Best Sleeping Positions for Neck Pain and Back Pain Relief

How Do I Know if My Sleeping Position is Causing My Neck Pain or Back Pain?

While there are some conditions that can directly cause neck pain and/or back pain when getting out of bed in the morning or when changing positions in bed such as a herniated disc in the spine, the most indicative way of determining if your sleeping position is the cause of your pain is to ask yourself a few basic questions:

1. Am I waking up with neck pain or back pain that I do not have when I go to bed?
2. Does my pain ease with gentle movements (moving out of my sleeping position) after waking?
3. Does my pain seem to be affected by changing beds, pillows, or sleeping positions (lying on your back, belly, or side)?

If you answered yes to each of these questions, then it is likely that your neck pain or back pain is being caused by your sleeping position, pillows, or even possibly your mattress.

The 3 Primary Sleeping Positions

There are three primary sleeping positions:

1. Back Sleepers
2. Side Sleepers
3. Belly Sleepers

Which Sleeping Position is the Worst for Neck Pain & Back Pain?

Sleeping on your belly is, by far, the worst sleeping position overall as it can easily cause neck pain and back pain for most adults.

Most of us can remember lying and sleeping on our bellies for several hours without issue as children, however, our bodies change with age, and we can no longer tolerate this position nearly as much as an adult.

Lying on your belly creates certain stresses on the body that naturally causes joints and muscles to stiffen and tighten eventually leading to the onset of pain.

How does belly sleeping cause neck pain and back pain?

When lying on your belly, your neck will undoubtedly be rotated to one side in order to breathe. Staying in this rotated position is not inherently a problem, though, if you stay in this position for several hours while sleeping, the muscles that have been stretched (stressed) and the joints that have been rotated to their end ranges of motion are likely to cause neck pain when you finally wake up to change positions.

Unfortunately, neck pain that is caused by lying on your belly is not the only concern. It is also very common for this position to cause back pain as lying on your belly places the lumbar spine (low back) as well as the low back muscles to be placed in a compressed and shortened position. The low back does not tolerate this position well for long periods of time.

After waking from sleeping on your belly, the lower back muscles often feel very tight and the lumbar spine feels stiff like it doesn’t want to move. This makes it difficult to bend and move the spine without stretching these low back muscles out first.

Tips for the Best Sleeping Positions

Ideal sleeping positions relate closely to natural body alignment. No matter what position you sleep in, your primary goal is to achieve a neutral position by utilizing whatever you have available (most commonly pillows, mattress, and your other body parts). 

So, let’s do a breakdown of each preferred sleeping position.

Back Sleepers

• To reduce neck pain, you should aim to achieve a neutral neck position with the pillow. 
• Pull the pillow to the top of both shoulders, but don’t let the pillow get underneath the shoulders as that will cause the head and shoulders to elevate.
• Pull the pillow in to fill in the space behind the neck. It should feel like the pillow is cradling the neck and head. This should make the head feel fully supported.
• To reduce back pain, place a wedge pillow, roll pillow, or regular pillow underneath the lower legs stretching from just below the knees to just above the ankles.
• A leg support pillow will help promote a neutral lumbar spine (optimal position).

Side Sleepers

• Pull the pillow in to fill in the space between the side of your neck and the mattress to provide the neck and head with enough support to allow for a straight, neutral head position. 
• The neck and head should be in a neutral position.
• Use a knee support pillow or body pillow to place between the knees and lower legs.
• This will help to maintain a neutral pelvis and lumbar spine.

Optimal Side Sleeping Position

• Try adding one additional pillow for shoulder and trunk support to create the optimal side sleeping position.

Belly Sleepers

• If you absolutely have to sleep on your belly, then at least try to set yourself up for success by choosing a thinner pillow. Place your head near the edge of the pillow to promote less neck rotation than if your head was placed directly in the center of the pillow.
• Use a smaller pillow to place under the pelvis/hips, which will provide a slight bend in the lower back. This will help to reduce low back pain when belly sleeping.
  

Choosing the Best Pillow

Choosing the right pillow can feel like an arduous task. There are thousands of types of pillows and there is no way that I could discuss each of them in detail. 

But don’t despair, as long as you understand a couple of basic concepts, you’ll be able to find a pillow that works well for your preferred sleeping position. Whether you are a back or a side sleeper, you should always try to find a pillow that supports your neck and helps maintain a neutral spine position. This means that your neck is in a mostly straight position, neither tilted nor rotated to either side. 

Check out the illustration below for a visualization.

Now that we have a better understanding of achieving a supportive and neutral neck position, let’s break down my favorite, recommended pillows by your preferred sleeping position.

Best Pillows for Back Sleepers

Back sleepers should consider using a slim to moderate-thickness pillow. You’ll want a pillow that can fill in the voided space in the back of your neck providing full support for the neck while keeping the neck in a straight, neutral position. A pillow that is too thick will push your neck into a flexed (forward tilt) position. Alternatively, a pillow that is too thin will allow the neck to extend backward.

• Cooling Neck Support Contour Pillow
• Deep Sleep Pillow

Also consider trying a Tempur-Pedic, contoured-type pillow that forms to the neck’s natural curvature.

• Neck Relief Ergonomic Contoured Cervical Pillow

Using a leg pillow to place under the lower legs from just below the knees to just above the ankles can significantly help to reduce low back pain.

• Casper Backrest Wedge Pillow (use for under the lower legs)
• 7.5″ Foam Wedge Pillow (use for under the lower legs)

  

Best Pillows for Side Sleepers

Side sleepers will need at least a moderate-thickness pillow or greater because the pillow has to fill in a greater space from the distance of the shoulder (which is lying against the bed) to the side of the neck. Again, we want the neck to be in a neutral position so that it is neither tilted to either side nor rotated.

• Purple Harmony Pillow
• Casper Hybrid Pillow

Cushion Lab Cooling Neck Support Contour PillowSide sleepers should also consider using a body pillow or a knee support pillow in order to prevent back pain. Side sleeping without a knee support pillow causes the pelvis to tilt, which then pulls on the lumbar spine and lower back muscles eventually leading to lower back pain.

• Cushion Lab Knee Contour Pillow
• Oubonun Body Pillow

Best Pillows for Belly Sleepers

• • Cooling Neck Support Contour Pillow

Recap – The Best Sleeping Positions

The following illustrations depict the best sleeping positions for neck pain and back pain relief.

1. Back Sleepers

2. Side Sleepers

3. Belly Sleepers