As a chiropractor, a topic that I get asked about on almost a daily basis, is sleep posture – “what’s the best position to sleep in?” “Is it bad if I sleep on my stomach?” “What pillow should I use?” are some of the most common questions! How you sleep can play an important role in managing back pain, but there are also a lot of misconceptions out there. This insight will cover the science of sleep posture, its relation to back pain, and some practical tips to help you get a better night’s sleep.
Does “bad” sleeping posture cause back pain?
Patients often come into clinic complaining of back or neck pain, exclaiming that they’ve “slept on it wrong”. Which often leads to questions around “good” versus “bad” sleeping posture. A quick google search will provide plenty of examples of what is often cited as the correct sleeping postures (Figure 1).
They usually describe side and back sleeping to be best, and to avoid sleeping on your stomach. This is believed to be because it puts increased strain on the muscles and joints of the neck and back. However, despite these claims there is very little science to tell us what is actually the best way to sleep for back pain. One study that summarised the current science, reported there is not enough research to support any specific position being the best (1). Another study asked people what positions that avoid because of back pain. They found 42% avoid stomach sleeping, 35% avoid back sleeping, and 28% avoid either their left of right side (2). This means that it’s difficult to give blanket statements (pun intended) about what is the best position, as it will depend on your own personal circumstances.
How to decide what’s the best posture for you? Our top tips!
As a general rule, you should sleep in which ever position you feel most comfortable, and rested! However, if you notice you’re not feeling fully rested when waking, or you’re waking up with neck or back pain… then you may need to make some adjustments. Try these tips to help you get a better night sleep, without back pain:
1. Try to maintain a neutral spine
When possible, you should aim to keep try your spine in a relatively straight position, avoiding excessive strain or rotation through your neck, spine or hips. If you are someone who likes to sleep on their stomach, try turning your head throughout the night to avoid having your neck rotated to one side for hours at a time.
If you get low back pain when you sleep, try putting a pillow between your knees (for side sleepers), or under your knees (for back sleepers), as shown in Figure 2. This aims to relieve pressure on the lumbar spine and pelvis.
2. Check your pillow and mattress
If you’re waking up stiff and sore, you may need to check your pillow and mattress. As for sleeping posture, there is no best pillow or mattress, only what works best for you. Ideally, your pillow and mattress should give you enough support to maintain a neutral spine, and avoid excessive strain. Most people find a medium to firm pillow and mattress to be the most supportive.
3. Work on your sleep hygiene
What you do before bed, and the environment you’re in can have a massive impact on your quality of sleep. Here’s a few things to consider:
- Avoid screens (phones/computers) immediately before sleep
- Have a consistent sleep/wake time
- Make your room as dark and as quiet as possible
- Avoid caffeine intake later in the afternoon if you’re sensitive
To sum up, there is no correct sleeping posture for everyone, and you should focus on what works best for you and your body. If you’re dealing with back pain, making some changes to your posture, pillow/mattress, and sleep habits can help to improve your pain, and reduce the likelihood of it returning.
If back pain is stopping you from getting a good night sleep, or you’re worried your sleep habits are contributing, reach out to the team at DMC health for personalised care to get you back on track.
About the authors
Isaac Searant completed a Bachelor of Chiropractic Science, Master of Chiropractic and Master of Research at Macquarie University. His research aims integrate chiropractic and physiotherapy into general practice for the effective management of low back pain. His clinical interests include spinal pain (neck and back) and sporting injuries. Regardless of the condition, his goal as a chiropractor is to work collaboratively with patients.
David McNaughton is a clinician, researcher and lecturer. He is the director and principal chiropractor at DMC Health & Wellness. He has an extensive background in the diagnosis and management of chronic pain. In addition to his clinical studies, David holds a Master’s of Research and PhD in Psychology. He regularly publishes his research in peer reviewed medical and psychology journals. David has taught both undergraduate and postgraduate studies in Chiropractic and Psychology.
References
- Cary D, Briffa K, McKenna L. Identifying relationships between sleep posture and non-specific spinal symptoms in adults: A scoping review. BMJ open. 2019 Jun 1;9(6):e027633.
- Ylinen J, Häkkinen A, Kautiainen H, Multanen J. Preferences and Avoidance of Sleeping Positions Among Patients With Chronic Low Back Pain: A Cross-Sectional Study. Cureus. 2024 May;16(5).
No responses yet