Low Back Pain and Sleep After 60: Why One Can Affect the Other
Low back pain is often thought of as a daytime problem. It can make it harder to walk, stand, bend, lift, garden, shop, exercise, or enjoy time with family. But for many adults, especially those over the age of 60, low back pain does not stop when the day ends. It can also affect sleep. A person may have trouble getting comfortable in bed, wake up when turning over, feel stiff in the morning, or notice that poor sleep makes their pain feel worse the next day.
A recent systematic review published in Chiropractic & Manual Therapies looked specifically at the relationship between low back pain and sleep quality in adults aged 60 years and older. The review, by Rahbar and colleagues, examined whether low back pain is associated with poorer sleep quality in older adults. This is an important topic because both low back pain and sleep difficulties become more common and more impactful with age (Rahbar et al., 2026).
The authors searched several major health databases, including MEDLINE, Embase, CINAHL, and PsycINFO, from their beginning dates through December 2025. They identified 2,394 articles, removed duplicates, screened 2,237 citations, reviewed 191 full-text studies, and ultimately included five low-to-moderate risk of bias studies in their evidence synthesis. These included three cross-sectional studies and two cohort studies. Although the studies used different definitions of low back pain and different ways of measuring sleep quality, the overall finding was consistent: chronic low back pain was positively associated with poorer sleep quality in adults aged 60 and older (Rahbar et al., 2026).
This does not mean that low back pain always causes poor sleep. It also does not mean that poor sleep always causes low back pain. The relationship is likely more complex than that. Pain can make it difficult to fall asleep, stay asleep, or find a comfortable position. Poor sleep can also make the nervous system more sensitive, reduce recovery, affect mood, lower energy, and make pain feel more intense the next day. Over time, this can create a cycle where pain disrupts sleep, and poor sleep makes pain harder to manage.
For older adults, this cycle can be especially frustrating. A poor night of sleep can make the back feel stiffer in the morning. Morning stiffness may make it harder to start moving. Less movement during the day can lead to more stiffness, reduced strength, reduced balance, and less confidence with activity. This can gradually affect walking, exercise, household tasks, hobbies, travel, and independence.
The review by Rahbar and colleagues is clinically important because it focuses on adults aged 60 and older. This age group is often affected differently by low back pain compared with younger adults. Older adults may be dealing with age-related spinal changes, arthritis, spinal stenosis, disc degeneration, reduced muscle strength, balance changes, medical conditions, medication use, or lower activity levels. Sleep may also change with age. Some changes in sleep duration and sleep maintenance can occur naturally, but significant declines in sleep quality can still affect health, function, and quality of life (Rahbar et al., 2026).
In the studies included in the review, sleep quality was measured in different ways. Some studies used self-reported sleep questions, while others used tools such as the Pittsburgh Sleep Quality Index. Sleep quality can include several different features, including how long it takes to fall asleep, how long someone sleeps, how often they wake during the night, how refreshed they feel in the morning, and how much sleep affects daytime function. This is important because a person may be “in bed” for eight hours but still feel poorly rested if they wake frequently or cannot get comfortable.
One of the interesting findings from the review was that the association between chronic low back pain and poor sleep quality was generally small. This matters. It means low back pain is likely one factor among many that can influence sleep. Sleep can also be affected by stress, anxiety, depression, medications, caffeine, alcohol, sleep apnea, restless legs, urinary frequency, medical conditions, reduced activity, and irregular routines. For that reason, it is important not to oversimplify the issue. Back pain may be part of the sleep problem, but it may not be the only reason a person is sleeping poorly.
At the same time, even a small association can matter in real life. For a person already struggling with mobility, balance, fatigue, or chronic pain, poor sleep can make daily life feel much harder. A patient may say, “My back is not terrible, but I wake up exhausted,” or “I can manage during the day, but I cannot get comfortable at night.” These are important clinical clues. They tell us that the goal of care should not only be reducing pain on a pain scale. The goal should also include improving function, confidence, movement tolerance, and quality of life.
At The Muscle and Joint Clinic, we often see this pattern in patients with low back pain. Some patients feel worse first thing in the morning. Others feel relatively comfortable during the day but struggle when lying down. Some wake when rolling over in bed. Others report that they sleep better after they have been more active, stretched gently, or received treatment. Some patients with spinal stenosis feel better sleeping slightly flexed or on their side, while others with disc-related pain may prefer different positions. There is no single sleeping position that works for everyone, which is why assessment matters.
