Best Sleeping Positions To Manage Lower Back Pain

Lower back pain is a common problem, and almost 70% of all people globally¹ will experience it at least once in their life. In most cases, it resolves on its own, but if the pain does not subside, you should consult a doctor.

Lower back pain can be classified according to how long the pain lasts:

• Acute lower back pain: Present for a few days to weeks, the pain goes away on its own as the body heals.

• Subacute lower back pain: This type lasts between six weeks to three months, and a medical checkup is highly recommended.

• Chronic lower back pain: This occurs when the pain lasts longer than three months. This pain can be severe and may not respond to initial treatment plans.

You may experience the symptoms of lower back pain as:

• Dull or achy pain localized to the lower back, which may lead to muscle spasms and limited mobility.

• Burning or stinging pain can originate in the lower back and spread down the legs to the thighs, calves, or feet. It may be associated with tingling and numbness if the sciatic nerve is irritated.

• Muscle tightness and spasms along the lower back, pelvis, and/or hips.

• Pain that comes on gradually after prolonged sitting or standing. Walking or stretching can help alleviate this type of pain.

• Pain that makes it difficult to stand, walk, or move from a standing to a sitting position.

The link between sleeping and lower back pain

Researchers have noted a significant connection between lower back pain and sleep². Discomfort from the pain makes it difficult to get high-quality sleep. It can also make it harder to fall asleep and stay asleep throughout the night.

Lower back pain makes it challenging to find a comfortable sleeping position, resulting in the frequent tossing and turning that disrupts your sleep cycle. A combination of these problems can result in poor quality sleep and recovery.

Pain-relief medications can also affect sleep quality. Long-term use of some prescribed medicines you take to ease lower back pain, such as opioids, may cause sleep apnea.

Research has also indicated that poor sleeping positions may affect spinal alignment, which results in lower back pain and stiffness. Such pain is particularly worse in the morning and can persist throughout the day.

Additionally, poor sleep may make you more sensitive to pain. Lack of proper sleep can make the central nervous system (CNS) overly sensitive to pain signals, which reduces our tolerance to pain. Overall, this means that lower back pain can be made worse due to sleep deprivation.

Best sleeping positions for a person with lower back pain

Lying on your side with a pillow between your knees

Research³has shown that side-lying is the most protective sleeping position for most people with lower back pain. However, it’s important to know this can vary from person to person.

While lying on your side, placing pillows between your knees helps with better body alignment and pain relief. Depending on what is more comfortable, you can use one or two pillows.

Try to resist the urge to always sleep on the same side, which may cause imbalances and additional pain. 

Lying on your stomach and placing a pillow underneath your stomach

If you find lying on your stomach a comfortable sleeping position, you can try these techniques that may allow you to sleep in a safer and more protected way.

• Place a pillow beneath your lower abdomen to take some of the pressure off your aching back.

• You can opt to add another pillow beneath your head, depending on how comfortable you feel. The pillow for your head is optional but can help with improving comfort.  

Lying in the fetal position

When your lower back pain is causing you a lot of restlessness during sleep, you could try adopting the fetal position. This position can be achieved by gently rolling onto your side, bringing your knees up to your chest, and gently curling your torso towards your knees. Remember to regularly switch sides to prevent any muscle imbalances.

This method is useful when your back pain increases while standing or lying on your back. Curling your torso relieves the compression between the lumbar (lower back) joints, which can help reduce the pain. This sleeping position is also highly recommended for people with osteoarthritis. 

Placing pillows under your knees while laying on your back

You can maximize comfort while laying flat on your back by placing a pillow or two underneath your knees. You can choose to add a rolled-up towel or sheet under the small of your back for additional support.

By sleeping on your back, your weight is spread evenly across the broadest part of your body, preventing any uneven strain through the back. The pillow underneath your knees helps keep your spine in a neutral position by maintaining the natural curve in your lower back. 

Lying on your back in a reclined position

This position may require you to invest in a wedge pillow or an adjustable bed, which you can adjust to suit your body alignment. This method is particularly useful for spondylolisthesis, which is a condition where one vertebra slips away from the one below it. Sleeping in a reclined position will help create a supportive angle between your thighs and midriff to ease the pressure between your spine.

Other tips

Choosing the appropriate pillows

Pillows are an essential part of reducing back pain. Sleeping on the wrong pillow could lead to further issues and worsen your symptoms.

When placing the pillow under your head, you should make sure it safely supports your head and neck for proper alignment of your upper spine. While sleeping on your back, place the pillow so that it fills any space between the mattress and your neck. Water pillows and memory foams are good options since they contour around your head and neck for personalized support.

When sleeping on your stomach, use the thinnest pillow available under your head and a more supportive version under your abdomen and pelvis. This prevents the back from sinking downwards and ensures the spine is correctly aligned in this position.

While sleeping on your back, place a firm pillow underneath your knees to reduce pressure on your lumbar spine and support the spine's natural curvature.

Side sleepers should consider using firm pillows between the knees or a rolled towel. It is recommended to replace your pillows after around 18 months.

Choosing a proper mattress

Research⁴ has shown that people who sleep on very firm mattresses have the poorest sleep. Soft mattresses conform to your body's natural curves, which favor joint alignment. However, they are also problematic since you may sink into the mattress during the night resulting in a lack of support throughout the body.

To help with back pain, choose a high-quality, firm, or medium-firm mattress⁵ made from good quality material. The appropriate firmness of the mattress varies from person to person, depending on your weight, body shape, sleeping position, and your comfort preferences. Some stores allow you to test out the mattress before purchasing to help you find the one that best suits you.

Night routines

Having a set bedtime routine can help improve your sleep. You can incorporate activities like taking a bath, reading, or performing gentle exercises approved by your physician. Start your routine 30-60 minutes before the set sleep time to give your body and mind the opportunity to relax and ease into a restful sleep. You can also place a heat or ice pack on your lower back to help with pain relief.

Applying heat and cold

Heat and cold treatment can be used to help relieve pain and inflammation in the injured area.

A cold pack can help lower inflammation and swelling, which helps relieve back pain. Try putting ice cubes in a plastic bag and wrapping the bag in a cloth before placing it on your lower back for not more than 15 minutes at a time. Repeat this as many times as you need throughout the day.

Applying heat after an injury is another option. Heat therapy creates increased blood flow, which helps with recovery. However, it is best to apply heat one to two days after the onset of an inflammatory condition. Do this by wrapping a heat pack or hot water bottle in a towel or cloth and placing it on your lower back for up to ten minutes at a time. Do not attempt to sleep with the heating pad throughout the night since you can easily burn yourself.

You can alternate between using heat and ice to improve results or opt for just one.

Medication

With advice from your doctor, you can take over-the-counter pain medicines like ibuprofen, naproxen, or acetaminophen. Your physician may also prescribe stronger drugs to help with the underlying condition causing your backache. Physical therapy is also advisable, like exercise, lifestyle changes, and/or hands-on treatment (e.g., massage, mobilizations, etc.).

When should you visit a doctor for your lower back pain?

It is highly advisable to seek medical attention if lower back pain persists for longer than one to two weeks and affects your ability to participate in essential activities.

You must immediately visit a doctor if your lower back pain occurs after severe trauma or your lower back pain is accompanied by:

• Severe abdominal pain

• Unexplained fever

• Unexpected and sudden weight loss

• Loss of bladder or bowel control

• Loss of arm and/or leg strength

The lowdown

Finding the right sleeping position can help reduce lower back pain and ensure you have a good night's rest. Other ways to improve your sleep while tackling lower back pain include taking pain-relieving medication, applying heat or cold to your lower back, and having a relaxing nighttime routine.