How to sleep with back pain? - Iron Health Physical Therapy & Cryotherapy
Joseph Rendina

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How to sleep with back pain?

Sleeping with back pain is challenging. You keep twisting and turning throughout the night to get that right position to sleep for a couple of hours, but all in vain. Although sleep plays an adequate role in the healing process of back pain, you feel restless and agitated throughout the night due to pain. It affects your day to day function and mobility.

Back pain drains your energy emotionally and physically. Getting a good night sleep is essential to get rid of back pain. Sometimes poor sleeping posture could be a significant cause of back pain

Cause of back pain

Before diving into ways to get rid of your back pain, let's look at the causes of back pain. Back pain could be due to various reasons. There is a vast array of causes that lead to backaches, including;

  • Sciatica

  • Disc herniation

  • Poor posture, either kyphotic or lordosis

  • Poor ergonomics sitting chair at the office

  • Poor lifestyle, reduce mobility

  • Lifting heavy objects

 Most people tend to experience it in the morning or during working hours. Usually, it's fine all day until you need to rest, and it starts to show up when relaxing on the couch or bed.

So what can you do about it?

The Best Sleeping positions to reduce back pain

The best sleeping position for you is when your body is comfortable and holds your spine as neutral as possible. Our body has three major curves that we need to take care of!

  • Lower back curve

  • Middle back curve 

  • Neck curve

The two primary curves needing support are the lower back and neck curves to hold the spine in a neutral position and minimize its rotation.

Sleeping posture

Every person sleeps differently. It all depends on the level of comfort a person experiences in various sleeping positions. There could be one or many different positions. The three most common positions are as follows

  • Sleeping on back

  • Sleeping on stomach

  • Sleeping on your side

Remember that the backache you experience in the morning is due to an abnormal sleeping position. 

Sleeping on your back

While sleeping on your back, your neck shouldn't be flexed or extended. This majorly depends on the type of pillow you are using. If the pillow is too full, it might result in a forward neck posture because the neck is in a continuous flexed position.

If you look at the lower back, your hip is in anterior pelvic tilt posture. As legs are lying in a flat position, they might stretch your hip flexors (psoas) which moves your hip forward, creating a hollow back and increased curvature.

Tips to make it better

Adding pillows is, so far, the best method to give support to your spine and body. While lying, here are ways you can add pillows and cushions to get sound sleep.

  • Check for the pillow's stuffing; it shouldn't be too full or have less filling than usual.

  • Always have a pillow that keeps your neck in a neutral position, nor flexed neither extended. It should fill the gap between the neck and the mattress.

  • Add a small pillow to fill in the curvature of your spine or use a wedge pillow.

  • Add another pillow under the knees to keep the legs in a neutral position; this reduces stress on anterior muscles and minimizes anterior tilting of the spine.

  • You can also add cold pack under your back and remove it after 2 hours. This helps in relieving pain

Sleeping on your stomach

Many of you like to sleep on your stomach. However, this might be the most comfortable position for you. If you look into it anatomically and biomechanically, it's not a good posture to sleep in. it does not support your spine. 

  • Let's see; when you sleep on your stomach, you have to rotate your neck on either side for breathing. This makes you sleep all night in a rotated neck position.

  • Now, if you look at the stomach, it sags into the bed as it doesn't have any support. This creates a bow-shaped back resulting in a tight or pinched back

  • Sleeping in this position puts pressure and weight on your internal organs. It affects breathing and digestion.

Tips to make it better

First of all, STOP sleeping in this position. It isn't ideally the best position to sleep in. but if you struggle to sleep in any other position, then you might consider sleeping in this position. This position is better for people with herniated disc pathology.

  • To minimize bow-shaped back and stomach sagging into the bed, you can add a flat pillow under your stomach and your thighs. 

  • Consider sleeping with a flat pillow under your head or no pillow at all.

Sleeping on your side

The side-lying position is the most common position majority of the population sleeps in. sleeping sideways might hurt your neck, back, torso and hips. Look if your pillow is too high or too low.

  • If the pillow is too high, then your neck is too high, causing stiffness in the neck and upper back.

  • If the pillow is flat, your head drops down too far, again leading to a crick in the neck.

  • The lower back sinks into the mattress depending upon the support provided.

  • The top leg slides down towards the table, which pulls or stretches the muscles from the lower back and hip.

  • Side sleepers turn into foetal position unconsciously, which cause excessive curvature on the back and neck.

Tips to make it better

Some people find it really hard to maintain a sideways position. At night they sleep in this position but wake up in a very unusual position. Their head might be supine, but their torso is rotated sideways, or their head is hanging down from the pillow, which usually happens when the pillow is too high. Following are the measures you can take to minimize rotation on the spine and support your body in this position.

  • Take a thick pillow that keeps your neck and upper back inline 

  • Add a slim under the spinal curvature in sideways.

  • Add a pillow in between legs. You can add it by either flexing the top leg or keeping both legs straight. 

Right support (mattress and pillows)

To get that correct sleeping posture, you have to have the right amount of support. Here speaking specifically of your mattress and your pillow.

Pillow

A good pillow is essential for good night sleep. It shouldn't be too firm to put a strain on your upper back and neck, neither too soft that your head gets buried in it. Ideally, your pillow should be 8 inches tall to support the upper back and neck. You want the right pillow that that is going to support your spine in a neutral position.

Mattress 

It doesn't matter in what position you sleep; remember to keep your spine neutral and midline position. Technically it would be best if you replaced your mattress every 10 – 12 years. And if you haven't done that, it might be time to look into a good mattress. Because mattresses wear out, they lose their ability to hold your body in a neutral position and support it during sleep.

Exercise

Generally, most will benefit by introducing simple exercises in their routine. This can be a brisk walk, jog, yoga or doing a mobility routine. The ache experienced is just a signal that it's time to MOVE.

Always consult your Physical therapist about which exercise is better for you according to your individuals need.

Joseph Rendina PT, DPT, OCS

Joseph Rendina PT, DPT, OCS

Doctor of Physical Therapy, Board-Certified Orthopedic Specialist
Joseph received his Doctorate in Physical Therapy from New York Medical College and is also recognized as a Board-Certified Orthopedic Specialist. As a former competitive athlete and weightlifter, Joseph understands the specific needs and demands of the human body. Joseph’s goal is to maintain an active approach to rehab while facilitating recovery.
Joseph Rendina PT, DPT, OCS

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