These Are the Best and Worst Sleeping Positions for Back Pain

Your back is your support system, literally, which is why keeping it in tip-top shape is key. After all, “if your back is strong and healthy, you have the foundation for a strong and healthy body,” explains Todd Sinett, DC, a chiropractor and owner of Tru Whole Care in New York City. Unfortunately, though, back pain is super prevalent, and many adults will experience it at some point in their life. In fact, according to the World Health Organization, it’s estimated that the number of folks with lower back pain will increase to about 843 million by 2050. What’s more: The position you sleep in could be contributing to your back aches and pains (and back pain can disrupt sleep, too).

That’s right, your sleep posture and setup can potentially do a number on your back, including “using too many pillows, sleeping upright in a chair, or falling asleep on a couch,” Sinett says. All of these can take you out of the best sleep position for your back, which is one where your spine is in a neutral position to lessen pressure points, and what you want is to find a sleeping posture that not only maintains the natural curves in your back, but supports them, too. 

(FYI: If back pain is disturbing your sleep quality and precluding you from getting the recommended seven to nine hours you need every night, you may be opening yourself up to a myriad of health issues beyond daytime fatigue and irritability, including heart disease and a weakened immune system.)n

Here our back experts offer sleep postures tweaks, better bed tips and even a few stretches to help you relieve back pain (or at least not exacerbate it) so you can continue to get good, restful sleep. 

What's the best sleeping position for back pain?

Best: Sleeping on your side and/or back.

Sinett says there isn’t one, “formulaic answer or magic sleeping position for all,” but there are ways to adjust your current sleeping position to alleviate pain and prevent further aches and stiffness in the morning. But generally speaking, research points to the preferable sleeping positions of lying on your side, lying on your back, or a combination of the two. Meanwhile, the least recommended sleeping position tends to be stomach-lying. 

A 2019 scoping review in BMJ Open compared and synthesized over 4,000 articles to pinpoint relationships between sleep posture and non-specific spinal symptoms in adults, and highlight the importance of evaluating sleep posture with respect to waking back pain symptoms. Though it concluded that there “were not enough high-quality studies to adequately answer” their question concretely—is there a relationship between sleep posture and spinal symptoms?—authors noted that “waking pain and stiffness were the most common symptoms explored” and that “side lying was generally protective against spinal symptoms.”

A small 2016 study on the effects of different sleeping positions on back pain in active seniors refers to the 2005 book Back and Bed: Ergonomic Aspects of Sleeping, by Bart Haex, in which Haex explains that lying on your side is one of the most commonly adopted sleeping positions, as well as one of the easiest to optimize to support the natural alignment and curvature of the spine, shoulders, and pelvis in bed with a well-placed pillow.

Per the study, Haex explains that pillows are a quick and easy way to keep your pelvis and shoulders supported while sleeping on your side: “putting a pillow, blanket, or pre shaped pillow between the knees as a spacer will stabilize the most elevated leg in a horizontal position,” and prevent any unnecessary twisting or improper alignment. The Cleveland Clinic also suggests the tip of alternating which side you sleep on, which can help stave off muscle imbalances.

The supine sleeping position—sleeping on your back—especially with a pillow or other comfortable, elevated object under your knees (to take some of weight of your legs off of your lower back), is a good way to evenly distribute your body weight and maintain spinal stability.

Worst: Sleeping on your stomach.

The above study also notes: “The prone sleep position, the lying position facing down, is the most unfavorable posture in relation to back support and…should be avoided.” But if this is the position you naturally gravitate toward, and you have no back issues to worry about, it’s not the end of the world. You can also place a pillow under you, by your pelvis and lower abs, to ease any strain on the back.

More Tips for Sleeping With Back Pain

Use one pillow for your head and neck.

“Placing a pillow between [or under] your knees can help alleviate back and hip pain while sleeping,” Sinett agrees. Too much pillow elevation isn’t great for your neck pillow, however. Having too many pillows under your head and neck may gradually cause irritation or even injury to the structure of your back. His recommendation is to stick to using a single pillow for your head. The type of pillow you prefer will typically depend on the type of sleeper you are (here’s how to choose the best pillow for your needs).

Upgrade your mattress. 

You may want to look into your mattress as well, which Sinett advises shouldn’t be too firm or too soft. Older research in the Journal of Chiropractic Medicine once found that changing out a mattress older than nine years old for a new one helped to ease back issues. You actually might want to ditch your mattress even earlier, though. According to the National Sleep Foundation, if it’s been between six and eight years since you sprung for a mattress, it’s time for a new one. If you haven’t hit this time block just yet, and there are no signs of wear and tear (think noticeable sagging or damage) to your mattress, Sinett suggests trying a mattress topper. “It's more economical than purchasing an entirely new mattress, but can offer better sleeping comfort,” he says. If you’re really concerned about back issues, it might be worth going to a mattress store in person to test them out. Here are a few helpful pointers when considering what kind of mattress to get.

Ease back pain with helpful stretches.

There is also plenty you can do outside of the bed, during the day, to make sleeping more comfortable. For Sinett that means taking time to decompress the spine. 

“You can do a simple ab stretch where you reach your arms straight up and gently bend backward,” he says, noting that you can do this stretch standing or sitting on the edge of a chair. Try to keep your lower back and tailbone relatively in place, while focusing on opening your chest and bending up and backward from your mid- and upper back.

Another great option is a hip and quad stretch called the couch stretch, recommended by Alex Rothstein, CSCS, program coordinator and instructor for the exercise science program at New York Institute of Technology. Here’s how to do it:

Put a pillow down on the floor in front of your couch (or a low bench). Get into a lunge position with your right knee resting on the pillow, as close to the couch as possible, then prop your right foot up and behind you onto the edge of the couch. Tuck your tailbone under and squeeze your glutes, holding this position for one to two minutes (don’t forget to breathe deeply!). Repeat on the opposite side. 

See a guided video on how to do the couch stretch and 3 other helpful stretches for back pain here.

It might seem odd to stretch the front of your body (thighs and hips) in order to help back pain, but they are directly related—and tight hip flexors can aggravate lower back pain more than you probably realize. “This is a deep hip flexor stretch that often relieves back pain in individuals who spend a lot of time sitting throughout the day,” Rothstein says. “Often the hips and/or upper back are the cause of low back pain, so instead of addressing the pain with a [back] stretch make sure the pain is not caused by tightness elsewhere.” He adds that side bends and upper back extensions (like Sinett recommends above) can help, too.

Remember: Back pain is nothing to play around with, especially if it's wrecking your sleep. If you make these changes and you’re still experiencing pain, it's important to see a doctor and/or physical therapist to help you get to the root cause, and get your back on track.