Back pain can disrupt a good night sleep. Conversely, how you sleep may worsen or improve your condition. Poor posture or posture that deviates from neutral spinal curvature is a known contributing factors of back pain. Certain sleep positions can put added pressure on your neck, shoulders, hips, lower back, knees, and even your heels, causing musculoskeletal pain.
While certain sleep positions can worsen an already aching back, others may help you find relief. Given that we spend one-third of our lives lying down, either resting or sleeping, proper posture helps the musculoskeletal system and the central nervous system recover. This subsequently reduces stress, relaxes muscles and promotes a better body balance.
There’s no strict guideline on sleep position to prevent back pain, but adjusting your preferred sleep position can help minimise your pain and provide your much-needed rest.
Usually considered to be the best sleeping position for a healthy back, lying on the back distribute the body weight over a large surface area, resulting in better stability. Besides minimizing pressure points, it ensures good alignment of the head, neck, and spine. To further improve supine sleep position, put a small pillow under your knees to allow your spine to maintain its natural curve.
In the supine position, various postures can be adopted with your hand placement. A study published in the Journal of Physical Therapy Science compared 3 postures adopted in the supine position: hands positioned at the side, on the chest and the dominant hand on the forehead. Of the three supine positions, placing your dominant hand on the forehead can actually increase neck muscle activity, causing unbalanced alignment of the cervical spine and consequently increase neck and shoulder pain.
Therefore, avoid making it a habit to raise your hand on or above your head while sleeping in a supine position to prevent musculoskeletal pain of the neck and shoulders.
The lateral position or side position is the most adopted sleeping posture. With a well-conceived sleeping surface and pillow, it is able to support the human spine correctly.
In the lateral position, the spinal column is in a straight line while the body natural curves are maintained. There are no differences between sleeping on the left or on the right side, except the weight of the liver is pushing on the stomach and the lungs when sleeping on the left side.
However, due to the decrease contact surface and the centre of gravity being more elevated, a lateral position can be unstable. It may even contribute to shoulder pain as a smaller area of contact between the body and the bed imply a greater per unit of area pressure on the shoulder. 3 If you are a side sleeper, draw your legs up slightly toward your chest and place a pillow between the knees to raises the upper leg. This helps to restore the natural alignment of the hips, pelvis, and spine.
In a study involving ageing women who suffered from back or neck pain, those who complained of low back pain were recommended lateral position while those who have neck pain were oriented to supine sleep position. Both are also supplemented with an additional pillow to the knee/between the leg. The result shows that 90% reported a decrease in pain after complying to the given instruction.
The prone sleep position, lying facing downward, also known as stomach sleep position is the most unfavourable posture in relation to back support and should be avoided. Prone position can flatten the natural curve of your spine, putting some additional strain on your back muscles. Stomach sleeping can also cause your neck to be rotated, which can actually result in neck pain or back pain between your shoulders.
Even so, sleeping on your stomach can be beneficial for people with a herniated disc or degenerative disc disease. If you’re a stomach sleeper, put a slim pillow under your lower abdomen and hips to improve spinal alignment and ease back strain. Use a flat pillow for the head or consider sleeping without one to avoid neck rotation.
Although you may prefer one sleep position over the other, we actually did not maintain the same sleep position throughout the night. It’s normal to move around a bit while sleeping, which actually help ease pressure on our back. In fact, sleeping in the same position for too long has the potential to amplify back pain.
Besides sleep position, your daily activity or a lack of it may be the actual culprit. We spend a great portion of our day time sitting, sometimes (or perhaps most of the time) in a slouched position with our backs rounded. Hence, during the day, try to vary your posture as much as possible, and practice good posture when standing and sitting to help ease back pain at night.
The firmness of your mattress and the type of pillow you use can also affect your level of comfort. Whether you prefer a hard mattress or a soft mattress, personal preference and comfort should be your guide in choosing the right sleeping surface.
There’s a wide range of pillows that address back and joint pain issues as well. If you sleep on your back, wedge pillows (bed wedges) have been known to provide back pain relief and they also fit comfortably between your knees. If you are suffering from neck strain, the use of a contoured pillow may help to alleviate it.
If a few changes to your sleep position don’t help your back pain or sleep troubles, it may be time to get a medical opinion. If your pain worsens, meet your doctor to check for any potentially serious problems.
Hello Health Group does not provide medical advice, diagnosis or treatment.
Review Date: March 6, 2019 | Last Modified: September 12, 2019
Desouzart G, Matos R, Melo F, Filgueiras E. Effects of sleeping position on back pain in physically active seniors: A controlled pilot study. Work. 2016 Jan 1;53(2):235–40.
Jacobson BH, Boolani A, Dunklee G, Shepardson A, Acharya H. Effect of prescribed sleep surfaces on back pain and sleep quality in patients diagnosed with low back and shoulder pain. Appl Ergon. 2010 Dec;42(1):91–7.
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