Sleeping Positions and Low Back Pain: The Best and Worst Ways to Sleep
How Your Sleeping Position Affects Your Back
Waking up with stiffness, aches, or sharp pain in the lower back is something many people experience, yet few realise their sleeping position might be the cause.
The way you sleep plays a huge role in spinal alignment, muscle relaxation, and overall back health. Poor positioning can put stress on the lower back, leading to discomfort that lingers throughout the day. But the good news? Small adjustments can make a big difference in how you feel each morning.
This guide explores the best and worst sleeping positions for low back pain and simple modifications that can help you wake up feeling refreshed and pain-free.
The Worst Sleeping Positions for Low Back Pain
1. Sleeping on Your Stomach: The Biggest Offender
Many people find stomach sleeping comfortable, but it is one of the worst positions for lower back health.
Why It’s Bad:
❌ Spinal misalignment – Sleeping on your stomach forces the spine into an unnatural curve, putting pressure on the lower back.
❌ Neck strain – Turning your head to one side all night can lead to neck and upper back discomfort.
❌ Increased lower back tension – The stomach pushes the midsection down, increasing strain on the lower spine.
How to Fix It:
🔹 Try a different position – Sleeping on your back or side is much better for spinal health.
🔹 Use a pillow under your hips – If you can’t give up stomach sleeping, placing a small pillow under the pelvis can help keep the spine more neutral.
🔹 Avoid thick pillows – A high pillow under the head exaggerates neck strain, so opt for a thin or no pillow.
2. Sleeping in a Fetal Position: Good for Some, Bad for Others
The curled-up fetal position can provide comfort, but when done incorrectly, it can increase back stiffness.
Why It’s Bad:
❌ Overly curled posture – Pulling the knees too high towards the chest can round the spine excessively, leading to tightness in the lower back.
❌ Restricted breathing – A tightly curled position can limit diaphragm expansion, affecting deep breathing during sleep.
How to Fix It:
🔹 Keep a slight bend in the knees – Avoid tucking them too high toward the chest.
🔹 Use a pillow between the knees – This prevents the spine from twisting and keeps the hips aligned.
🔹 Ensure proper head and neck support – A pillow that maintains neutral head positioning helps prevent further strain.
The Best Sleeping Positions for Low Back Pain
1. Sleeping on Your Back: The Gold Standard for Spinal Alignment
For most people, sleeping on the back is the best position for spinal health. It evenly distributes weight and maintains a neutral spine position, reducing pressure on the lower back.
Why It’s Good:
✔️ Keeps the spine aligned – Supports the natural curve of the lower back.
✔️ Minimises pressure points – Reduces strain on the hips and lower spine.
✔️ Prevents twisting of the spine – Ensures proper posture throughout the night.
How to Optimise It:
🔹 Use a pillow under your knees – This helps maintain the lower back’s natural curve.
🔹 Choose a supportive mattress – A medium-firm mattress provides the best balance of comfort and spinal support.
🔹 Avoid overly thick pillows – A pillow that supports the natural curve of the neck is ideal.
2. Sleeping on Your Side: A Great Alternative
Side sleeping can also be good for the lower back, as long as proper alignment is maintained.
Why It’s Good:
✔️ Supports spinal alignment – Prevents excessive pressure on the lower back.
✔️ Reduces snoring and acid reflux – Side sleeping can improve breathing and digestion.
✔️ Can be great for those with sciatica – Keeping the spine aligned may ease nerve compression.
How to Optimise It:
🔹 Use a pillow between the knees – This keeps the pelvis and spine neutral.
🔹 Avoid sinking too deep into the mattress – A mattress that’s too soft can throw the spine out of alignment.
🔹 Ensure your pillow is the right height – Your head should stay in line with your spine.
Other Tips for Improving Sleep and Reducing Back Pain
1. Choose the Right Mattress
Medium-firm is best for most people.
Too soft – Can cause the spine to sink and increase misalignment.
Too firm – Can create pressure points and discomfort.
2. Pillow Positioning Matters
Under the knees (for back sleepers) – Supports the lower back’s natural curve.
Between the knees (for side sleepers) – Keeps hips aligned and reduces twisting.
Under the pelvis (for stomach sleepers who won’t switch positions) – Minimises lower back strain.
3. Stretch Before Bed
Simple stretches before sleep can relax tight muscles and prepare the body for a better night’s rest. Try:
✅ Knee-to-chest stretch – Loosens the lower back.
✅ Pelvic tilts – Activates core muscles to support the spine.
✅ Cat-cow stretch – Increases spinal mobility.
4. Avoid Sleeping in One Position All Night
If you feel stiff in the morning, try switching positions throughout the night.
Using a body pillow can help keep the body in proper alignment while sleeping.
When to Seek Professional Help
If lower back pain is interfering with sleep, affecting daily activities, or worsening over time, seeking guidance can make a difference. Physiotherapy can help by:
✅ Identifying posture-related issues
✅ Recommending stretches and exercises to relieve back tension
✅ Providing hands-on techniques to improve mobility and reduce discomfort
Final Thoughts: Small Changes for a Pain-Free Sleep
Low back pain doesn’t have to be a part of your nightly routine. By making a few simple adjustments to your sleeping position, you can wake up feeling refreshed instead of stiff and sore.
✅ Best position? Sleeping on your back or side with proper support.
✅ Worst position? Stomach sleeping, unless modified with a pillow under the hips.
✅ Biggest tip? Keep your spine aligned and supported to reduce stress on the lower back.
📅 Struggling with lower back pain? Book an appointment at Proactive Physiotherapy to get expert advice on movement, posture, and pain relief.
💡 A good night’s sleep starts with the right support—both from your bed and your body!
