Sleeping Positions That Ease SI Joint and Lower Back Pain
If your lower back or SI joint hurts at night, or you wake up stiff and sore, the way you lie down may be part of the problem. A few small changes, mostly involving pillows, can take strain off your back while you sleep. Here’s what tends to help, what to avoid, and how to get out of bed without setting off a flare.
The Short Answer
Sleep on your side with a pillow between your knees, or on your back with a pillow under them. The Sleep Foundation calls side sleeping with a slight bend in the knees and a pillow between them the best position for lower back pain, with back sleeping next. Cleveland Clinic gives similar advice: sleep on your back with a lumbar roll, or on your side with your knees slightly bent, but not with your knees drawn up to your chest.
If one side hurts more, as is common with SI joint pain, lie on the other side.
Side Sleeping, Done Right
Side sleeping is the easiest position to improve with a pillow or two.
- Pillow between your knees. The Sleep Foundation notes that it keeps your hips, pelvis, and spine in better alignment and prevents the twisting that strains the low back.
- Knees slightly bent. A gentle bend is enough. Cleveland Clinic advises against pulling your knees up to your chest.
- Head level with your spine. Use a pillow that fills the space between your shoulder and head without tilting your neck up or down.
- Sore side up. Mayo Clinic lists sleeping on the painful side as something that can make SI joint pain worse.
The Sleep Foundation also suggests switching sides from night to night so one side doesn’t take all the pressure. Pain that sits low on one side, just below the dimple at the back of the pelvis, and flares when you roll over is a common sign of SI joint dysfunction.
Back Sleeping With Support
Put a pillow or rolled towel under your knees. Lying flat spreads your weight evenly, but it can leave a gap under the curve of your low back and let it arch, and the Sleep Foundation notes that support under the knees helps keep that curve in a comfortable position.
A few other options for back sleepers:
- A thin lumbar roll under the small of your back, which Cleveland Clinic also suggests
- A slightly reclined position, using an adjustable bed or a wedge pillow, if lying flat is uncomfortable
- A medium pillow under your head, so your neck isn’t pushed forward
Positions and Habits to Avoid
Some habits make a sore back harder to sleep through.
- Stomach sleeping. The Sleep Foundation notes that it flattens the natural curve of your spine and twists your head and neck. If it’s the only way you can fall asleep, put a thin pillow under your pelvis.
- Knees pulled to your chest. A tight curl can strain the back you’re trying to rest.
- A sagging mattress. Cleveland Clinic recommends a firm mattress and box spring that don’t sag, and a board under the mattress if needed.
- Staying in bed all day. NIAMS advises avoiding bed rest for back pain and limiting only the activities that cause pain.
What to Look for in a Provider
If changing how you sleep hasn’t helped after a couple of weeks, a few things are worth asking about before you book.
- An exam before any adjustment. A detailed history, range of motion, and orthopedic and neurologic testing, so care is based on what’s found.
- Questions about your nights. When the pain wakes you, and which positions make it worse, are useful clues.
- A plan you can follow at home. Good care includes what to do between visits, not just what happens on the table.
- A willingness to refer. If the exam points somewhere outside chiropractic, you should hear that plainly.
- Clear communication. You should understand what care involves, how long it may take, and what it costs before you start.
Getting Out of Bed Without a Flare
Roll to your side before you sit up. The first move of the morning is often the one that hurts most, and Cleveland Clinic recommends this sequence:
- Turn onto your side.
- Draw both knees up a little.
- Swing your legs over the side of the bed.
- Push yourself up to sitting with your hands, without bending forward at the waist.
If you’re stiff for the first part of the day, a warm shower or a heating pad often helps you loosen up, since heat suits stiffness while ice suits a fresh flare. Pain that’s worst first thing in the morning, or pain that wakes you at night, is worth mentioning at an exam, because those patterns help sort out what’s behind your low back pain.
What a Visit Looks Like at River of Life
Care here follows three steps: Prime, guided breathing to help your body settle; Facilitate, a gentle, specific adjustment based on what the exam found; and Integrate, what happens between visits, including how you sleep. Pain isn’t the only thing that breaks up a night. Stress can keep you waking up between 2 and 4am, and the Sleep Foundation notes that poor sleep can heighten pain sensitivity, so we ask about both.
When Night Pain Needs a Doctor
Most night-time back pain is mechanical and eases as things settle, but some symptoms need medical care first.
When to get medical care right away
These are reasons to see a doctor or go to the ER, not to book a chiropractic visit.
- Numbness in the groin or inner thighs, or new trouble controlling your bladder or bowels. These can be signs of cauda equina syndrome, which needs immediate medical attention.
- Leg weakness that is new or getting worse.
- Back pain with a fever, or after a fall or accident where a broken bone is possible.
- Night pain with unexplained weight loss, or pain that won’t ease no matter how you lie.
Your Setup for Tonight
Try this setup tonight:
- On your side, sore side up, with a pillow between your knees
- Knees slightly bent, not pulled to your chest
- Or on your back, with a pillow under your knees
- A head pillow that keeps your neck in line
- In the morning, roll to your side and push up with your hands
Give a new position a few nights before you judge it. Your body may need a little time to get used to it.
Back pain keeping you up at night?
We’re glad to answer questions before you book. Read about our low back pain care in College Station, or check what to expect at your first visit.
Sources
This article is for general education and is not medical advice. For questions about your own health, talk with your doctor or another qualified healthcare provider.
From the team at River of Life Chiropractic, 4519 Mills Park Cir Ste 300, College Station, TX 77845.
About the Author
Dr. Levi Hansen, DC
Founder of River of Life Chiropractic in College Station, TX
Webster Certified (ICPA)B.S. Neuroscience, WSU
Raised in Kenai, Alaska, Dr. Hansen played football at Washington State, earned a B.S. in Neuroscience, then his Doctor of Chiropractic from Parker University. Every visit starts with a real exam, followed by his three-step Prime, Facilitate, Integrate process.
- Every visit starts with a physical exam
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