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What is the Best Sleeping Position if I Have Back, Neck or Shoulder Pain?

Originally published on: March 28, 2016

Best sleeping position

As a physiotherapist, the most commonly asked question about sleep that I answer almost every day is:

“What is the best pillow/mattress to use to get rid of my neck/back pain?”

We’re all built so differently. There is no one solution that fits everybody. However, there are general guidelines you can follow to help you get a better sleep.

Best Sleeping Position

You should keep the spine (including the neck, mid-back and lower back, and pelvis) in a neutral position. This is generally the position of good posture that I referred to in the posture article. Regardless of what sleeping position you are in, a good posture is one where there is a little ingoing curve in your neck and low back, and a little outgoing curve in your mid-back.

Here are a few examples of sleeping positions that are optimal:

If you are a back sleeper:

The pillow under the head should not be too thick, so that it is pushing the head, neck, and shoulders forward. It should just be supporting the ingoing curve of your neck as if you were standing or sitting with good posture.

sleeping neutral position

If you have back pain: Begin by putting a pillow under your knees to lessen the curve in your low back. This reduces the stress on your low back, if your back is very arched or does not like extension (to be arched). The pillow generally does not stay put, but it can help you to get to sleep, or be used as a resting position.

Sleeping position clos up
If you are a side sleeper:

The pillow under your head should be thicker than if you are sleeping on your back, since it has to fill the gap between your neck and shoulder. Make sure to keep your neck and shoulder at a  90 degree angle as much as possible. If you have very broad shoulders, one generally needs a thicker pillow.

If you have shoulder pain: Please ensure that the pillow is thick enough that you are not ‘squishing’ the shoulder into its’ socket, since you have to be aware that your body weight is going through the joint when you are asleep. If you do not have a ‘large layer of muscles’ covering the shoulder joint, there is even more reason to use a thicker pillow to ‘cushion the joint’.

If you have shoulder pain: It is best not to sleep on the affected side while it is healing, and then only intermittently when it is improving. And one can see that hugging a pillow or a body pillow prevents the top arm from crossing the midline when you are sleeping on the non-affected side. This prevents the shoulder joint from getting ‘squished’ in the front, where a lot of us have tendinitis problems.

I like to prescribe body pillows for people with neck and shoulder girdle and low back, or lower limb problems since the pillow can be draped between the knees and then hugged, keeping you in neutral as much as possible.

If you have hip, knee or ankle pain, it is better to sleep with a pillow between your knees. This keeps your hips in neutral and ‘cushions’ the knee and ankle joints.

best side sleeping position

If you are a tummy sleeper or sleep on your abdomen: It is not advisable to sleep in this position since you have to sleep with your head and neck turned to one side for a few hours at a time. If you have a pillow under your head, it is putting your neck in extension, especially if it is thick. If you have no pillow under your lower abdomen, it is causing your lower back to go into too much extension (too much arching)

Here are two photos of  more ideal positions to sleep in, if you truthfully can only sleep on your stomach:

best stomach sleeping position 1 best stomach sleeping position 2
Other Medical Conditions Which Can Disrupt Sleep and Alternative Sleeping Positions To Try

Aside from pain being a sleep-disrupter, the following medical conditions can also prevent a good nights’ sleep:

      1. acid reflux
      2. gas and bloating
      3. breathing issues due to nasal congestion, sinus problems, or sleep apnea
      4. poor general circulation, or in a body part
      5. obesity
      6. hot flashes
      7. Restless Leg symptoms
      8. Anxiety, Stress and Depression

Unfortunately, not many of us can afford to buy a hospital-type bed that has the ability to raise and lower certain sections to accommodate for these issue/s. An alternative solution is to buy orthopaedic posture cushions, pillows and wedges to set up the best scenario for the condition. For example, the first three conditions are generally helped by raising the head end of the bed or body, about 18-23 inches. If a body part is swollen, we generally recommend elevating it slightly higher than the heart if possible. Clients with sleep apnea have to accommodate as best they can with their Continuous Positive Airway Pressure (CPAP) apparatus, be it nasal prongs, or a face mask, and tubing.

Bedding and night-wear that wicks away moisture may help for hot flashes.

Treating the root cause of what is disrupting one’s sleep is ultimately the best solution , and sometimes that is investing in a good pair of over-the-counter or custom earplugs, if your snoring sleeping partner is the problem!

In Conclusion

There is no one pillow or mattress that works for everybody, since a 105 lb woman needs different support from a  250 lb man. It can be a $20 or a $250 pillow, just as long as it keeps your neck in a neutral position. The mattress should not be more than 10 years old and should either be turned regularly and/ flipped if allowed. It is the ideal mattress and pillow combination that will give you that elusive wonderful nights’ sleep.

There are so many sleeping positions that I have not discussed, since this is an area where we truthfully do not have much control over, especially when we are in deep sleep. We all move around to varying degrees as well. Some us ‘play soccer’ in our sleep, while some of can lie in one position quite still the entire night. Some of us have to wake up frequently to go to the washroom, or because we are in pain, because we have night sweats, or because we have insomnia, and some of us are blessed to be able to sleep deeply in any position we land in.

Because this subject of sleeping position fascinates me, if you would like to give me any feedback on what has worked, or not, for you, please contact me. Since you would be astounded by the number of people out there just wanting a good nights’ sleep.

Sweet dreams!

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