Updated: June 23, 2020
Author: Dr. R.J. Burr
Lower Back Pain is Debilitating
Lower back pain is the leading cause of disability in the US, and the mainstream approach to “treating” it has been suggested to be a major player in the cause of the opioid epidemic.
What’s interesting is most lower back pain problems are not the cause of serious infection, disease or injury, rather the result of postural habits and movement behaviors, including lack of physical activity. Georgetown Health Policy Institute states that large proportions of adults with any type of back pain report fair to poor mental and physical health (25%), which is more than double of those without back pain.
Low back pain affecting your lifestyle during the day is a problem, but what if you have trouble getting rest? Here we provide several strategies that will help show you how to sleep with back pain and hopefully find some relief.
Is There A Sleep Position That Reduces Lower Back Pain?
There are a lot of opinions regarding sleep positions. I can’t tell you how many times I’ve heard from my patients, “I know it’s bad, but I sleep on my back.” It’s a myth.
The realistic truth about sleep position is two-fold:
- Sleep in whatever position gives you the best opportunity to rest.
- The pain you feel at night or in the morning is not necessarily because of your sleep position alone!
Rest and recovery are crucially important. If you sleep better laying like Sid from Toy Story than in the perfect supported position on your back, then I’m saying be like Sid, other than the dismemberment of toys. Don’t do that -- it’s just weird.
Many times, pain at night and in the morning is the hangover of your postural habits and movement behaviors causing your lower back pain in the first place.
You see, the shock absorbers between every one of our spinal bones, or “discs,” are loaded and compressed by movement and gravity all day long. At night, the discs decompress and fill with fluid in a physiological process called, “imbibition.” Envision a sponge in water: you press it down and the water pushes out, but if you let go, it sucks water back in.
Because those discs are plump with fluid in the morning, you can be more sensitive to your symptoms for the first hour of the day where you're getting your body initially moving against gravity.
In the clinic, I rarely mess with sleep unless needed. However, there are some helpful tips and tricks I give patients to test out on their own to determine if it’s a useful strategy for their case of lower back pain.
Rather than go through “the Top 5 Sleep Positions,” we’re going to go discuss tried and true useful strategies for sleep, whether it’s during or leading up to it. There is not one better strategy than another — it comes down to trial and error to discover what works for you!
Tips for Reducing Lower Back Pain
Use Your Extra Pillows for Support
This isn’t anything new or groundbreaking, but it’s important to clarify how to use proper support depending on what type of sleeping position you prefer. Finding the right pillow is key for neck and back pain. Check out our guides on finding the right pillow for back and side sleeping.
Back Sleeping — placing a pillow under your knees can help flatten your back, which can open up the spaces where irritated nerves traverse, giving them a break. However, this may be irritating for some people. If this is the case, try placing a rolled-up bath towel (longwise) underneath the small of your back to maintain your natural low back curve at night.
Stomach Sleeping — Contrary to popular belief, stomach sleeping is not a bad position to sleep. Yes, it may not be ideal for someone with neck pain, but can be therapeutic for those with low back pain. Laying on your stomach places your low back in a more extended or arched spine position than the other sleeping positions. On the same boat, most people who suffer from low back pain can significantly reduce their symptoms with a low back extension exercise (below), so it makes sense why someone may “feel good” sleeping on their stomach. If you do, however, prefer sleeping on your stomach but it becomes uncomfortable on your back, place a pillow underneath your hips and waistline. Much like the pillow underneath your legs as a back sleeper, the pillow opens up space for the nerves in your low back to decompress and reduce tension.
Side Sleeping — Putting a pillow between your legs can be quite helpful. However, if it doesn’t help, try placing that pillow or an extra pillow under your abdomen between your ribs and pelvis. When you lay on your side, your abdomen caves in or side flexes downward, placing your spine out of ideal alignment. The pillow simply buttresses the flank, supporting the spine in a better position, where the pillow between the legs doesn’t. If you want to learn more about pillows for side sleeping, check out the in-depth guide we created.
Use a Night Roll
The McKenzie Night Roll is a simple device you can use to make your nights more comfortable, offering you a better night's sleep.
The night roll works by supporting your spine in a neutral spine alignment so you’re not bending excessively in one direction whether you’re sleeping on your back or sides. Do you tend to change positions quite a bit at night?
The Night Roll may be a great strategy for you as it moves with you. Here’s a helpful video of how to use your Night Roll. The Night Roll is not a miracle fix, nor is it going to be a good fit for everyone. Before you purchase a Night Roll, you can test to see if it may work for you by rolling up a bath towel and placing it underneath your waistline for support as you sleep. It won’t move with you like the Roll but it’s an easy test anyone can try.
