I’ve worked with many people who have lower back pain. Most of them sleep in positions that make the pain worse. If you wake up stiff or your back hurts more at night, your sleeping position might be the problem.
The best sleeping positions for lower back pain are simple. You just need to know how to set them up right.
In this guide, I’ll show you three positions that doctors recommend. I’ll help you pick the right one for your pain. I’ll also point out common mistakes that hurt your back while you sleep. And I’ll tell you when it’s time to see a doctor.
Let’s fix how you sleep so you can wake up feeling better.
Is Your Sleeping Position Causing Your Lower Back Pain?
Here’s a simple test: Is your back pain worse in the morning than it was before bed? Does stiffness ease up after moving around for 20 minutes? That’s a strong sign your sleeping position is part of the problem.
When you sleep in the wrong position, your spine gets stuck in awkward angles for six to eight hours straight. That puts constant pressure on your discs and muscles.
Over time, this makes pain worse instead of giving your body a chance to recover overnight. The good news is that switching to better sleeping positions for lower back pain doesn’t require special equipment or major changes.
Small adjustments to how you position your body can make a real difference in how you feel when you wake up.
The Best Sleeping Positions for Lower Back Pain
These three positions keep your spine aligned and reduce pressure on your lower back. Start with the one that feels most natural to you.
1. Side Sleeping with a Pillow Between the Knees
This is the most recommended position for lower back pain. It keeps your spine straight and stops your top hip from pulling your pelvis out of alignment.
How to set it up:
- Lie on your side with knees slightly bent
- Place a firm pillow between your knees
- Keep your top leg from sliding forward
This works especially well if twisting motions make your pain worse. The pillow does the work of keeping everything neutral while you sleep.
2. Back Sleeping with a Pillow Under the Knees
Back sleeping takes pressure off your lower spine by reducing the arch in your lower back. The pillow under your knees keeps your spine in a gentle, natural curve.
Setup takes 30 seconds:
- Lie flat on your back
- Slide a pillow under both knees
- Make sure your head pillow doesn’t push your chin to your chest
Avoid this position if you snore heavily or have sleep apnea. Otherwise, it’s one of the easiest positions to maintain all night.
3. Stomach Sleeping
Stomach sleeping usually makes lower back pain worse. It forces your spine to arch and twists your neck for hours. But if you can’t sleep any other way, here’s how to reduce the damage:
- Put a thin pillow under your hips and lower stomach
- Use a very flat pillow for your head, or skip it completely
This keeps your spine flatter. But honestly, try the side or back positions first. Your back will thank you.
How to Choose the Right Position for Your Lower Back Pain
Not all back pain is the same. The position that helps someone else might not work for you. The key is matching your sleeping position to the movements that make your pain worse during the day.
| Position | Best For | Avoid If |
|---|---|---|
| Side sleeping with pillow between knees | Pain from twisting, one-sided pain, general back discomfort | You have shoulder problems or hip bursitis |
| Back sleeping with pillow under knees | Pain from arching backward, standing too long, general stiffness | You snore heavily or have sleep apnea |
| Stomach sleeping (modified) | You absolutely cannot sleep any other way | You have neck problems or severe lower back pain |
Use this table as your quick reference. For more detailed explanations on exactly why each position works best for your specific pain type, keep reading.
Sleeping Positions that Quietly Worsen Lower Back Pain
Some positions feel comfortable when you fall asleep but create problems overnight. Here’s what to avoid:
- Side sleeping with your top leg pulled forward: When your top leg crosses in front of your body, it rotates your pelvis and twists your spine for hours. If your hips feel uneven in the morning, this is usually why.
- The half-stomach recovery position: Lying partially on your stomach with one leg bent up combines the worst of stomach and side sleeping. Your spine twists, your neck cranks sideways, and your lower back arches all at once.
- The over-curled fetal position: Pulling your knees tight to your chest rounds your lower back and puts pressure on your discs. A gentle knee bend is fine, but extreme curling for eight hours makes you stiffer, not more rested.
- Sleeping without pillow support: Even if you’re in the right position, skipping the pillow between your knees (side) or under your knees (back) means gravity pulls your spine out of alignment. Your body has to work all night to compensate.
Avoiding these common mistakes is just as important as choosing the right position. Small adjustments prevent bigger problems over time.
See a doctor if you experience: leg pain past your knee, numbness or tingling, leg weakness, bladder or bowel issues, pain worsening over weeks, severe night pain, pain after injury, or unexplained weight loss. These symptoms need professional evaluation, not just position changes.
Before You Go to Sleep Tonight
You’ve read the advice. Now it’s time to put it into practice. Here’s your step-by-step plan for tonight:
- Choose your position: Side or back sleeping, based on your pain pattern
- Get your pillow ready: Between knees for side sleeping, under knees for back sleeping
- Check your mattress: Does it sag visibly? If yes, even perfect positioning won’t help much
- Set realistic expectations: The first 2-3 nights will feel awkward, and that’s normal
- Give it time: Stick with the new position for at least 5 nights before deciding it doesn’t work
- Watch for red flags: If pain gets worse or new symptoms appear, see a doctor instead of just adjusting positions
Final Thoughts
Finding the best sleeping positions for lower back pain comes down to three things: choosing side or back sleeping, using pillows correctly, and avoiding positions that twist your spine.
The decision guide and table should help you match a position to your specific pain. The first few nights will feel awkward. Your body is used to your old position, even if it hurt you.
Give yourself at least five nights before deciding something isn’t working. Most people notice improvement within a week. If your pain worsens or you see any red flags, skip the experiments and talk to a doctor.
But for most back pain, these simple adjustments make a real difference. What position are you trying tonight? Let me know in the comments.
