By Dr. Marcus Hale | Physical Medicine and Rehabilitation Physician
A Note About the Author
I’m Dr. Marcus Hale, a physical medicine and rehabilitation physician with a focus on helping adults manage common muscle and joint problems. In my clinical work, I often hear the same complaint: “My back feels manageable during the day, but the moment I get into bed, I cannot get comfortable.” I wrote this article to explain how sleep position can affect comfort and how you can make simple changes without treating a pillow or mattress as a cure.
Best Sleeping Position for Lower Back Pain
Do not obsess over finding the perfect sleep position. According to Cleveland Clinic, there is no single sleeping position that works for everyone with lower back pain. Instead try what is comfortable for your spine and which does not worsen your symptoms. For many it is useful to start with side sleeping which has a pillow between the knees or back sleeping which has a pillow under the knees.
I’ve had reports of people spending great sums on mattresses, pillows, and supplements which instead they should have tried a more basic solution. Body position does play a role, but so does the cause of your pain. What may improve your sleep is a more comfortable position, but it does not in fact treat an issue at the root of your health.
Side Sleeping: Start With a Pillow Between Your Knees
I also bring to notice that for side sleepers we use a pillow between the knees. You lay on your side with your knees bent a little, then put the pillow there. According to Cleveland Clinic, side sleepers may find it helpful to place a pillow between the knees. This may correct the upper leg from waking out of alignment and also the pelvis. Also pay attention to your head pillow, it should support your head in a way that your neck is at ease and not forced into a sharp up or down position.
If you find your pillow too thin which can causes your knee to drop towards the mattress try a thicker one. We are after comfort and support which may not include forcing your legs into a rigid position.
Back Sleeping With Support Under Your Knees
If you are a back sleeper try positioning a pillow under both of your knees which in turn will gently bend your legs and may reduce the need for your lower back to maintain that arch.
I will also check pillow it should support your neck which in turn should not see your chin press into your chest. Also if lying flat makes your pain worse do change the leg support instead of forcing that position on yourself.
What About the Fetal Position?
A very slight fetal position is to taste for some side sleepers. I suggest bending the knees instead of drawing them tight to the chest. Also if you twist your body or notice that it increases the pain try loosening the position up or put together a different set up.
Should You Sleep on Your Stomach?
Stomach sleeping is often more difficult if you have lower back pain since that is where you head will go at which may also put your lower back in a less than ideal position for comfort. Also when you have lower back pain the body’s natural response is to turn the head to one side which in turn causes issues in the lower back.
If you find that stomach sleeping is the only way you do fall asleep, try out a thinner pillow for that and also a small support under the pelvis or lower abdomen if it is comfortable. At any point stop if the change causes your symptoms to increase.
How I Would Set Up Your Bed Tonight
I would not change all at once. Try one at a time and see how your body reacts.
· Side sleeper: Place a pillow between your legs.
· Back sleeper: Put a pillow under your knees.
· Check that your pillow is in place for neck support.
· Steer clear of a position which causes pain, numbness or tingling.
· Notice what you are feeling upon awakening.
Your Mattress May Matter Too
A mattress doesn’t always bring about back pain but it does play a role in comfort and pressure. If you wake up sore on the same mattress every night and notice you feel much better with a different sleep surface that’s a good sign to look at your mattress and pillow.
I won’t say that a firm mattress is always the best. We all have different bodies, sleep postures, and pain issues which is why what you find comfortable and which relieves your symptoms is what counts.
What If You Wake Up With Pain Every Morning?
According to Mayo Clinic, back pain can have many possible causes, so recurring or worsening pain should not automatically be blamed on sleep position. I do not assume that your sleep position is to blame. That which causes lower back pain is many sided — muscle strain, joint issues, disc problems, nerve irritation are all players. If you are experiencing recurrence of the pain, an increase in intensity or it’s a regular guest at your awake times then it is advised to bring it up with a health care professional instead of trying out different pillows.
Magnesium and Sleep
Magnesium is a required mineral but I would not put forward a magnesium supplement as a sure fire solution for back pain or poor sleep. If you are to take a supplement which in addition you may be taking medication for or have a health condition, ask a doctor or pharmacist first.
Sleep and Weight Loss
Better rest is a component of healthful daily routines, also it is true that no sleep position brings about weight loss. If back pain is a factor in your sleep quality which in turn affects your activity level during the day, improving your comfort at night may in turn make it easier to maintain routine activities.
When Back Pain Needs Medical Attention
Pillows are not the only solution when you have warning signs. See your doctor right away for new issues of incontinence, difficulty urinating, numbness in the groin or anal area, large scale weakness or numbness in both legs, severe and quick to progress pain, fever with back pain, or very bad pain after major injury. The NHS likewise advises urgent assessment for certain neurological symptoms and changes in bladder or bowel function
Persistent and increasing pain also has to be evaluated by a professional, also if it is that which does not go away during sleep or which interferes with daily activities.
Frequently Asked Questions
Which way I should sleep: With lower back pain, on my back or side?
Both of these are good options. Side sleep with a pillow between the knees and back sleep with a pillow under the knees is a good start. Choose what is most comfortable for you and which does not worsen your symptoms.
What is the best way to sleep with lower back pain and sciatica?
There isn’t a one size fits all position. Many do side sleep with knee support or back sleep with a pillow under the knees. Also report to doctor if you see increase in weakness, major numbness, or problems with bladder and bowel.
Is it better to sleep without a pillow for back pain?
Not at all. Your neck still requires support. For best results choose a pillow which is at a height that which your neck feels at ease and is well aligned with your sleeping position.
Does a mattress cause lower back pain?
A mattress does play a role in pressure and comfort but is not always the issue. If you are feeling better on a different bed try evaluating your mattress and pillow.
The Position I Would Try First
If you have no idea where to begin, try side sleeping which has a pillow between your knees. If you are a back sleeper at all times, try a pillow under your knees instead. Give each change a few nights out and notice how your back feels in the morning.
The best sleep position for back pain is a very personal thing. What you want is a position which allows for relief and does not increase your pain. If you are in constant, severe pain which also includes warning signs see a medical professional instead of looking to sleep position as a solution.