Do you have neck or upper back pain in the morning or when sleeping at night? You can use the same bath towel strategy here.
Sleep on Different Surfaces
There’s lots of mattress “science” regarding what is best for you — a lot of “if, then that.” It may become an expensive experiment, but the only way to know if the surface you’re sleeping on is right for you is by, yes, once again, testing it out!
If you’re having back pain with your current mattress and you’ve tried the strategies above and below, then you may want to nestle in other nests. A great way to know if you’re mattress is a problem for you is to sleep on a guest bed, your kid’s bed, a futon, the couch - whatever. Traveling is a good opportunity to try out beds of different firmness levels.
If you discover an alternate surface makes and drastic difference, you may want to consider a new mattress or replacing your existing one. As you probably know, trialing mattresses is not exactly easy. Luckily, there are many “Bed in a Box” brands who guarantee a great night's rest or they will remove it from your home with a full refund.
Other Strategies That Reduce Lower Back Pain
Take Your Time in the Morning
As mentioned prior, your spinal discs contain more fluid from decompressing after a night's rest in a process called imbibition.
The excess fluid leaves the discs after a period of spinal loading in upright positions, e.g., standing, walking, sitting. However, this process takes a bit of time.
When the discs are pressurized with fluid, a lower back pain problem can be more sensitive, which is why many people with back pain report more pain and stiffness in the morning. Further, the risk of suffering a disc injury from a nominal task such as putting on a pair of socks, getting out of bed, or even brushing your teeth over the sink is much greater.
Don’t make your back pain worse from something as nominal as getting out of bed!
A good rule of thumb is to give your body about an hour to “warm-up” with general movement, avoiding any tasks requiring excessive bending or anything more than mild-to-moderate exertion.
Change Your Daytime Behaviors
Your daytime postural and movement behaviors are likely the reason why you have low back pain at night in the first place. Opposed to focusing on sleep positions, it’s important to address why your back pain is plaguing you in the first place.
Since the beginning of our human existence, we’ve been moving creatures. Only in the last 100 years have we become the most sedentary due to modern conveniences. Hunting for food was a necessity for survival, where any day now drones will be dropping “delivery” at our front doors. We have partitioned spaces dedicated to movement (gyms) because we just don’t have to anymore. What we call “exercise” used to be called, “work.”
We were made to move and to move often.
Simply, making it a point to move and frequently change positions throughout the day to avoid negative effects associated with prolonged poor postures and sedentarism can make all the difference between suffering from lower back pain or not.
Here are some helpful tips to reduce lower back pain occurrence during the day:
- For every 30 min of sitting, stand up tall and reach toward the sky. Set an alarm on your cell phone, if needed!
- When you do sit, sit with lower back support.
- Invest in a standing or convertible desk.
- Drink more water. Hydration is healthy and it will make you move your body more because you’ll have to get up to use the bathroom more often!
- Try this exercise to reduce the stresses of sitting most of the day.
- Tight hips from sitting? Stretch them like this.
- Squat to reach for the ground as opposed to folding forward from the waist.
- You’ve heard them many times before, but still relevant:
- Take the stairs.
- Park your car further away.
- Opt for standing versus sitting.
To ask, “what’s the best sleeping position to reduce lower back pain?” is a valid question but as you no know, a moot point.
There is such a thing as ideal alignment and positioning while sleeping, but it doesn’t make a lick of a difference until you test what’s best for you.
Do you prefer to sleep on your side? Sounds good. On your back? Awesome. On your face? I’m cool with that. Ultimately, what matters is what allows you for the best rest. And the only to do it is to test cause and effect when employing sleeping strategies as outlined above.
Your mattress may be the problem but the only way to know is to try sleeping somewhere else than your own bed, and you may want to explore more cost-effective options before pulling the trigger on a new mattress. If you've determined you need a new mattress, check out our guides for more information and how to choose a mattress for your sleeping position:
- Mattress Guide for Back Pain Sufferers
- Mattress Guide for Side Sleepers
- Mattress Guide for Stomach Sleepers
In a similar vein, your pillow may also need testing. If you've determined your pillow is the likely the cause and needs to be replaced, we have guides for pillow selection based on your sleeping position:
Because of what your spinal discs go through as your spine decompresses throughout the night, you may be more sensitive to lower back pain when you wake up. It’s important to avoid excessive bending or vigorous activity the first thing in the morning.
What’s often missed when discussing sleep is what happens during the day. If you’re unintentionally compromising your body throughout the day based on your postural habits and movement behaviors, it doesn’t matter how you sleep — it’s going to suck.