Experts reveal the best (and worst) sleeping positions for back pain

When you frequently suffer from back and neck pain or inflammatory conditions like arthritis, getting good quality sleep can be difficult. Finding a comfortable sleeping position that doesn't exacerbate your pain, along with pillows that provide the best support, can make all the difference in improving your sleep and prevent further pain and discomfort. To discover exactly what makes the most difference, we consulted an expert to discuss the best - and worst - sleeping positions for pain relief.

Why does sleeping position matter?

You may not think your sleeping position has much of an impact on your well-being, but according to Dr. Braden McKnight, a fellowship-trained orthopaedic spine surgeon at DISC Surgery Center at Carlsbad, San Diego County, the way you sleep can affect everything from your joints to your digestion.

"When you sleep on your back, you improve your spinal alignment in both the neck and back, which can help alleviate pain in those regions. Cervical (or neck) spinal alignment is ideal with a pillow that is not too large as to cause neck flexion, but also not too small as to cause neck extension. For most patients, low-profile cervical pillows help keep the neck in an ideal neutral position. Again, with respect to the low back, spinal alignment is ideal when you’re lying on your back with a pillow under your knees," he says.

"And although snoring may be improved in some patients by sleeping on their stomachs, I don’t recommend this, given the negative effects on joint pressure, spinal alignment and digestion. Instead, I suggest trying to sleep on your side, which can provide an improved spinal alignment while being better for snoring than sleeping on your back."

What are the best sleeping positions for back and neck pain?

When you're suffering with back or neck pain, there are some particular sleeping positions that can help to prevent it from getting any worse, as Dr. McKnight explains: "For those with back and neck pain, the best possible sleeping position is on your back, which places your spine in a more neutral position and can improve your symptoms, especially if you place a pillow under your knees.

"From a spinal health perspective, sleeping on your back is a far better option than sleeping on your stomach. When you sleep on your stomach, you put your neck into an extended and rotated position, which may increase facetogenic pain (or pain in the back of your neck from arthritis) as well as increase foraminal stenosis (when nerve roots are pinched as they exit the spine). When this happens, you may see increased neck pain as well as increased nerve pain in the arms. As I mentioned before, sleeping on your back puts your neck in a more neutral position, which can decrease these two pain generators."

Meanwhile, you may also want to avoid sleeping on your stomach if you have lower back pain. "For low-back pain, stomach sleeping increases the curvature of the lumbar spine. I like to ask patients to imagine the individual vertebrae of the spine like the shingles on a roof. The stomach-sleeping position essentially increases how tightly they are stacked, which can exacerbate symptoms from spinal stenosis and arthritic pain in the facet joints in the back," the surgeon explains.

What are the best sleeping positions for joint pain or arthritis?

Arthritis and joint pain are incredibly common, and the best sleeping position for this depends on where you are experiencing the most discomfort. "Joint pressure depends on the region of the body at hand. For those with shoulder arthritis, pain is typically worse when you sleep on the shoulder and made better when you offload it by sleeping on the other side or on your back," Dr. McKnight shares. 

"Rotator cuff tears, on the other hand, are typically more painful with sleeping on your back or stomach, as the sag of the shoulder increases rotator cuff tear pain. Hip and knee arthritis are typically improved with gentle knee and hip flexion – this involves sleeping on your back with a pillow underneath your knees."

Mattress and pillow tips

Along with your sleeping position, your mattress and pillows can also help to provide suitable support and help to alleviate pain. A new mattress may be an investment, but it is worth considering if you regularly experience back and neck pain. But what should you be looking for? "In my experience, a medium-firm mattress provides the best support for sleeping on your back or on your side, which are the positions I recommend for most patients," says Dr. McKnight. "A high-firm mattress may create pressure points on bony prominences of the pelvis, shoulders and spine, while a mattress that is too soft may not provide enough support to the spine, which could lead to increased pain."

When to seek professional advice

Ongoing pain isn't something you should just try to ignore or put up with. If discomfort doesn't go away after a few weeks of adjusting your sleeping posture, or you notice any other worrying symptoms, it's important to seek help. The spinal surgeon shares: "You should also seek immediate help for any pain that’s severe or if you’re also experiencing other red-flag symptoms like numbness, weakness or tingling in your arms, legs and pelvis or a loss of bladder or bowel control. This can indicate a more serious problem."