# Back aches - but only late at night ?? Can't sleep, please help !!!!



## Rattus (Feb 6, 2006)

Thanks for looking in, sorry for the long post, but I need to explain steps already taken.

Symptoms = I feel good all day (lucky me) and ride / work / play without any pain. But after about 4hrs in bed I wake with a sore aching back. Seems like my leg and back muscles have tightened up as I have reduced flexibility. I can't get back to sleep, so I get up and sit at the PC for about an hour or two, then I will have loosened up enough to go back to bed.

Sometimes I have to get up twice during the night, this is very disrupting and makes early starts difficult.

This started about 9 months ago, which was about 6 weeks after I increased my weights training for an important race. I increased my leg extensions, leg curls and leg press, and saw steady gains in strength, endurance and muscle mass. Great, but now I can't sleep. I think the sleeping problem is muscle imballance caused by my weight lifting. 

Over the last 9 months I have tried all kinds of measures to try and fix this.

Have been to 2 different highly regarded masseuses. 
An Osteopath
A Physio who works with our institute of sport riders - she put me on a stretches program, but when that didn't help she sent me for xrays.

Tried more stretches, different stretches, yoga, core strength work, inversion table, less riding, shorter stem and less aggressive position on bike.

Checked position and leg lengths, new mattress, supplements such as glucosamine and magnesium, pain killers (no use - not using them now).

My Doctor thinks it isn't muscle imbalance caused by my weightlifting, as muscles should be relaxed at night, and he doesn't think this would be waking me up. He thought it might be disc issues, till the x-rays showed they were ok. Scarily he started using terms such as "red flag" this how Doctors say "potentially cancer" without actually using the big C word as that may make you panic.

Had X-rays, CTscan, MRI and bone scan......the Doctor recommended these because of the waking at night "red flag" issues. They found no cause, my back looks good, that is great news, but doesn't fix me.

They did find a large cyst inside my pelvis bone, which at first I thought , but apparently this is a "red herring", not related. I have had a bone biopsy to prove this is benign, get the result in a few days time, but all tests so far say it is ok.

Anyway, does anyone else have the waking at night problem ?

After many different tactics, false hopes and trials, I'm going back to muscle imbalance theory. It does seem like a long time to correct, I have not done any weights for about 7 months and I have backed off the training and done all the above steps, but I suppose I just need to persevere.

Will anyone here be able to give me better advice than the plethora of professionals I have already consulted ? Will anyone read such a long rant? probably not, but I needed to have a vent anyway.

I will keep slogging away with the stretches and core work, and hope that my body balances itself and the problem just goes away. Eternally optimistic 

Sleep........................don't ever take it for granted 

At least I can still ride


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## mlepito (May 1, 2007)

sometimes the simple answer ends up being correct when all the "bad" tests come back negative. It seems that immobility is causing the cramping. This can happen with electrolyte imbalances. Try drinking gatorade before you go to sleep. Also calcium levels can effect muscle contracture since your body uses calcium to evoke muscle potential. Have your parathyroid levels checked. Calcium deficiency usually causes spasm because the Ca receptors become super sensitive. 

Pain at night is a red flag for cancer, however only because cancer is a nagging pain which does not change with posiiton. since at night you have nothing else to focus on the pain seems more intense since usually it is a low grade pain. However, cancer usually will not wake you from sleep and certainly does not cause cramping. So I would not be too worried about cancer.


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## Rattus (Feb 6, 2006)

Hi mlepito, thanks for your input, I have tried extra electrolytes, but not specifically before bed. I usually use gatoraide when I have a hard / sweaty ride or workout. I would have thought if it was an electrolyte imbalance that I would only suffer sometimes and with differing intensity. But I will try and persue this again.

Calcium intake is something I have not played with, I will do some research and give it a try, thanks. I will also ask my Dr about getting my parathyroid levels checked.


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## Rattus (Feb 6, 2006)

Hmmm, did a bit of quick research and it seems that I probably get enough calcium already.

