Is Your Sleeping Position Contributing to Your Pain?
Written by Michele Vieux

It’s pretty safe to say that most people understand the importance of getting “quality” sleep each night. It’s also probably safe to say that when most people define quality sleep, they mention things like getting eight hours of sleep each night, that the sleep be uninterrupted or that they hit REM at least three times per night. But how many people factor in their sleep position as a major player in sleep quality?

Different sleeping positions can determine how well we digest, how much we snore, and how much pain we have in our necks, backs, shoulders, hips and knees. So if you have nagging joint stiffness, tightness or pain that you’re unable to resolve with mobility work and virtuous form in the gym, it might be time to examine if how you’re sleeping is contributing to your pain.

Fetal Sleeping Position

Did you know that this is the most common sleeping position amongst adults with 41 percent choosing to sleep this way? The fetal sleeping position is another side-sleeping position but instead of long legs and spine, both are curled and bent so that the sleeping person forms a loose ball with their body.

Although this is a great position if you are pregnant – especially if you are on your left side – and for snorers. It’s maybe the WORST if you have arthritis and achy joints because you literally have to uncurl yourself from being stuck in a ball all night.

If you sleep in this position and you wake up stiff and sore, it might be time to try a new pose. You can try uncurling yourself a bit and using a pillow between your knees to straighten out your hips and relieve discomfort and pain. Or, you can start to make the move to the ideal sleep position (below).

Sleeping on Your Stomach

Sleeping on your stomach can be a major contributor to low back pain due to your head and upper half being elevated by a pillow, placing pressure down the chain. This can be an especially painful position if you have limited mobility in your thoracic spine – lack of mobility there needs to be made up somewhere and that’s usually the lower back. This low back pain can occur while you are in your sleeping position but can also rear its ugly head at other times throughout your day like when you are sitting or working out.

This position can also be a major contributor to neck pain if you sleep with your head turned to one side. So if you have a nagging pinching in your neck, your neck rotation is limited, or the ability to touch your ear to your shoulder is shortened, you could be causing it from how you are sleeping.

For stomach sleepers who MUST sleep on their bellies even after reading this, try doing so face down (instead of with your head turned to one side). You can either prop your forehead up on a pillow so you have room to breathe, or you can try out some sort of massage table headrest apparatus. These should be a last resort though because, again, this is the WORST position for your body to sleep in.

Sleeping on Your Side

Although you are less likely to snore in this position, sleeping on your side is more likely to cause shoulder pain from putting weight on your arm in this position and even numbness and tingling in your arms and hands because either your circulation is being restricted or a nerve in your neck is being pinched.

There is not a lot of extra space in the shoulder so putting a piece of the moving puzzle even just a little out of position can cause major issues. Besides being painful, let’s remember that if a nerve is being pinched then the signal is not getting through or it is weak and/or delayed so your body is not performing at its peak level.

Sleeping with Elevated Knees and/or Legs

Some of us get into this habit to alleviate lower back pain or post-injury or surgery in the case of the knee. Yes, it feels better…at first…but then other types of pain and tightness creep in with this position.

Many times, “unexplained” knee pain will occur for those sleeping in this position because the sleeper’s knees never hit extension for 6-9 hours of the night. Lack of terminal extension of the knee can lead to many-a-problem and much pain for the knees. With lack of terminal extension, your quads are always loaded – causing patellar pain. When the quads are always under tension, the knees can become “twisted” out of position (ouch!). And, the popliteus – the small muscle behind the knee – gets tight and has to work overtime to stabilize.

Hip pain and tightness can also rear their ugly heads for those who sleep with elevated legs for reasons similar to the issues that arise with lack of extension in the knee. When you sleep with your legs elevated, your hips remain slightly closed for hours at a time causing stiffness, tight hip flexors and tight psoas – all of which can lead to pain in the hips but also lower back.

Sleeping on Back with “Froggy” Legs

This is ALMOST the ideal position where the sleeper is face up but instead of the legs straight out on the bed, the knees are slightly bent and the hips are in external rotation. Similar to the leg lifter above, this sleeper will likely experience some tightness in the hip flexors that can lead to pain in the hips but also in the glutes.

By keeping your leg(s) in external rotation all night long, you are shortening all those muscles, especially the glute medius, causing pain in the actual glute itself, but also possibly pulling the hip and knee out of position which can be painful. Not to mention, you are totally shutting off your internal hip rotators and adductors. So if you’ve noticed those things aren’t working on your deadlifts…you might examine if this is the cause.

The Ideal Sleep Position

You know that anatomical drawing of “supine man”? Well that’s also the ideal sleep position – on your back with your head, neck and spine resting in neutral positions. The head should be elevated just slightly above the stomach to prevent acid reflux and snoring. *MOST* people should be sleeping in this position.

* If you have sleep apnea, then the supine sleep position might not be right for you and could even be dangerous. In this case, you would be best off in the side-lying sleep position which still elongates the spine and takes pressure off it and the lower back. BUT…it can lead to shoulder pain if you can’t figure out what to do with that arm.

* Pregnant ladies are the other group of people who should probably not sleep on their backs, but instead adopt the side-lying sleep position while carrying.

How to Fix Your Sleep Position

Your bad sleep position is your bad habit and you basically have to train yourself to sleep in the ideal position. Here are a few ways you could try to make this happen.

One is this sleep belt which straps on around your waist and the attached balls poke – very uncomfortably – into your sides and stomach if you roll over in your sleep. You can adjust the balls depending on your ideal sleep position to keep you there.

Another option is a little more comfortable and you should already have what you need at home – pillows! Just pack them around you – one touching each side – when you go to bed to help keep you in position. If you wake up in the night and find that you’ve rolled out of your ideal sleeping position, just get back into position, repack the pillows and return to slumber.

A third option for pet lovers – enlist the help of your furry friend(s)! Instead of packing pillows around you, pack your furry pets! They can lay next to you but also ON your legs to help keep you in position. This only works if they don’t weigh more than 20 pounds or move around too much in the night. Also, pets are known contributors of interrupted sleep so if your furry friend doesn’t already sleep in your bed, it’s best not to get that started.

Improving your sleep position will lead to better sleep quality and less pain! Give that “ideal position” a try to see how much better you can feel and perform!

The Best Sleep Position for Your Body. The National Sleep Foundation.

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September 13, 2021 6:10 pm

Excellent article!!! Well thought out and detailed. Thank you for this!!! I will fix my sleeping position tonight!