It comes on slowly over time—as you age you may wake up one day with a sore neck, or a stiff lower back. And you have to wonder, is my sleeping position contributing to this pain? What are the best sleeping positions for neck and back pain?
Is there really one sleeping position that is best for everybody?
Not exactly. Everyone’s body composition is different, not to mention the firmness of your mattress, size/shape of your pillow(s), etc. So we can make generalizations, but in the end every person will have to do some experimenting to figure out what works best for them!
I have heard that sleeping on your stomach is the worst position, is that true?
This is mostly true. There was a great scoping review article completed in 2019 (find it here via open access!) that looked at 4 different studies to determine which sleeping positions are recommended for neck and back pain. While the authors do state plainly that their results need to be interpreted with caution due to inconsistencies between the articles that were analyzed, sleeping on your stomach is not one of the positions they recommend. However, if sleeping on your stomach is your favorite and it doesn’t cause you pain, then you are probably fine!
So what sleeping positions are recommended?
Again taking the study results with caution—the authors recommend that laying on your side is best for neck pain, and laying on the side or back is best for lower back pain. However, as with most things in life, it’s more about HOW you are achieving these positions rather than just WHAT the position is.
Can you recommend exactly how to achieve a good sleeping position then?
Yes! So your alignment while sleeping is incredibly important, and this is especially true if you are sleeping on your side. The authors of this review found that people who slept in a symmetrical position on their sides had less pain than those who slept in an asymmetrical position. So this means that sleeping with your shoulders, hips, and legs all stacked upon one another is better than with the top leg and shoulder rolled forwards on the bed. This also typically means you need 1-2 pillows in-between your legs.
What if I prefer to sleep on my back?
Your alignment is still important! You want the bones in your neck to be in line with the spine of your mid back. This means that no matter what pillow you choose, your head should not be propped up too far away from the mattress, or tilted backwards towards the mattress. Generally only one pillow is recommended underneath your head! For many people a contoured pillow works well, as it has a little “bump” at the end of the pillow that fits nicely under your neck bones. And you may want a pillow underneath your knees too.
I’ve often wondered if waking up with neck or back pain means something is really wrong with my spine. Do I need to call my doctor or get an X-ray or MRI?
The authors emphasize the importance of NOT focusing on what is “wrong” with the spine on x-rays or MRIs, as only 8-15% of cases of spinal pain have a specific anatomical problem that can be identified as the source of the pain. Read this article for more information on imaging tests for lower back pain. Instead, the authors emphasize that other things are more-important in the management of spinal pain, such as: changing your movement patterns, working on strength and conditioning, addressing sustained or repeated postures, and changing sleeping positions. The times when you do need to be more-concerned and call your doctor right away are when you notice any of the following: pain, weakness, or numbness/tingling radiating into the arms or legs; you develop a fever along with the pain; or you develop bowel and bladder changes. See this article from the Mayo Clinic for more information.
So how can MommaStrong help if my neck or lower back pain becomes a problem in my daily life?
MommaStrong has TONS of resources for neck, mid back, and lower back pain! We have fix-me’s for each of these areas, several series of videos dedicated to helping strengthen the key muscles that support the spine, and a lot of options for stretching and releasing those oh-so-achy muscles that tend to do too much work when your neck or back is hurting.
Cary, D., Briffa, K., & McKenna, L. (2019). Identifying relationships between sleep posture and non-specific spinal symptoms in adults: A scoping review. BMJ open, 9(6), e027633. https://doi.org/10.1136/bmjopen-2018-027633
Choosing Wisely article on imaging for lower back pain:
Mayo Clinic article on lower back pain: https://www.mayoclinic.org/symptoms/back-pain/basics/when-to-see-doctor/sym-20050878