The sleep positions people with back pain avoid most

A study of 375 people with long-term low back pain found that 42% avoided sleeping on their front because of the pain. Another 35% avoided lying on their back, according to a Cureus study published on 6 May 2024.

The same patients did not always avoid the position that seemed to cause them the most trouble. 87% said they preferred sleeping on their side. The researchers found that side-lying was linked to a higher score on the Oswestry Disability Index, a standard measure of how much back pain limits daily life, and to more pain running down the leg.

NHS advice on back pain does not point to one specific sleeping position. It tells people not to stay in bed for long periods and to keep up their daily activities where possible, and says walking, swimming, yoga and pilates may also help ease the pain, alongside ice packs, heat packs or anti-inflammatory medicine such as ibuprofen.

Away from that survey, sleep specialists have their own long-standing advice on pillows for a bad back.

• Back: lying flat is “traditionally thought to be the best sleep position” because it spreads pressure evenly across the back, said Dr Robert Griffin, director of the Ambulatory Pain Medicine Program at the Hospital for Special Surgery — though Griffin added that this “hasn’t been scientifically proven”.
• Side: side sleepers typically need a taller pillow to keep the neck in a neutral position, plus a small pillow between the knees, Griffin said.
• Front: people who sleep on their stomach can put a small, flat pillow under the lower belly or hips to stop the spine sagging, and a flatter pillow under the head, Griffin said.
• Mattress: a medium-firm mattress works best for most people, Griffin said, rather than one so soft that the lower back sinks below the shoulders and feet.

The Cureus researchers point to limits in their own findings. The study relied on people recalling their own sleep position, capturing only how they lay down at the start of the night and when they woke up, so it did not track movement once they were asleep. The authors said the design “limits our ability to establish causality” — it cannot show whether a position causes the pain or the pain leads people to choose that position. They also found no significant link between sleep position and how much pain people felt overnight.

Griffin said people should see a medical professional if back pain is stopping them from sleeping, working or getting through daily activities.

“There is no one sleep position that works for everyone,” Griffin said, adding that back pain is “very person-specific” and that trying different positions is often the only way to find what helps.