Morning pain
Sleep position and getting it right to avoid strain on the body is important given that we spend a third of our lives in bed.
A lot of patients tell me that their back, neck or even arm pain is worse in the morning when they wake up. There are several reasons why pain behaves like this. One is that it’s a ‘hangover’ from whatever they’ve done the day before. If they’ve had a heavier day at work, or overdone things in the garden, it’s possible the pain doesn’t get worse that day but on waking the next morning. Of course, if someone has done nothing out of the ordinary in the preceding 24 hours, then that isn’t the reason, and it’s something else.
Going to sleep and waking up
So, the next most obvious thing is your sleep position. In the clinic, I don’t ask patients what position they sleep in; I ask them in which position they wake up. That’s because they might go to sleep on their left side, then, 5 minutes later, roll onto their right and spend the rest of the night in that position.
Prone lying
Some people prefer sleeping on their front. The problem with that is your rib cage has a larger diameter than your pelvis, so being on your front extends – or arches – your back. This can cause low back pain. In terms of your neck, if you lay flat on your stomach, you’ll be face down in your pillows. This means you need to turn your head to one side, which is a position of stretch.
Would it be much of a stretch, though? It’s only your head or neck after all… But if we consider some basic physics:
Load is determined by the amount of force involved, multiplied by time.
So even a relatively small force, like a 5 kilo head, for a few hours in a stretched position, can become a substantial load. Or certainly a big enough load to cause strain in your neck.
Supine
A very common thing to hear from people is that they sleep on their back because it’s good for their spine, or even, ‘because you should do.’ But sleeping flat on your back isn’t that great for you. And not just because of the snoring!
To understand why, we need to think about the anatomy. Your hip flexor muscles are the muscles that cross the front of your hip. At the top, they attach to the front of your spine and at the bottom, to your thigh. So, when you lay flat on your back, the hip flexors are stretched, which pulls on their attachment on the back, causing it to arch. And just like in the example above, that stretch over a period of time asleep can cause enough load to be painful.
If you prefer sleeping on your back, however, there is a simple solution. You can put 2-3 pillows under your knees, making them a triangle or tent, with your feet flat on the bed. This takes the stretch off the hip flexors and allows the back to nestle into the bed, which will be a lot more comfortable.
Side-lying
Side-lying is a better sleep position than on your front or back. Your spine stays in a neutral position, meaning there is minimal strain.
This introduces another variable, and that is pillow height. In my clinic, this is the most common sleep position issue I see. But there is an easy way of checking this. Take your phone (or a mirror) and put it on your bedside table or chair, facing the bed in ‘selfie’ mode. Lay down on your side, in the position that you wake up in – as we discussed above. Relax for a moment, so your head settles into the pillow and you are comfy. Just like you would be when in bed asleep. Then, look at your phone screen. If your head looks like it’s leaning downwards, the pillow height isn’t enough. If your head is up and slopes down to your shoulders, the pillow height is too high. You want the ‘Goldilocks’ position in the middle of these two that’s ‘just right.’ When you are doing this, it’s a good idea to have a couple of spare pillows around to play with until you get the height right for you.
If you sleep on your side, you can end up rolling forwards, so you are half on your front. As we’ve seen, this can cause your neck to twist, and it can also mean you are leaning on your uppermost arm and shoulder. If that’s the case, it might be worth cuddling a pillow or two to stop you from doing this. This is also useful if you’ve got a shoulder problem or have had upper limb surgery because the pillows support the arm and stop you from rolling onto it.
Summary
Your sleep position can contribute to neck and back pain because it can create a low-grade stretch that is applied over a fairly long time.
Sleeping on your front isn’t a great idea because it arches your back, and means you have to rotate your neck a lot. Sleeping flat on your back also arches your low back but can be remedied by putting pillows under your knees.
Side-lying is a better position, but try to get your pillow height right, to avoid getting any strain on your neck, and even cuddle some pillows so you stay put in one position.
If you’ve got a problem that you want me to take a look at then do get in touch and we can book an appointment. If you aren’t local to me, then we can still have a consultation with my new remote service! Or alternatively, seek out a suitably qualified healthcare professional near you.
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