Living with Lower Back Pain? Which Sleeping Position is Best For You?
As is likely no surprise to you, we see a lot of lower back pain complaints in our office. Among those living with back pain, we often get a lot of the same questions. One of the more popular questions we receive is which sleep position is best? It’s understandable why we get this question, as sleeping is frequently a trigger of back pain. Unfortunately, it’s typically not as simple an answer as we would hope. Let’s break it down and figure it out!
First, let’s go over the basic sleeping positions: supine (on your back), prone (face-down), and side sleeping. Side sleeping can be further divided into asymmetric side sleeping (no extra support) and symmetric side sleeping (pillow between the knees). Of these options, which is the best for you?
Your answer will ultimately lie in determining which positions trigger pain during the day. There are two broad categories of lower back pain to consider: flexion-biased back pain and extension-biased back pain (keep in mind, this does not determine what you injured, but will help you understand which position feels better). Flexion-biased means that bending forward helps alleviate pain, but a back bend hurts. Extension-biased is the opposite. Keeping this idea in mind, flexion-biased pain tends to fair better when sleeping supine, while extension biased pain often feels better lying prone. Both of these conditions may do OK when side sleeping.
For many back conditions, I recommend sleeping supine with the knees bent and using pillows to prop them in position. If this is still uncomfortable, I will show my patients how to create a makeshift lumbar support with a thin pillow or towel to give them a little more support in the lower back. This would act in the same way an arch support in your shoe helps your foot.
For side sleeping, as a general rule I recommend NOT sleeping on the side of more pain. For example, if you have sciatic pain down your left leg and really want to sleep on your side, sleep on your right side only. This will help keep the pressure off of the injured side.
Of course, if you can’t find any comfortable position, your mattress may also be the culprit. A mattress that is too soft isn’t going to support you very well. It may feel nice at the time, but you could likely be waking up with more pain in the morning.
Unfortunately, the big take away is that there’s no perfect recipe to answer this question and the answer largely varies from person to person. Finding your best position will likely require some trail and error, but don’t stick with a position if you’re quickly experiencing pain! As always, we are here to help. When in doubt, reach out!
Dr Rob Liguori
