The Best Sleep Position for LBP Patients
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Research has confirmed that sleep postures can increase or decrease spinal pain, and addressing sleep posture can reduce the development of symptoms. (1-3) Fortunately, providers can help patients modify sleep postures through appropriate intervention. (2,4)
Chiropractors are routinely asked to help patients find the optimal sleep position. So what’s best? Well… your ChiroUp team reviewed the latest research to answer that question. And like most topics that require a doctor’s advice, it turns out there’s no simple answer, but there is some worthwhile advice. We’ve summarized that data here to help you help your patients sleep more comfortably and recover quicker.
Sleep Position Options
The most common adult sleep postures are side-lying, supine, and prone. (5-7) Each posture has advantages and disadvantages.
Side-lying asymmetrical
“Side-lying was reported as protective of spinal symptoms (1,2,8) and participants that slept in supported side-lying were found to have less symptoms than those sleeping in ¾ side-lying or prone.” (1,9)
Side-lying symmetrical (with a pillow between the knees)
“Participants spending more time in symmetrical side-lying reported less morning symptoms than those in asymmetrical side-lying.” (1,10)
Supine
Many providers recommend sleeping supine with a pillow beneath the knees; however, not all researchers agree. One study found supine sleep positions increased the likelihood of lumbar pain by 1.9 times. (10)
Prone
While many patients with neck or low back pain will want to avoid sleeping on their stomach, some people, particularly younger patients with sciatica, might find stomach sleeping more comfortable.
So, what’s the best sleep position? Unfortunately, that answer is still a little fuzzy. A 2019 BMJ scoping review concluded:
“With regard to recommending a sleep posture to minimise spinal symptoms, this review finds that side lying and supine were the sleep postures recommended by authors for those with lumbar spinal pain. However, there is a lack of high-quality studies from which to draw firm recommendations.” (1,2)
Fortunately, several condition-specific predictors can help us make more appropriate recommendations.
Directional Preference Predictors
Defining a (flexion vs. extension) directional preference for your patient’s lumbar condition can help predict the most comfortable position.
patients will typically prefer sleeping in a supine or side-lying position.
patients may be more comfortable in a prone position. Sometimes, placing a pillow beneath the chest for added extension may prove even more comfortable.
Diagnostic Predictors
Likewise, the structural diagnosis can also help predict an optimal sleep position.
Isthmic spondylolysis/spondylolisthesis - Providers should counsel patients to avoid stomach sleeping. (11)
Osteoporotic Vertebral Compression Fracture - The inability to lie supine is common in patients with a vertebral compression fracture. (12)
Maigne Syndrome - Excessive fascial tension can generate traction ischemia and hyperexcitability of the thoracolumbar dorsal nerve roots. (13) Thus, asymmetrical side-lying positions may aggravate symptoms.
Pregnancy-related LBP affects between 45-90% of women at some stage of their pregnancy, and sleep postures can play a significant role. Pregnant patients should generally avoid sleeping supine, as this position is linked to an increased odds (1.9 times) of stillbirth. (14) Experts recommend that pregnant patients sleep on their left side to avoid excessive compression of the vena cava and liver. A firmer mattress with a pregnancy support pillow positioned beneath the abdomen may help maintain a neutral sleep posture as the fetus grows. Placing a pillow behind the back may provide additional comfort.
The Bottom Line
Since each presentation is unique with endless variability, there is no one-size-fits-all sleeping position. Research suggests that the optimal sleep position is the one that allows patients to rest most comfortably without after-effects.
Finding the ideal sleep position usually takes some experimentation. Patients should progressively test to see if symptoms increase or decrease before spending significant time in any new position. Research has also suggested that back pain sufferers may benefit from alternating positions throughout the night. (2)
Educating Your Patients
Your ChiroUp team has added the latest recommendations to your ADL library, plus this infographic on Tips for Healthy Sleep to share with your patients and social media followers.
Want to learn more about sleep recommendations for other conditions? Check out this prior blog on Top Sleep Positions for 6 Common Conditions.
Neck pain
Rotator cuff tendinopathy
Carpal tunnel syndrome
Cubital tunnel syndrome
Lateral epicondylopathy
Gluteal tendinopathy/ GTPS
ChiroUp is changing how chiropractors diagnose, prescribe, and market outcomes. Learn more about our software for improved practice performance to deliver better results for your patients.
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1. Cary D, Briffa K, McKenna L. Identifying relationships between sleep posture and non-specific spinal symptoms in adults: A scoping review. BMJ open. 2019 Jun 1;9(6):e027633. Link
2. Desouzart G, Matos R, Melo F, Filgueiras E. Effects of sleeping position on back pain in physically active seniors: A controlled pilot study. Work. 2016 Jan 1;53(2):235-40. Link
3. McKenzie R. The cervical and thoracic spine: mechanical diagnosis and therapy. Orthopedic Physical Therapy; 1990.
4. Murayama R, Kubota T, Kogure T, Aoki K. The effects of instruction regarding sleep posture on the postural changes and sleep quality among middle-aged and elderly men: A preliminary study. Bioscience Trends. 2011 Jun 30;5(3):111-9. Link
5. De Koninck J, Lorrain D, Gagnon P. Sleep positions and position shifts in five age groups: an ontogenetic picture. Sleep. 1992 Mar 1;15(2):143-9. Link
6. Haex B. Back and bed: ergonomic aspects of sleeping. CRC press; 2004 Nov 29. Link
7. Gordon SJ, Grimmer KA, Trott P. Self-reported versus recorded sleep position: an observational study. Internet Journal of Allied Health Sciences and Practice. 2004;2(1):7. Link
8. Gordon SJ, Grimmer KA, Trott P. Sleep position, age, gender, sleep quality and waking cervico-thoracic symptoms. Internet Journal of Allied Health Sciences and Practice. 2007;5(1):6. Link
9. Cary D, Collinson R, Sterling M, Briffa K. Examining the relationship between sleep posture and morning spinal symptoms in the habitual environment using infrared cameras. Journal of Sleep Disorders: Treatment & Care. 2016. Link
10. Abanobi O, Ayeni G, Ezeugwu C, Ayeni OA. Risk-disposing habits of lowback pain amongst welders and panel beaters in Owerri, south-east Nigeria. Indian Journal of Public Health. 2015 Jul;6(3):333. Link
11. Agabegi SS, Fischgrund JS. Contemporary management of isthmic spondylolisthesis: pediatric and adult. The Spine Journal. 2010 Jun 1;10(6):530-43.
12. Langdon J, Way A, Heaton S, Bernard J, Molloy S. Vertebral compression fractures–new clinical signs to aid diagnosis. The Annals of The Royal College of Surgeons of England. 2010 Mar;92(2):163-6.
13. Seong JW. Principle and insight into pain. Paju. Korea: Koonja Press. 2012:844-55.
14. Cronin RS, Li M, Thompson JM, Gordon A, Raynes-Greenow CH, Heazell AE, Stacey T, Culling VM, Bowring V, Anderson NH, O'Brien LM. An individual participant data meta-analysis of maternal going-to-sleep position, interactions with fetal vulnerability, and the risk of late stillbirth. EClinicalMedicine. 2019 Apr 1;10:49-57. Link
