“Sleeping on the stomach is a big culprit when it comes to exacerbating neck and back pain, as it causes an unnatural extension of the spine.” —Jonathan M. Greer, MD
To start, Dr. Greer’s top recommendation across the board for anyone who suffers from any kind of back or neck pain is to remove stomach-sleeping from the equation. “Sleeping on the stomach is a big culprit when it comes to exacerbating neck and back pain,” he says, “as it causes an unnatural extension of the spine.” Not to mention, it can trigger numbness or tingling in the arms due to nerve compression, says physical-medicine and rehabilitation doctor Jaspal R. Singh, MD.
- Jaspal R. Singh, MD, Dr. Jaspal R. Singh, MD, is a triple-board certified physician specializing in Physical Medicine and Rehabilitation, Sports Medicine, and Pain Medicine. He is the Vice-Chair of Strategy and Clinical Operations & Associate Professor within the Department of Rehabilitation Medicine. He...
- Jonathan M. Greer, MD, Dr. Jonathan M. Greer, MD, is double board-certified in Rheumatology and Internal Medicine. He is an Assistant Clinical Professor of Medicine at both Nova Southeastern University and the University of Miami, as well as a member of the Florida Society...
But before we get into the back and side sleeping positions that work best for different pain scenarios, a quick word about what exactly you’re sleeping on, as that plays a big role in sleep comfort, too: You can let go of the common refrain about an ultra-firm mattress being best for those with back pain. “In actuality, I recommend a medium-soft mattress for anyone with back pain, and for those who already have a hard mattress, adding a pillow top or egg-crate mattress topper to remove some of the pressure points that can happen otherwise,” says Dr. Greer. Just be sure you don’t go too soft, as you don’t want to be sinking deep into the mattress either, adds Dr. Singh.
A similar goldilocks situation applies to your pillow (or multiple pillows), which can also affect your overall sleeping position—and whether it works with or against your body. This is particularly important when it comes to upper-back and neck pain, says Dr. Greer: “A neck pillow or contour pillow that conforms to the shape of the neck helps extend the neck and prevent it from slipping into a compressed position while you sleep.”
In both cases, however, it’s important to let comfort be your guide, according to Dr. Greer: “I always say, if you’re doing any kind of exercise or activity that creates or worsens some kind of pain, it’s a signal that you need to adjust," he says, "and that applies to your mattress, pillow, and sleeping position, as well.”
And while we’re at it, don’t forget about your daytime posture and alignment, too, adds Dr. Singh, which can, of course, trigger or exacerbate spine pain in just the same way that a bad sleeping position can. “It’s essential to maintain a good, ergonomic workstation and a highly mobile lifestyle, frequently changing positions, rather than sitting in one spot all day, in order to bring blood flow and nutrients to the spine,” he says.
Scroll down for the best sleeping positions for different aches and pains
For back pain: Lie on your side with a pillow between your knees
Lying flat on your back with your legs outstretched can cause unnatural extension of the spine leading to pain, says Dr. Greer. Instead, both he and Dr. Singh suggest lying on your side with your legs bent (toward your stomach, in the direction of a fetal position) with a pillow sandwiched between your knees. “Supporting and aligning the hips in this way will take pressure off your spine,” says Dr. Singh.
If, however, you strongly prefer to lie on your back, you can do so in a more spine-supportive way by propping a pillow beneath your lower legs (as noted for anyone with hip pain below). Another option: Consider an adjustable bed that bends upward a bit, so that you’re not lying fully flat, but instead, a bit more upright. "Elevating the head above the feet, similar to how you would in a recliner, can remove some pressure from the lower part of the back, and help with snoring, too," says Dr. Singh.
As a precautionary note, if your back pain is regularly keeping you awake or persists longer than three weeks, it’s worth getting it evaluated by a medical professional, says Dr. Greer. And the same goes if you’re experiencing recurring numbness or tingling radiating down a leg, which could be a sign of a pinched nerve.
For hip pain: Lie on your back with a pillow beneath your knees or lower legs
Because lying on your side may worsen hip pain, it’s best to try sleeping on your back with your legs slightly propped up by way of a pillow placed under the knees. “The bony prominence that sticks out of the hip called the greater trochanter has a sack of fluid on top called a bursa,” says Dr. Greer, “which can often get aggravated when you lie on one side all night, especially if you’re on a hard mattress—and that can cause inflammation called bursitis.” Choosing a back-sleeping position can help you avoid that.
For neck pain: Lie on your side or back using a contour pillow
You can choose either your back or your side—it’s a matter of personal preference and comfort, in this case—but be sure to select your pillow carefully, as noted above. A pillow made specifically to conform to the neck’s natural shape will be your best bet. “You don’t want to go with multiple pillows under the neck or no pillow at all, as either option can cause unnatural extension,” says Dr. Singh.
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