How Back Pain While Sleeping Could Be Your Position


Break the Vicious Cycle of Back Pain From Sleep

Sweet senior couple sleeping in bed and woman hugging him
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If you're like most people with chronic neck or back pain, one of the biggest problems you have to deal with is getting to sleep and staying that way. Often it's the unrelenting pain that is responsible for a sleepless night, but sometimes, the way you position yourself may contribute, and make things worse. And of course, lack of sleep will most likely only increase your pain.

It's a vicious cycle.

In the spirit of doing everything you can to disrupt this negative spiral, here are some ideas on how to support your body keep pressure off your spine when you sleep.


Use Pillows Wisely

Neck arthritis pillows
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Key to establishing good bedtime positions is the use of pillows. Propping up certain areas of your body with pillows may improve your odds of getting a full night sleep; this is because pillowing can lend support, which in turn, may help you relax, make you more comfortable, and help you avoid muscle or joint strain to vulnerable areas.

If you have lower back or neck pain, the idea is to experiment with pillowing as a way of reducing strain around the vertebral joints. 

Pillow support from positioning or from a pillow type may be especially valuable in or around the curves of your spine, as these areas don't get a lot of support from the bed.Your lumbar (low back region) and cervical (neck area) curves are the ones you can do something about; again, experimentation is the key.

Lumbar support pillows are designed to relieve strain and pressure on the spine.


Pillowing Strategies for Side Sleepers

Sleeping on the side.
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If you are a side sleeper, consider the following pillow strategy.

Put padding between your knees to raise your top leg a bit. This small lift of the top leg may keep your hip and knee in good alignment, which may, in turn, help relax the hip muscles and keep them from straining. Improving your hip and knee alignment may also help avoid strain or irritation in the hip joint—one less thing to keep you up during the night.

Along with that, you might use a pillow to fill up the space between the bed and your waist. The same idea applies to your neck curve. Consider positioning your (regular) pillow such that part of it is under your neck which thereby fills in the space between your neck and the bed, providing more support for your neck curve.


Pillowing Strategies for Back Sleepers

woman Sleeping on her back in a bed
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Supine (i.e., sleeping on your back) is, in general, a recommended position Along with other positive health benefits, it allows you to establish good body alignment, which may help decrease joint strain and relieve any pain that is associated with a muscle strain.

But in this position—as with side sleeping—a bit of padded support can go a long way towards helping you get a night's sleep. In this case, it's the knees. 

For many people, lying on their back with their knees fully extended (straight) creates low back strain. This position pulls the pelvis out of its normal alignment and leads to an arched position of the low back. Sleeping all night with your back arched may tighten low back muscles and cause pain.

So if you support the back of your knees by putting a pillow under them, your legs will likely rest in a slightly bent position, which in turn will encourage a more neutral pelvic position. This is another excellent way to relieve joint strain and low back pain during the night.

By the way, If you sleep on your back, you may, in addition to a pillow under your knees, put padding under your ankles. This is mostly a matter of comfort, but you may notice that padding under your ankles furthers increases your comfort.


Pillowing Strategies for Stomach Sleepers

woman napping on her stomach on a couch
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Sleeping on your stomach, which is a position called prone, tends to be problematic for a lot of people. It creates stress on back muscles by accentuating your low back curve—and not in ​a way that's harmonious with good posture. Rather, it puts too much arch there, which may lead to unnecessary tension in the nearby muscles.

Along with that, stomach sleeping all but requires you rotate your head to one side or the other. This can cause neck pain or result in spasm of the upper back muscles (between the shoulder blades.)

So the best advice is to avoid stomach sleeping altogether. If that's not possible, you might consider putting a flat pillow under your abdomen to help lengthen your low back curve (and relax the muscles.)

You might also skip using a pillow for your head to allow your head to rest in good alignment during the night.

6 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  2. Staffe AT, Bech MW, Clemmensen SLK, Nielsen HT, Larsen DB, Petersen KK. Total sleep deprivation increases pain sensitivity, impairs conditioned pain modulation and facilitates temporal summation of pain in healthy participants. PLoS One. 2019;14(12):e0225849. doi: 10.1371/journal.pone.0225849

  3. Lee WH, Ko MS. Effect of sleep posture on neck muscle activity. J Phys Ther Sci. 2017;29(6):1021-1024. doi: 10.1589/jpts.29.1021

  4. Jeon MY, Jeong H, Lee S, et al. Improving the quality of sleep with an optimal pillow: a randomized, comparative study. Tohoku J Exp Med. 2014;233(3):183-188. doi: 10.1620/tjem.233.183

  5. The Cleveland Clinic. Bike, Side, or Stomach: What Sleep Position is Best for You?

  6. Cary D, Jacques A, Briffa K. Examining relationships between sleep posture, waking spinal symptoms and quality of sleep: A cross sectional study. PLoS ONE 12021;6(11): e0260582. doi: 10.1371/journal.pone.0260582

By Anne Asher, CPT
Anne Asher, ACE-certified personal trainer, health coach, and orthopedic exercise specialist, is a back and neck pain expert.