A proper assessment of low back pain should include more than simply asking where the pain is. It should include questions about sleep, morning stiffness, walking tolerance, sitting tolerance, standing tolerance, leg symptoms, numbness or tingling, balance, strength, activity level, and medical history. It is also important to ask whether symptoms are changing, whether pain wakes the person at night, whether there has been unexplained weight loss, fever, trauma, cancer history, bowel or bladder changes, or progressive neurological symptoms. These details help determine whether conservative care is appropriate or whether medical referral is needed.
When conservative care is appropriate, chiropractic and manual therapy care may help by addressing some of the physical factors that contribute to discomfort. This may include improving spinal and hip mobility, reducing muscle tension, addressing joint stiffness, improving movement patterns, and helping patients gradually return to activity. Treatment may include gentle spinal mobilization or manipulation when appropriate, soft tissue therapy, assisted stretching, exercise therapy, education, posture advice, and strategies to reduce flare-ups. For older adults, the plan should be individualized and adapted to the person’s comfort, health status, goals, and tolerance.
Exercise is also an important part of managing persistent low back pain. For many older adults, the goal is not aggressive exercise. The goal is safe, consistent movement that improves confidence and function. This may include walking, gentle mobility exercises, hip strengthening, core endurance work, balance training, and gradual conditioning. When people move better during the day, they may also feel less stiff at night and in the morning. However, exercise needs to be prescribed carefully. Too much too soon can flare symptoms, while too little movement can lead to deconditioning.
Sleep positioning can also be worth discussing. Some patients feel more comfortable lying on their side with a pillow between the knees. Others prefer lying on their back with a pillow under the knees. Some patients benefit from adjusting pillow height, mattress support, or how they get in and out of bed. These changes do not “cure” low back pain, but they can reduce strain and help the body settle more comfortably at night.
It is also important to recognize when sleep concerns need medical attention. If a patient has loud snoring, pauses in breathing, morning headaches, severe daytime sleepiness, restless legs, significant insomnia, medication concerns, mood changes, or ongoing sleep disruption that does not improve, they should speak with their family doctor or appropriate healthcare provider. Low back pain may be part of the sleep problem, but sleep disorders and medical conditions should not be missed.
The study by Rahbar and colleagues also reminds clinicians to be humble about the evidence. The authors noted that more high-quality studies are needed. Many existing studies use different definitions of low back pain and different measures of sleep quality. Most rely heavily on self-reported sleep measures. Cross-sectional studies can show an association, but they cannot prove cause and effect. Even the better-quality studies suggest that the relationship between low back pain and sleep quality is real, but generally small and influenced by many other factors (Rahbar et al., 2026).
For patients, the practical message is simple: if you are over 60 and struggling with low back pain, your sleep matters. If your sleep is poor, your back pain may feel harder to manage. If your back pain is persistent, it may be one of the reasons you are not sleeping well. Either way, it is worth discussing both issues during your assessment.
Low back pain care should not only focus on the spine as a structure. It should focus on the person. That means understanding how pain affects walking, sleep, mood, confidence, independence, and daily life. For some patients, the first goal may be sleeping more comfortably. For others, it may be walking farther, standing longer, returning to exercise, or feeling less stiff in the morning. These goals are connected.
At The Muscle and Joint Clinic, our approach is to assess the full picture. We look at spinal movement, hip mobility, muscle function, posture, walking tolerance, strength, flexibility, and symptom patterns. We also ask how pain is affecting sleep and daily function. From there, we create a treatment plan that may include hands-on care, exercise, education, and practical strategies to help patients move with more confidence.
Chronic low back pain and poor sleep often travel together in older adults. The relationship may not be simple, and it may not be the same for every person, but it is important. Better care starts by asking better questions. If back pain is affecting your sleep, or poor sleep is making your pain harder to manage, it may be time to have a proper assessment.
References
Rahbar, P., Wong, J. J., DeSouza, A., Papaconstantinou, E., Wang, D., Hogg-Johnson, S., & Côté, P. (2026). The association between low back pain and sleep quality in adults 60 years and older: A systematic review. Chiropractic & Manual Therapies. Advance online publication. https://doi.org/10.1186/s12998-026-00656-w
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Rahbar, P., Wong, J. J., Wang, D., Papaconstantinou, E., Hogg-Johnson, S., & Côté, P. (2025). The association between chronic back problems and poor sleep quality among Ontarian adults aged 60 years and older: A cross-sectional study analyzing the Canadian Community Health Survey 2015–2016. Canadian Journal of Public Health.
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