I had already just finished my sardines on toast for lunch, which is one of the recommendations, I eat veggies and cheeses, milk, yoghurt, seeds, and get outside for my sunshine dose when I can.

I used to take magnesium supplements, but have stopped them as I have reduced my training intensity and didn't think I need them. Only stopped them a couple of months ago.

My diet is generally very healthy, diverse and researched.

Still I will experiment more and not rule out diet as a possible solution.


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## ilostmypassword (Dec 9, 2006)

Have you tried a week off from riding?


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## Rattus (Feb 6, 2006)

ilostmypassword said:


> Have you tried a week off from riding?


Yep, 10 days I went from memory, no different, and I stopped weightlifting altogether.

My leg muscles have retained the extra bulk they put on when I did the weights though. I would have thought they would be shrinking a bit now after many months with no weights.


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## MaddSquirrel (Aug 5, 2005)

Stop doing leg presses. Leg presses are pretty easy to do in correctly and may be causing nerves to be pinched in the back. What kind of machine are you using to do them? The best thing to do would be to start doing free squats so you will be using your core. Also remember not to go past parallel when doing them. I would definately go see a good orthopedic that specializes in backs. It definately sounds like a pinched/irritated nerve to me.


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## Rattus (Feb 6, 2006)

Rattus said:


> Will anyone here be able to give me better advice than the plethora of professionals I have already consulted ? Will anyone read such a long rant? probably not, but I needed to have a vent anyway.


Thanks Madsquwerelool, I knew some would not read the original post. Yes as stated about 3 times I have stopped weights.

OK I know you meant well and thanks for trying dude


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## MaddSquirrel (Aug 5, 2005)

I did not mean to stop doing weights, I meant stop doing that specific excercise as it is easy to hurt yourself. If you read my post, I was stating an alternative and possible causes to your pain. I did read the entire post, no were did you state that you have thought about your nerves. My mother has a degenerative back disease which cause her spinal cord to move and it would pinch nerves and cause severe back spasms and her legs to go numb. Took 5 years of her going to doctors before it was recognized. So, take your own advice and read my post a little more carefully, not just the first line (wink).


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## Rattus (Feb 6, 2006)

Fair enough, I did read your post, but only responded to the first bit due to being tired and a bit inebriated.

I don't know how to describe the leg press machine I was using except to say it's an old one where you sit and lift horizontally. I think I was fairly careful using it, many people say free weights are a better exercise, but others also say free weight squats can be dangerous. When / if I do start doing weight again I will research the options and techniques again.

I would have thought the masseuses and physio I have been to would discover a pinched nerve if that was the cause, but perhaps not. 

The orthopaedic I was sent to for the cyst in my pelvis bone has suggested referring me to his collegue who is an othapedic back specialist.

So yes I'm going down that path, he will be the 6th professional I've consulted.

Fingers crossed.


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## MaddSquirrel (Aug 5, 2005)

The back specialict hopefully will get it all sorted out. I am a bit nervous about these issues since my mother's back disease can be hereditary. The key with squats is to start doing them with no weight at all, feet shoulder width apart, toes pointing straight ahead and chin up. Go down to your quads are parallel and then back up. The main thing once you add weight will be making sure the bar is resting on your shoulders and not your neck.


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## Cranked (Jun 1, 2006)

Obviously there are a mountain of potential problems that could be the cause. Not to over simplify things but I had a major problem a couple years ago. I would wake up screaming from back pain at all hours of the night. Got a new mattress thinking that was the problem, but it was the wooden supports under the bed that had slowly sagged over years of sleeping on them. Took a while to figure it out, but haven't had anymore problems since. I would start with the simplest options and begin to eliminate those first, as they tend to be cheaper and easier to try.


