Sleep Series Part 2: Best Sleeping Positions for Low Back Pain

Updated: Oct 15, 2020

Sleep and low back pain (LBP) can be a catch-22. Having LBP can cause difficulties with falling asleep and staying asleep while not getting enough sleep can increase fatigue and delay healing. Sleep is important whether you are suffering from a recent injury or a chronic condition.

Woman resting in a peaceful setting.

Nearly 60% of patients with LBP chronic pain also suffer with difficulty sleeping.

Pain can interfere with falling asleep or finding a comfortable position, as well as with waking up during the night. One way to help fall asleep and stay asleep is to put the body in an ideal sleeping position that limits possible strain on the back.

Figure 2.8: a) shows a neutral spine with lumbar lordosis. This is the "ideal position"  b) shows hyperlordosis or hyperextension of the lumbar spine    c) shows hypolordosis of the lumbar spine or "flat back"
Lower Back Anatomy

Figure 2.8:

a) shows a neutral spine with lumbar lordosis. This is the "ideal position"

b) shows hyperlordosis or hyperextension of the lumbar spine

c) shows hypolordosis of the lumbar spine or "flat back"


The supine position (back sleeper) is thought to be the best to allow equal distribution of body weight.

The supine position (back sleeper) is thought to be the best to allow equal distribution of body weight. As you can see in the photos, both positions allow for the lower spine to rest in a neutral position. If you choose to place a pillow under your knees or your calves, your legs should not be elevated too high above your heart or it can decrease blood flow to your legs and feet.
The Supine Position: Sleeping on your Back

As you can see in the above photos, both positions allow for the lower spine to rest in a neutral position. If you choose to place a pillow under your knees or your calves, your legs should not be elevated too high above your heart or it can decrease blood flow to your legs and feet.


If you are a side sleeper who suffers from back pain, the use of props of pillows or blankets can help prevent torsion of the body which can increase symptoms. By placing pillows between your knees you can help maintain neutral hip and spine position.

If you are a side sleeper who suffers from back pain, the use of props of pillows or blankets can help prevent torsion of the body which can increase symptoms.  By placing pillows between your knees you can help maintain neutral hip and spine position.
Sleeping on your side

In the picture above on the left, you can see that the hips are not supported and the leg falls across the mid line of the body, creating torsion in the back which can potentially create discomfort with a sustained overnight position. With the use of a pillow between the knees on the right, the hips and legs are placed in a more neutral, supported position.


Prone or stomach sleeper is the least ideal position as it tends to put more pressure on your organs and may allow for hyperextension of the spine.

Prone or stomach sleeper is the least ideal position as it tends to put more pressure on your organs and may allow for hyperextension of the spine.
Prone Sleeper: Stomach Sleeper

In the photo above on the left, the individual has increased lordosis or hyperextension of the spine. With the use of a pillow under the hips and lower abdomen on the right, there is a more neutral curvature of the lower spine and neck.

If you tend to be one of the above types of sleepers, and it is not working for you, try one of the other positions; it just may become your new favorite!



*This is not medical advice. There are potentially other positions that may be beneficial depending on your specific condition. Reach out to a trusted provider for more information.



References:


Figure 2.8 Bony landmarks and standing pelvic alignment (side view): https://doctorlib.info/yoga/pilates/3.html


Alsaadi SM, McAuley JH, Hush JM, Maher CG. Erratum to: prevalence of sleep disturbance in patients with low back pain. Eur Spine J. 2012;21:554–560. Effects of sleeping position on back pain in physically active seniors: A controlled pilot study. Gustavo Desouzart, Rui Matos, Filipe Melo, Ernesto Filgueiras. Work Journal 53(2016): 235-240.

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