Backs are often at their stiffest first thing in the morning. Discs rehydrate overnight and muscles cool down, so the first movements of the day can feel like the hardest ones you'll make. These five habits, drawn from what we teach patients every week, make mornings kinder to your spine.
None of them take long, and most cost nothing. Every one of them is something our therapists walk people through at the clinic on US-1, often in the first week of care, because the way you get out of bed and through the first half hour tends to set the tone for the rest of the day.
By The First Rehabilitation Team · Reviewed by Dr. Dave Kashuba, Ph.D.
Why is your back worst when you first get up?
You've spent the night lying more or less still. The discs between your vertebrae have taken on fluid, the muscles along your spine have cooled off, and nothing has asked your back to move in hours. Then, within about ten minutes of waking, most of us ask it to do a whole lot at once: sit straight up, bend over a sink, lean into a car seat, hunch over a phone at the kitchen table.
Dr. Dave Kashuba, Ph.D., OTR, who founded our clinic in 1991 and still treats patients, pointed out on Episode 8 of our Pain 2 Power show that people are about the only creatures that skip the warm-up. “Babies wake up, they stretch, dogs and cats wake up, they stretch before they do anything,” he said. “We grab our glasses, a cup of coffee, and go to work.”
Morning stiffness on its own is common, and it usually eases as you get moving. What makes it worse is loading a stiff back hard and fast. The habits below are about giving your spine a gentler ramp into the day, and then building the strength that makes the ramp less necessary over time.
If your mornings come with leg pain, numbness or a back that never really loosens up, skip ahead to the section on when to get it checked. Those call for a proper evaluation rather than a better routine.
Habit 1: Don't sit straight up out of bed
Roll to your side first, drop your legs off the edge, and push up with your arms. This “log roll” spares your spine the loaded crunch of a straight sit-up while the tissues are still waking up. It feels a little fussy the first few times. After a week it's automatic.
Here's how we usually coach it, one step at a time:
- Lying on your back, bend your knees so your feet are flat on the mattress.
- Roll onto your side, letting your shoulders and hips turn together so your back doesn't twist.
- Slide your lower legs off the edge of the bed.
- As your legs go down, push yourself up sideways with your bottom elbow and your top hand, so your trunk comes up without curling forward.
- Sit on the edge for a breath or two before you stand.
Getting back into bed at night is the same thing in reverse: sit on the edge, lower yourself onto your side using your arms, then roll onto your back. If you're a snowbird sleeping on a softer rental mattress for the season, you'll probably notice the difference this makes even more, since a deep mattress makes the straight sit-up harder work.
Habit 2: Give it two gentle minutes before the coffee
Before coffee, spend two minutes moving gently. Pelvic tilts lying on your back, knees rocking side to side, or a slow walk around the house all count. Motion is lotion: easy movement gets the circulation going and takes the edge off that first-hour stiffness.
Keep it gentle enough that nothing hurts. You're reminding your back how to move before you ask it to carry anything.
Still in bed, or on the floor
Pelvic tilts are the simplest start. Lie on your back with your knees bent, then flatten the small of your back gently toward the mattress and let it relax again. Knee rocks are the follow-up: keep your knees together and let them drift a little way to one side, then the other, only as far as feels easy.
Some people prefer to do this on the floor because the bed is too soft. That's fine, with one condition borrowed from Dave's note on our exercises page: before you get down on the floor, make sure you can get back up.
On your feet
If lying down isn't your thing, walk. A slow lap of the house or a trip to the end of the driveway for the paper counts, and so do a few minutes on the lanai. Dave's advice on the show was to start small and build: “Just a little bit of exercises, 10, 15 minutes a day, three minutes a day, and work your way up.” Our everyday movement set lists walking as a daily habit for exactly that reason, and notes it's good for the back and the knees at the same time.
Habit 3: Rethink the couch scroll
Thirty minutes slumped over a phone puts sustained load on the very structures that stiffened overnight. If you like a slow morning, and plenty of us do, sit supported rather than folded into the couch. Sit with your back against a firm chair and your feet on the floor, and raise the phone toward eye level instead of resting it in your lap.
Dave has a line he uses on the radio that always gets a laugh, though he means it: “I tell everyone the invention of the chair is one of our demise.” His fix is plain. Put the phone down, then get up and walk or do a few sit to stands. The movement you already know how to do is usually the one that gets skipped.
On Episode 10, talking about hips that are just starting to hurt, he listed the small changes he'd try first: “you want to avoid sitting with your legs crossed, repetitive bending, a modification of tasks.” The same thinking works for a cranky low back in the morning. If your routine involves sitting cross-legged with the news, unloading the whole dishwasher bent at the waist, then sitting again for the drive to work, try spreading those jobs out or changing how you do them.
The home office deserves a look too. A monitor set a couple of inches too low will pull you into the same slump as the couch, eight hours at a stretch. Raise the screen and bring the chair in close. Then get up every so often.
