We don’t often think about our spines when we’re lying in bed. But our sleep posture can help determine whether or not we experience back pain. So when you turn in for the night, remember these tips from physical therapist Marleen Caldwell, PT, MS, Cred MDT, on how to sleep to avoid back pain.

1. Keep your spine in a neutral position

Choose a well-made innerspring or foam mattress, or add a foam mattress topper to your innerspring mattress for additional support. You can also alter your sleep position or use pillows to keep your spine neutral.

An innerspring mattress can create pressure points at the back of the head, the shoulder blades, the tailbone and the heels, and depending on how firm the mattress is, won’t support the curve of your spine at the neck or lower back.

2. Sleep on your back

The optimal sleeping position is on your back. This evenly distributes weight across the widest surface of your body, minimizing pressure points and ensuring proper alignment of your internal organs. The worst position for sleeping is on your stomach due to the unnatural position of your neck.

3. Alternate sides if you’re a side sleeper

Some evidence suggests that habitually sleeping on one side on an ill-fitting mattress may contribute to muscle imbalance and pain. Always sleeping on the same side suspends the middle of your body between your hips and shoulders, the broadest parts of the trunk. Place a pillow between your knees as shown below to keep hips, pelvis and spine aligned.

When you sleep on your side, notice how hip alignment changes with and without a pillow between your knees.

4. Use a pillow

Whichever sleep position you choose, put your pillow beneath your head and neck, but not your shoulders. If you sleep on your back, make sure the pillow fills the space between your neck and the mattress to maintain a neutral position, as illustrated below. If you sleep on your side, use a thicker pillow, also shown below.

When sleeping on your back, keep your neck properly aligned by filling the space between your neck and the mattress with a pillow. When lying on your side, use a thicker pillow and place it under your ear.

5. Your body type dictates the type of support you need

If your hips are wider than your waist, a softer mattress can accommodate the width of your pelvis and allow your spine to remain neutral, as shown below. If your hips and waist are in a relatively straight line, a more rigid surface offers better support.

Sleeping on a rigid surface (top) versus a softer surface (bottom) affects the position of the pelvis and lower spine.

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