Back pain, it seems, can be hard to avoid. Estimates suggest that worldwide as much as 80% of the adult population will experience lower back pain at least once during their lifetime.
If you have experienced back pain you may know firsthand how different positions can aggravate the condition and how back pain can itself hinder sleep. So are there any sleeping positions that are better for back pain sufferers?
Back Pain and Sleep
According to a new research published in the Clinical Journal of Pain chronic low back pain can negatively affect the quality of sleep in terms of duration, satisfaction, day-time functioning, time taken to fall asleep and sleep efficiency. 
Interestingly, most researchers and clinicians also believe that sleeping positions may play a preventive as well as a therapeutic role in the management of backache.
For example, non-neutral sleeping positions can pose unnecessary stress and strain on the intervertebral joints and surrounding tissues that may lead to backaches, spinal degenerative disorders and other disturbing ailments.
The Best Sleeping Positions for Back Pain
1. Sleeping on the side
Sleeping in the right lateral or left lateral position is perhaps one of the best positions to combat acute backache, mainly because sleeping on the side reduces stress on the musculoskeletal system (especially the spine and pelvis). Additionally, since your back stays in a generally neutral position, the deteriorating effects of pressure and gravitational forces are also minimized.
Here are a few tips to obtain maximum benefit:
- Ideally, keep your legs straight to minimize pressure on the spine (log pose).
- You can also place a pillow between your legs to sleep more comfortably.
- If you are not comfortable sleeping with your legs fully extended, you can flex your knees at a 90 degree angle to maintain a neutral posture.
- Sleeping in the left lateral position is recommended if your back pain is due to pregnancy.
- Sleeping in the left lateral position increases blood flow to the fetus and minimizes the risk of heartburn.
2. Sleeping on the back
Sleeping on the back with legs fully extended is also considered a great sleeping posture. Remember:
- Not to cross your legs or slide one knee over the other (this increases the pressure on your pelvis).
- To avoid a very thick pillow, or more than one pillow, in this position.
- To reduce the influence of gravity, you can use soft physical support (in the form of pillows or rolled towels) at the sites of anatomical curvature (lower back and under the knees) to maintain a less stressful posture.
- Arms should ideally be aligned parallel to the torso (soldier pose), rather than being elevated above the head or pillows (star-fish pose).
There are a number of other benefits as well. For example, the risk of acid reflux, regurgitation and hiccups decrease in this posture. In addition, women who are worried about the wrinkling of facial and neck skin can benefit from this sleeping position.
The only reason why this posture is not the most preferred choice is that there is a mild risk of snoring or sleep apnea in some susceptible subjects, as well as a moderate risk of shoulder pain if pillow alignment and pillow height are not appropriate.
The Worst Sleeping Positions for Back Pain
If you want to prevent back pain while sleeping, you should avoid the following sleep positions:
1. Sleeping on the side with one leg hiked up
Sleeping on the side with one leg hiked up or lying at a higher level than the other leg in a modified fetal position. This position may increase the pressure in your pelvic region and may aggravate back pain.
2. Sleeping on your stomach with your face turned to the side
In this position, your lower spinal muscles and tissues are minimally supported. Additionally, your cervical spine undergoes excessive stretching in either the right or left direction (to maintain normal breathing), which further leads to stress and twisting pressure on the spinal column. This position (also sometimes referred to as the ‘freefall’ position) can increase the risk of tingling, paresthesia and numbness in the extremities.
- Make sure your pillow is soft and comfortable. Refrain from using very thick or hard pillows that may stress your neck muscles and/or increase the risk of spasm of the cervical or spinal muscles.
- Change your pillow once every 6 to 12 months and your mattress every 5 to 7 years.
- Choose your mattress after careful research. If you are suffering from chronic back pain, it is always a good idea to consult your primary care provider for recommendations and advice about the type, height, stability, brand and style of mattress.
- Always stand up from the lying position in a step-wise manner. Avoid twisting your back excessively.
Although in most cases changing your sleep position can help to reduce the intensity and frequency of back pain, it is not a permanent solution. Make sure to discuss continuing back pain with your primary care provider to identify the cause, triggers and optimal management options for permanent pain relief.