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## split.therapy (Apr 27, 2008)

Rattus, The only thing I could think of is going the extra step (whatever that may be.) to eliminate anything in your bowels. I can't work on you from here. Too bad. Yours is just the kind of challenge I look forward to.
Good luck and please keep us posted.
Chris


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## jamesjoker (May 3, 2005)

*I've had a closely related problem*

I had a serious bout of back pulling hamstrings tight and vice versa problem last year. Since then, the better part of a year, I awoke with back pain in the middle of the night and the morning. My latest chiro/therapist told me that episode may have put to sleep the muscles, tendons whatever in my lower back. To wake them back up, he had me suck in my stomach muscles for 2 minutes, then again every time I got in car, got out of car, got into bed, got out of bed, got into a chair and got out again. Within a day, my back pain in bed went away. Unbelievable, but true!!!


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## Rattus (Feb 6, 2006)

Thanks everyone for all the suggestions..........

MaddSquirrel.....I will keep your squats tips in mind if I ever start to do them.

Cranked......Good suggestion, but I have already had the slats under my bed reinforced and supported with an extra leg in the middle. Then bought a new mattress, no go............when I sleep in other beds in hotels I still wake up sore also.

split.therapy.........I will put bowels on my list of things to pursue and eliminate, hmmm that doesn't sound right does it LOL.

jamesjoker..........I'm thinking this could eventually could help me. You were very lucky to find relief so quickly. My Physio has me doing similar as part of my core strength work. I suck in my lower stomach muscles and engage the "traversus abdominus" keeping them engaged I breath normally and do alternating leg lifts. I do heaps of other core work also.


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## BoiseBoy (Mar 1, 2006)

*Instability!?*



Rattus said:


> Thanks for looking in, sorry for the long post, but I need to explain steps already taken.
> 
> Symptoms = I feel good all day (lucky me) and ride / work / play without any pain. But after about 4hrs in bed I wake with a sore aching back. Seems like my leg and back muscles have tightened up as I have reduced flexibility. I can't get back to sleep, so I get up and sit at the PC for about an hour or two, then I will have loosened up enough to go back to bed.
> 
> ...


Your sx's are a bit remeniscent of a Lumbar instability. Typically, these instabilities will feel better with a sitting or flexed position that will stabilize the segments via the ThoracoLumbar Fascia. In a erect or extended position, similar to lying prone while we sleep, it is not uncommon for a person to get pain and even radicular type sx's. Often, as soon as we change positions into sitting or bending forward the back will feel better.
Imaging may or may not inidicat any issues. The instability is soft tissue related (ligamentus) so a good manual therapist (PT) should be able to pick one up on you if it is truly the issue.


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## The Squeaky Wheel (Dec 30, 2003)

Rattus,
Any family history of back pain?
Any history of psoriasis or eye inflammation in you or your family members?
Have you had imaging specifically of the sacroiliac joints? These tend not to be included on spinal MRI/CT.
Anyone do blood tests called Sed Rate (ESR), C Reactive protein or HLA-B27?


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## Dgage (Aug 20, 2006)

I know a few years ago when my legs were cramping up, I went to my doctor about it and the first thing he asked if I had cut down on my salt intake. When I said I had, He said to start using it again. Problem solved!
I know, sounds too simple to work but sure can't hurt. I just added a bit to my food like most people do.
Doug


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## Rattus (Feb 6, 2006)

The biopsy result was good, so no cancer 

The surgeon thinks it's most probably muscular or nervous system. He was dismissive of it being anything to do with nutrition or internal organs, and didn't think and further blood tests were necessary. I actually printed out a couple of suggestions from here to discuss with him.

He gave me a referral to a back specialist, I have an appointment in three months  

Tomorrow I'm going to a second physio, for a new perspective. 

The last couple of weeks I actually think I have noticed a slight improvement. The discomfort that wakes me up is less intense, sometimes I can get back to sleep without getting up. 

