as a standard test for instability.
What do we do about it (how to turn over in bed using the brace)
Welcome the power of the brace. We’re talking about your abdominal muscles. Stand up and put your hands across your belly. Feel how firm or floppy it is, and then tense it up a little bit, tighten it up. It should be nice and firm, when you brace. If you’ve not used your belly muscles for a long time, you might struggle to brace it. Imagine somebody is going to punch in the stomach and tighten it up. That is an abdominal brace.
Brace those abdominal muscles in preparation for turning over. Initiate the brace and hold it while you do the turning. It’s very important to brace before initiating the movement, because for many people it’s the first movement that they feel pain. Before you even think about starting to move, just brace everything, tighten everything up. Then pull your shoulder blades down your back. This assists the brace so you’re bracing your back muscles more powerfully as well as the front muscles. Hold the brace while you do the turning over action, and when you get to your resting destination, relax again. Don’t stay braced all the time.
Remember you can get a free assessment for lower back pain / sciatica