Habit 4: Let warm water do some of the work
A warm shower relaxes the muscles along your spine and makes the morning's movement easier. Let the water hit your lower back for a minute or two, then follow it with a gentle bend forward and back, staying well inside what's comfortable.
If you don't shower in the morning, a warm pack does the same job. Our patient glossary uses “a warm pack before stretching a stiff back” as its example of a modality, which is the clinical word for supporting treatments like heat, cold and electrical stimulation. You can read the glossary entry on modalities if you're curious what else falls under that heading.
Heat has one limit. It makes the stiffness easier to move through, but it doesn't build anything, so in the clinic we use modalities to support strengthening work rather than replace it. Think of the shower as the warm-up for habit five. And if warmth makes your back feel worse rather than looser, stop and mention it to your therapist.
Habit 5: Anchor one strengthening habit
The long-term fix for most recurring back pain is strength: core, hips and glutes. Attaching one simple exercise, such as a bridge or a bird dog, to something you already do every morning, like brushing your teeth, is how it sticks.
A short menu to pick from
You don't need all of these. Pick one or two that feel manageable and make them part of the morning. Every exercise in this table appears on our home exercises page, and every one of them is something Dave prescribed on air.
| Exercise | How much, as listed | What our exercises page says it does | Episode |
|---|---|---|---|
| Walk | Daily, starting at three minutes and working up toward 10 or 15 | Gets blood moving and helps the back and knees at the same time | 8 |
| Stretch before you start the day | Every morning | Costs nothing and sets up everything else | 8 |
| Sit to stands | Little and often, without pushing off with your hands if you can | The most functional movement most people stop practising | 8 |
| Glute bridge | 3 sets of 10 | Works the glutes; lift your hips, pause and squeeze at the top | 7 |
| Clams | 3 sets of 10 each side | Strengthens the hip's external rotators, which nothing in daily life asks for | 10 |
| Standing leg abductions | 3 sets of 10 each side, holding the back of a chair | Direct work for the gluteus medius | 10 |
Why your hips get a say
You'll notice half of that menu is hip work. That's on purpose. A stiff or weak hip can push extra work onto the low back, and sometimes what feels like back pain is actually coming from the hip.
Orthopedic surgeon Dr. Zach McVicker, MD, of Paley Orthopedic and Spine Institute, made the point on Episode 10: “for hips, a lot of times it's causing the back pain, it's causing the groin pain and other symptoms that you're having.” Asked which symptoms should send someone to have their hips checked, he started with groin pain, then added “low back pain, SI joint type pain. So pain kind of towards the buttock, pain on the outside of the hip.” If that sounds familiar, our post on hip impingement and back pain goes further.
Making it stick
The habit matters more than the exercise. Ten bridges while the coffee brews, sit to stands every time you get up from the breakfast table, clams before you get dressed. Three minutes counts. A little every day does more than a long session now and then, which is the same thing Dave tells every patient leaving with a home program.
When should morning back pain get a professional look?
If mornings are consistently painful, if the stiffness doesn't ease as the day goes on, or if pain runs into your leg, have a professional look at it. Sciatica, discs and spinal stenosis are all on the list our back pain program treats, and they respond better to a plan than to a routine you've pieced together yourself.
A few things shouldn't wait for a therapy appointment at all. Back pain with loss of bladder or bowel control, numbness in the groin or inner thighs, or leg weakness that keeps getting worse needs urgent medical care. So does back pain after a real fall or accident, or back pain that comes with a fever. Once a physician has ruled those out, physical therapy can treat the mechanical side with confidence.
Dave's view, said plainly on Episode 10, is that “you can't cookie cut what programs you're going to do if someone comes in with back pain.” Two people can describe the same stiff morning and need very different things. That's the job of the evaluation, and it's why nothing on this page should replace one.
What we'd do at the clinic
Plan on about an hour, one-on-one with your therapist. We'll ask what your mornings look like, what you do for work and fun, and what makes the pain better or worse. Then we watch you walk, bend and sit, check your hips as well as your spine, and measure strength and range of motion. Treatment usually starts the same day, and you leave with the first exercises of your home program, often one or two of the moves in the table above. Our post on what to expect at your first visit walks through the hour in more detail.
In most cases Florida's direct access law lets you start a physical therapy evaluation without a physician referral, though some plans still require one and Medicare needs a physician to certify your plan of care. Our front desk checks all of that, along with your benefits, before your first visit. If you're on Medicare, the 2026 Medicare guide on our insurance page explains deductibles and coinsurance.
If your back has been running your mornings for a while, call 561-624-4263 to book an evaluation, or request an appointment online. We're at 733 US Highway 1, Suite 2A in North Palm Beach, open Monday to Friday 8:00 AM to 5:30 PM and Saturday 8:00 AM to 12:30 PM.
This article is general information, not medical advice. Every situation is different, so please consult a qualified professional about yours.