Thanks again to everyone here who has contributed. I will keep positive and keep trying


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## Rattus (Feb 6, 2006)

The Squeaky Wheel said:


> Rattus,
> Any family history of back pain?
> Any history of psoriasis or eye inflammation in you or your family members?
> Have you had imaging specifically of the sacroiliac joints? These tend not to be included on spinal MRI/CT.
> Anyone do blood tests called Sed Rate (ESR), C Reactive protein or HLA-B27?


You were onto it Mr Wheel, some months ago I asked the Surgeon about the blood tests that you suggested and he dismissed them. I now assume that was because he had no idea why they would be suggested, and his ego got in the way of him admitting that.

The second Physio (in above post) tried her stuff for a few weeks, then referred me to a Sports Physician. He was straight onto the A.S. symptoms Ankylosing spondylitis and ordered the blood tests. He told me they were for arthritis type things. So that night I typed into Google "arthritis wake at night" and found out about A.S.

Yes I am HLA-B27 positive, I now have my very own Rheumatologist who has diagnosed me as "undifferentiated spondyloarthritis".

I am now on NSAID's drugs, and doing the low starch diet (which sucks) and I feel much better. I have books, forums and a very well regarded and researched Rheumatologist who specialises in A.S.

Diet, drugs and exercise are my recommended therapy, all things that I have experience with 

For now I am still OK to keep on MTBing, but if I start to fuse up then I will have to take up less risky exercises. Fingers crossed that will not happen, I'm doing all I can to stop it, but the rest is just chance / luck.

So thanks for your help Squeaky Wheel, even though it was dismissed, I will have to give the Surgeon a lesson in the hope he doesn't tell any other A.S. people to "go home and learn to live with it."

Cheers,
Rat


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## The Squeaky Wheel (Dec 30, 2003)

Glad to hear you're now on the right path :thumbsup:


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## mkimber (Sep 10, 2008)

I've had this exact same problem for the past 3 months. My chiro says it's early stages of arthritis.  I feel better the more active I get. He told me to stretch my back and hamstrings more, use my tenz a few times a week and use a heating pad to keep the muscles loose. I take an aleve almost every morning and that helps me get going untill it loosens up on it's own. Other than that, a steriod shot is another option but doesn't always help.


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## Rattus (Feb 6, 2006)

Hi mkimber, if your chiro thinks it's arthritis then they should refer you onto a rheumatologist. Chiro manipulation can be dangerous for anyone with A.S.

But you may not have A.S. so don't panic and worry about worst case scenario. I am still getting my head around it, but I need to keep in mind that I have an 85% chance of not fusing up. Due to age, and my scans I have been told I have *undifferentiated spondyloarthritis* and it might stay that way and not get worse.

You need to get professional advice though.

With drugs, exercise, stretches, posture and diet (low starch) I am now sleeping much better.

I also plan on being competitive at my next local 6hr enduro race 

Some info here.............good luck 

http://www.kickas.org/
http://arthritis.about.com/library/quiz/blspondyquiz.htm
http://rheumatology.oxfordjournals.org/cgi/content/full/44/12/1483
http://www.kickas.org/as_dietary_primer.shtml
http://en.wikipedia.org/wiki/Ankylosing_spondylitis


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## m.morrison (Jul 25, 2016)

