How to Sleep with Lower Back Pain (Based on Science)

Today we’re going to answer the big question: How to Sleep with Lower Back Pain. Because let’s be honest: this is a huge problem!

I saw an Instagram post the other day. The physiotherapist was talking about the perfect sleeping position for lower back pain. He was using 5 pillows, to position the patient in a way that was “safe” for the spine. Safe for him meant – keeping the spine in the neutral position.

You hear so many different opinions out there. So many, that you don’t know what’s right and what’s wrong.

The advice that I will give you in this article uses the current scientific evidence. And at the end I will show you an easy 5-step framework, that you can use rightaway. It’ll help you find your perfect sleeping position.

Sleeping Positions

I want you to take a look at those 4 sleeping positions.

What do you think is the healthiest one? Supine, aka lying on your back, right?

And what do you think is the unhealthiest one? Either the provocative side lying or lying on the belly).

The Most Common Perspectives

This is a big one. We must understand the reasons behind this thought process. Because we often accept perspectives without questioning them.

Some research articles suggest that certain sleep postures can provoke back pain. Lying on your stomach is the most common example here (Gordon et al. 2007), (Desouzart et al. 2016).

Also, the number of people experiencing low back pain isn’t decreasing. And there’s one big reason for this. Most people still believe, that a mechanical or structural problem is the cause of their pain.

Examples are:

• a herniated disk
• blocked vertabrae
• disk degeneration

And I get it. This makes sense IN THEORY.

For this to be correct, there are three things that we have to assume here:

1. There is a correct sleeping posture.
2. You can influence your sleeping position.
3. If you don’t adopt the right sleeping position, you will get back pain or worsen your back pain.

These statements need to be correct. Otherwise, there’s no point in freaking out about your sleeping position.

Sleeping with lower back pain – What Does Science Say?

If we take a look at what science has to say about this, we come to the following conclusion:

No sleeping position is generally better than another one.

90-95 % of lower back pain is actually non-specific. This means, that we cannot exactly say what is causing it (Bardin et al. 2017)

Let me give you another example for this.

Think of a plant that’s looking droopy. And you say: the cause is a lack of water. But the health of the plant depends on many more factors. Examples would be: sunlight, soil, pests etc.

And those factors all influence each other. So while a lack of water can contribute, we can’t always reduce it to this.

That’s why blaming a sleeping position for lower back pain is very reductionist.

And we also know that back pain is a complex phenomenon. Meaning that many other things can cause, maintain and influence it Hartvigsen et al. (2018) .

Not only the state of your tissue and your movements.

These other factors would be:

• Your social environment
• Your Psyche
• Your Genetics
• Other diseases you might have (like Diabetes, etc.)

“But my Physio/Doctor said so.”

I completely understand! And that’s the worst part. This isn’t even your fault. It’s physios and doctors who create and maintain these beliefs in their patients (Zusman 2013).

“But I definitely have pain when sleeping on (insert sleeping position here)…”

I get it! I’m not saying that a sleeping position cannot trigger your pain. I’m questioning whether the sleeping position is the main CAUSE of your pain.

We’ll get into some practical advice on how to find your perfect sleeping position soon.

Before that, you need to understand how lower back pain relates to sleeping positions.

Why? So that your back pain isn’t maintained by false beliefs (as discussed before).

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What’s the Relationship Between Sleep and Pain?

We used to think, that pain impacts sleep and sleep impacts pain in the same way (Cary et al. 2021).

To answer this, let’s compare the sleeping positions of people with and without back pain.

That’s what Cary et al. did in their study.

They found that people with lower back pain spend 3x as much time in provocative sleeping positions. Like lying on their belly.

Does that mean, that lying on your belly causes lower back pain? No.

That’s a correlation, not a causation.

Let me give you another example.

Imagine that you have shoulder pain. Sleeping on your side triggers your pain. What do you do? You sleep on your back.

If I analyze your sleeping position now, what do I notice? That people with shoulder pain lye on their backs.

Can we now draw the conclusion that lying on your back causes shoulder pain? Of course not.

And another one to make this even clearer:

In summer, people eat lots of ice cream, because it’s hot outside. And the hotter it gets, the more ice cream people eat.

Can we now say that eating ice cream leads to hotter temperature outside? That would be awesome! But wrong.

Let’s get back to sleep.

Research shows that if you sleep less, your pain gets worse (Lautenbacher et al. 2006)!

But this doesn’t mean that pain leads to worse sleep. Studies show, that it’s the other way around (Finan et al. 2013).

Poor sleep has an impact on your pain. If you sleep less, your pain level might increase.

The same goes for the ice cream example: the weather influences the ice cream consumption. But not the other way around.

Another fun fact here:

You can actually only have an impact on the position you fall asleep in!

Depending on your age, you change sleeping position between 17 and 45 times per night!

Let’s say you optimize the HELL out of your sleeping position.

Your body won’t be staying in this position for a long time. So it’s not worth freaking out about it.

Still, there is a sleeping position that will best suit you and your pain.

The Perfect Sleeping Position For Lower Back Pain (5 Simple Steps:)

Here’s a 5-Step Framework that you can follow.

Step 1: Discover Aggravators

Ask yourself: What movements increase my back pain?

Rounding the spine? Think childs pose or toe touch.

Extending the spine? Think cobra stretch.

Rotating? Think 90/90 Stretch with Arm Sweep.

Side-bending? Think lateral line stretch.

Step 2: Discover Relievers

Same procedure as step one but with a different question.

Ask yourself: What movements decrease my back pain? Rounding the spine? Extending the spine? Rotating? Side-bending?

Step 3A: Perform Relievers

Did you find some movements, which ease your pain? Do them for 5-10 minutes before going to bed.

Step 3B: Perform Mindfulness

You can’t find any movement that helps?

Try to calm your entire system down. Use mindfulness techniques.

One example would be a body scan, where you scan your body down from head to toe, focusing on each separate body part.

Or box breathing where you:

• breathe in for 4 seconds
• hold your breath for 4 seconds
• exhale for 4 seconds
• hold your breath again for 4 seconds.

Those methods help activate your parasympathetic nervous system. This can have a positive impact on your pain.

Do that either immediately before going to bed or in bed. Aim for at least 5 to 10 minutes.

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Step 4: Find Comfort

This is the most important part.

Adopt ANY sleeping position that feels comfortable to you. Forget about what sleeping positions seem correct or incorrect.

You don’t know where to start? Try to avoid the aggravators and imitate the relievers (see steps 1 and 2).

Step 5: Rest Assured

This is my favorite part.

You can rest assured that your back is strong & resilient. Even if you have pain at the moment.

Don’t stress about a “correct” sleeping position for lower back pain. It doesn’t exist. As long as it’s comfortable for you – go for it!

If you’ve tried a lot and your pain isn’t improving, you can get in touch with me. For that, simply click on this link.

If your back pain is very acute, then check out this article here for help.

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