The Common Sleep Position That’s Hurting Your Back, According to Physical Therapists

We spend about one-third of our lives sleeping. Sorry, not sorry, hustle culture—that’s a good thing. Sleep is restorative and necessary for your overall health. Yet, it’s not just about the number of hours of sleep you log per night that counts. Your sleep position can determine whether your waking hours are a literal pain in the neck.

“The positions we spend hours in every night influence our spine’s health,” says Dr. Joseph Hribick, DPT, a clinical assistant professor of physical therapy at Lebanon Valley College. “When sleeping, our muscles, discs and joints are held in certain positions for long periods of time.”He warns that poor spinal alignment places stress on the spinal structure, irritates nerves and strains muscles. Over time, it can lead to pain and stiffness that make completing daily tasks feel like a nightmare. One sleep position in particular can hurt your back. Physical therapists share what it is, how to avoid it and the best sleep position for back pain.

The Common Sleep Position That Can Cause Back Pain

Physical therapists caution against sleeping on your stomach. “When someone sleeps on their stomach…[their] body is held in non-neutral spinal positions and places uneven loads on the spine and surrounding tissues,” Dr. Hribick says.He adds that the top three issues with stomach sleeping are that it causes spinal twisting, excess lumbar extension and nerve compression, explaining, “To breathe effectively when sleeping on one’s stomach, the head usually turns to one side. This places the neck and upper back into a prolonged position of rotation, which can irritate the cervical joints and muscles and result in neck pain.”

Let’s move down the spine to your lower back, AKA the lumbar spine.“When lying on your stomach, your lumbar spine (lower back) is positioned into spinal extension,” Dr. Hribick says. “This position can compress the joints and can aggravate existing lower back pain, especially in individuals with spinal stenosis and degenerative disc/joint disease.”The combination of the neck rotation and low back extension puts pressure on your cervical and lumbar nerves, triggering compression. As a result, Dr. Hribick warns that you may start feeling tingling, numbness and discomfort in other parts of the body, such as your arms and legs.Even one night of stomach sleeping can cause back pain (and pain throughout the body). However, consistently snoozing on your tummy can lead to long-term and chronic low back pain, warns Dr. Andrew J. Bach, DO, FAAPMR, a physiatrist at Cedars-Sinai Spine Center. He says stomach sleeping promotes what’s known as “facet joint arthropathy”—a fancy term for what happens when the joints rub against each other and become inflamed, causing pain. It can also trigger Intervertebral disc degeneration (IDD), or a breakdown in your spine’s vertebrae that makes them less cushy. Ouch, right? Right.

“This can lead to structural changes and persistent pain,” Dr. Bach says.

However, stomach sleeping isn’t always a no-go. “If someone is sensitive to lumbar flexion [forward bending of the low back] and experiences an increase in symptoms with common positions such as sitting, prioritizing some time spent on the stomach over the course of the night could be beneficial and relieving,” explains Dr. Landon Uetz, DPT, a physical therapist and professional pickleball coach on TeachMe.To.

How To Stop Stomach Sleeping

You’re not conscious when you sleep. However, it’s possible to train the body to avoid stomach sleeping, so you can wake up with less (or no) back pain. Dr. Uetz shares that one common way to avoid stomach sleeping is to place “a tennis ball or something similar in your front pocket of shorts/pajamas so that every time you roll onto that position you naturally aren’t going to stay there without waking up.”

Dr. Bach also suggests:

• Hugging a body pillow

• Elevating one leg while on your side to make side-sleeping more comfortable and reducing your urge to roll over

• Investing in a firmer mattress to support spinal alignment and discourage stomach sleeping

Remember: Changing sleep positions is a process. “This change doesn’t happen overnight—no pun intended,” Dr. Hribick says. “Changing sleep habits and positions does take time and some patience.”

What Is the Best Sleep Position To Reduce Back Pain?

“For most people, sleeping on their side with a pillow between the knees is one of the better positions,” Dr. Hribick reveals. “It keeps the pelvis, hips and spine in a neutral alignment and reduces twisting or rotation of the neck. Also, sleeping with a pillow under the knees can be excellent for people without sleep apnea.”

OK, but which side? That depends.

For instance, Dr. Hribick says that right-sided sleeping can assist with reducing snoring and mild sleep apnea while avoiding lumbar spine extension. However, he and Dr. Bach note that people with acid reflux often report that this position aggravates their condition and that they prefer to snooze on their left side.

Dr. Bach also notes that it can increase pressure on the inferior vena cava—a large vein that runs from the heart to the legs—and lead to increased swelling and discomfort in pregnant people during their second or third trimesters. For this reason, doctors often recommend pregnant people sleep on their left side.

Believe it or not, back sleeping isn’t completely off the table, either. “Back sleeping keeps the spine in a generally neutral position and reduces pressure on joints and discs, depending on mattress, pillow and spinal alignment,” Dr. Bach says. “However, it can worsen snoring and sleep apnea.”In short, as with many aspects of life, sleep position is personal.“There is no perfect position to reduce back pain for everyone,” Dr. Uetz says. “You may talk with 10 people and hear four different ‘favorite’ positions for their backs. I would suggest trialing stomach, back and side sleeping to determine what works best for you and roll with it for a few weeks.”

The Surprising ‘Must-Start’ Habit For Avoiding Back Pain

We wish we could wave a magic wand and tell you that you can cure back pain in your sleep. However, experts stress that daily, conscious habits also make a significant difference. Their top tip? Get in several types of movement.“The most common aggravating activity for back pain is likely prolonged sitting,” Dr. Uetz shares. “I generally recommend someone stand up from the chair, walk or go through light mobility exercises every 30 mins to avoid static positions.”

He also recommends strength training two to three times per week, saying, “Increasing your body’s capacity to handle the demands of life is a great way to reduce the risk of back pain developing or also help try and manage current symptoms.”

Dr. Hribick suggests working deep core work into your resistance regimen. “A strong core stabilizes the spine and reduces stress during daily movements.”

That said, Dr. Bach says it’s important to take a day off if your body is telling you it needs one. “Avoid pushing through pain,” he advises. “If exercise or stretching triggers back pain, stop and reassess. Pain may indicate incorrect form or overuse.”

On these days, prioritize rest—in a sleep position that works for your back and body.