I had this problem and finally figured out what it was -- now it's totally gone. A little history... I had this problem for about 2 years. It would wake me up in the night and I'd have to sit up in bed to get any relief. In the morning the pain would be awful, but after sitting for a while, it would go away – totally gone. But then after about a year, it started to get worse. It used to hurt just when I was lying down but then it got painful when I was walking too. I'd have to sit down to make it feel better. I went to my GP who offered meds, which totally didn't work. I had x-rays, which showed a bit of arthritis, but nothing major. Then my Dr. sent me for an ultrasound (because the pain was starting to feel like it was throbbing in my lower abdomen) and they found nothing. Out of desperation I went to a chiropractor -- who I was sure was a total quack -- but like I said, I was desperate. He cracked my back a couple of times a week, for a couple of weeks, and I still didn't have much improvement. BUT THEN the chiropractor says he thinks it's my hamstring muscles. What?!! I told him: "Absolutely, no way this has anything to do with my hamstring muscles. It's my BACK not my Legs!" But, according to him, the hamstring muscles get tight as you age and they are so much bigger than your back muscles that, at night, they pull and pull your back muscles, for hours -- and it jacks them up. Anyway he was insistent that I do hamstring stretches several times a day for 20 min. each time, to stretch out my hamstrings. I was totally 100% sure this diagnosis was absolute nonsense, but I had nothing to lose, so I did it. And It ABSOLUTELY worked. After about a week the pain was totally gone. Totally. And the pain is still gone – as long as I keep doing the stretches, because if I forget, the pain at night comes back. But basically it is all better: I don't take any meds and I don't go to the chiropractor either (he solved my problem but I don't see any reason to keep getting my back cracked.) Nobody was more surprised than me. You can find tons of hamstring stretching exercises online -- do the ones that don't put stress on your back ( do the lying down ones) and if it works for you, pass on the info to others and ask that they do the same. The more people who get well and don't have to take meds the better. Pay if forward. Hope this helps!


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## Rattus (Feb 6, 2006)

Glad you found something that worked for you m.morrison  I'm not a fan of chiropractors but it sounds like you got the right advice and to be able to be pain free from just doing stretches is a great result.

Update on my condition, about 12 months ago I had a blood test as part of my routine monitoring and the Dr found that my inflammation levels were way down and suggested I try going off the NSAIDs meds. I did and I have no pain my arthritis has gone into remission, fingers crossed it stays that way 

But after breaking my ankle two years ago it was suggested I have a bone density scan and the results came back that I have low bone density, not quite to osteoporosis levels. This may be genetic or be because of my arthritis but I think at least contributing would be the fact that I have worked shift work for 26 years and not got enough vitamin D. I now take vitamin D supplements year round and watch my calcium intake, which has always been reasonable anyway.

I thought long and hard about what it meant to be a MTBer with low bone density and in the end I decided f^%k it I'm not going to let it worry me I'm not going soft and will ride like I always have as it's what I love and I will do it as long as I can.

Then 6 months ago I had a BAD crash and flipped OTB after clipping the top of a tricky double jump landed flat on my back hard from a height. 
Three fractures in my spine, broken hip and three broken ribs, two weeks in traction in hospital. Anyone would have broken themselves in that crash low bone density or not, but it probably contributed. After three months of rehab on crutches I have now been back on the bike for 3 months and I'm smashing it (nice pun) and getting Strava PBs and going for 8hr training rides  I sometimes get a little twinge in the hip going from sitting down in a chair to standing, but that's the only discomfort I have and I'm totally pain free and comfortable on the bike.

OK.......NOW it's time to back off a bit.......no more looking at big jumps and drops that scare me and making plans to attempt them and return with someone to take a pic for me. FFS I'm 48 years old why can't I move on from that **** and give my ego a rest? I suppose it's not all about ego I do love the adrenalin.

I rode an awesome new trail just a few days ago and didn't attempt any of the jumps or difficult A lines and still enjoyed the ride with my wife and son. I did look at some of the lower risk small jumps and decided I would do them next time, but the big jumps NO WAY.

I'm so grateful that I can still ride (or even get out of bed to go for a ****) now and I hope to be back for the long haul not crashing out in a blaze of glory 

Ride on folks


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## WHALENARD (Feb 21, 2010)

I admittedly read very little of this thread, but will put this out there in the event it helps anybody. Leg presses cause the pelvis to rotate away from the backrest. This unatural lumbar flexation causes herniating conditions for the discs.


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## jgerrish (Nov 3, 2016)

THANK YOU m.morrison!!!! I registered just to leave this reply to hopefully help others suffering from this problem.

