If you’ve lain down at night, only to be bothered by aching or discomfort in your legs, but noticed it doesn’t bother you during the day, you’re not alone. It might feel strange, even confusing, and I can’t tell you how many people walk through our doors saying, “I just don’t get why it hurts when I’m trying to rest.”
As a vascular surgeon specializing in vein care, I see leg pain daily. But the trick is this: not all leg pain is caused by veins. That’s why identifying the pattern of your pain is so important.
Let’s talk about what might be going on when your legs hurt more while lying down than when you’re up and about.
When Leg Pain Points to the Back
When someone tells me their leg pain only shows up while lying down, but not while standing or walking, that often points us in a different direction: the back.
Most people are surprised to learn this, but pain in the legs can start in the lower back, where nerves live. If one of those nerves is irritated or pinched, it can send pain signals down into the leg. Even though the discomfort feels like it’s coming from your leg, the source is higher up.
Sometimes that back pain is so subtle that people don’t even notice it because the leg hurts more, and that’s where their attention goes. But I always ask questions like:
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Is there a position you get into at night that makes it worse?
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Do you feel it more when you bend, twist, or lift something during the day?
Pain that gets worse in certain positions is a common sign that the real issue might be a back-related nerve problem. In those cases, the best next step is to visit a back or orthopedic specialist who can do an X-ray, CT scan, or MRI to take a closer look.
Pay Attention to Patterns
As I mentioned, how and when your pain shows up tells us a lot. While pain that flares up when lying down might suggest a back issue, leg pain that worsens as the day goes on could be pointing to something else, like a vein condition.
This pattern is one I see all the time. People tell me their legs feel fine in the morning, but by afternoon or evening, their legs feel:
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Tired
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Heavy
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Achy
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Swollen
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Restless
They often feel better after sitting down and putting their feet up. That’s not just a coincidence. It’s a common sign that blood may be pooling in the lower legs, due to a condition called vein reflux, when the veins can’t push blood back up the leg the way they should.
Over time, this backup of blood causes inflammation, which not only affects your legs but can leave you feeling fatigued and like you didn’t sleep well, even if you did.
And here's something important to remember: you don’t need to see varicose veins or spider veins to have a vein issue. Sure, visible veins are one clue, but I’ve treated many patients whose legs looked perfectly normal on the outside. What was happening inside was a different story.
So, What’s Next?
If your leg pain is linked to positions or movement, especially while lying down, it might be time to look at your back.
But if you notice your legs feel worse at the end of the day, and better when you elevate them, or if you're dealing with swelling, heaviness, or fatigue, your veins might be the culprit.
Here’s the good news: there’s hope.
Vein conditions are treatable, and you don’t have to keep wondering or suffering in silence. At Missouri Vein Care, we offer free vein screenings to help you find out if your leg pain might be coming from a vein issue.
Let’s get you some answers—and help you feel normal again.