I've had thoracic (middle) back pain for ~2 weeks (I had it a few years ago for ~9 months) that occurs ~2-3 AM every night and prevents me from sleeping after that. When it occurs, I'm in pretty bad pain no matter what position I get in and cant fall back asleep. I started self medicating with Advil PM before bed every night and then popping a couple more when the pain would wake me up again around 3 AM. It was ruining my life.

When I got this a few years ago, it lasted for ~9 months. I went to doctors, x-rays, ct-scans, physical therapy, etc. I (and my doctor) thought it was spice related since I've had a ruptured disk in the past and other back issues (including a bad bicycling incident that really hurt my thoracic spine) . Eventually the physical therapy resolved the issue...it just went away at some point...until a couple weeks ago.

This time I decided to research online and came across your post. What caught my attention is your comment about leg muscles. I've been painting the exterior of my house and up and down ladders a lot. My legs have been sore too from all the workout. I previously thought the recurrence of this pain was due to carrying the ladders and injuring my spine somehow. Because of your comment, I decided to try stretching my legs before bed. WOW! After ~8 consecutive nights of bad pain, I only had mild pain ~5AM. I then did it the second night too...stretch, sleep, only mild pain much later in the morning. I even skipped the second dose of Advil both nights and could sleep OK.

I am SO hopeful that this is the issue! I'm going to keep up the stretching and see how this goes.

If anyone has these same symptoms...please try stretching your legs thoroughly before bed and see if it helps.

THANK YOU!!!

Jason


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## Flamingtaco (Mar 12, 2012)

Regardless of any solutions to your issue, please replace Gatorade with just about any other electrolyte source. They may have been the first, but in modern times Gatorade is the McDonalds of electrolyte replacement.


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## DM33 (Aug 3, 2020)

I know this is a super old thread, but I'd like to share my experience as well. I had similar symptoms that were described*here: Since April 2020, I've had excruciating lower back pain during the second half of the night that got better with movement or exercise. Like some of the others, I tried many different things, and nothing seemed to help. Since I'm 30 years old and otherwise in-shape and perfectly healthy, I was becoming more and more convinced I had ankylosing spondylitis. In fact, I was just about to schedule a visit with a rheumatologist until I came across m.morrison's post (huge thanks man!!).

I've always had really tight hamstrings. Since the COVID outbreak started, I've been working at home and sitting in the same spot sometimes for 12+ hrs a day, and my hamstrings have gotten even tighter. However, after extensive stretching for a week, the pain at night is almost completely gone.

The disappointing thing is I saw PTs weekly for over 2 months, and they never identified tight hamstrings as a possible culprit.

I was also prescribed NSAIDs for the pain, and it didn't help the pain at all. So, in hindsight, this may have been a sign for me that this was not AS.


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## DrDon (Sep 25, 2004)

It’s the core man..... All about the core. Also, inflexibility and repetitive trauma. 

For me, it’s my neck. I wake up in the middle of the night with a severe headache. Built like bull. Since I started hiking more, the pain has mostly resolved. Yoga and Pilates would help, but I don’t like doing either. Weight training the entire body with multiple reps helps me. 


Sent from my iPad using Tapatalk Pro


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## Kumara (Jul 13, 2021)

Rattus said:


> Symptoms = I feel good all day (lucky me) and ride / work / play without any pain. But after about 4hrs in bed I wake with a sore aching back. Seems like my leg and back muscles have tightened up as I have reduced flexibility. I can't get back to sleep, so I get up and sit at the PC for about an hour or two, then I will have loosened up enough to go back to bed.


I've joined just to tell you this:

I've found the cause to the lower back pain mystery: leaky gut. When lying down, acid seeps through the leaky gut (downwards by virtue of gravity) and affects the nerves in the lower back.

Solution:
1. Repair the gut by consuming healthy oil.
2. Find out (such as through a blood test) what you are allergic too, and stop consuming that completely (until your gut is fully repaired). (Mine is eggs.)

By doing this, you should notice the difference the next morning. I'm very glad to have found the solution because my issue has improved to a fraction of what I had.


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