Best Sleeping Positions for Back & Neck Pain: Expert Physiotherapist’s Guide

Why Sleep Position Matters?

Have you ever woken up in the morning with a stiff neck or sore back, wondering what went wrong while you were asleep? You’re not alone. In fact, most of my patients are surprised when I tell them: “Your daytime posture isn’t the only thing hurting your spine — your sleep posture matters just as much.”

Think about it — you spend 6–8 hours every night in one position. If your neck is bent awkwardly or your lower back is unsupported, your spine is under strain the entire night. No wonder you wake up feeling worse instead of refreshed.

The good news? You don’t need expensive gadgets or complicated changes. With a few simple adjustments to your sleeping position, pillow, and mattress, you can wake up feeling lighter, pain-free, and more energetic.

As a physiotherapist with 17+ years of experience treating back and neck pain, I’ll walk you through the best sleeping positions for pain relief, common mistakes to avoid, and a 7-day challenge you can start tonight.

In this guide, you’ll learn:

✅ The best sleeping positions for back and neck pain relief.

✅ Pillow and mattress tips for proper spine alignment.

✅ How to sleep during pregnancy or with shoulder injury.

✅ Common mistakes to avoid at night.

✅ Physiotherapist’s 7-day sleep position challenge.

Understanding Spine Alignment During Sleep

Natural Spinal Curves

Your spine has three natural curves:

• Cervical (neck) curve – slight inward bend
  
  

• Thoracic (upper back) curve – slight outward bend
  
  

• Lumbar (lower back) curve – slight inward bend
  
  

During sleep, these curves must stay neutral. If the neck is tilted or the lower back sags, your spinal and neck muscles and joints stay under stress all night. As a result, you feel more stiffness and pain after getting up.

Pillow & Mattress Role in Sleeping Posture

• Mattress: Medium-firm is best — supports curves but avoids pressure points.
  
  

• Pillow: Height should match your sleep style. Too high = neck bends forward, too low = neck drops backward.Use a good quality memory foam pillow if you have neck pain.

💡 Tip: If you wake up with pain, it’s often your *pillow or mattress — not your spine — that’s the culprit.

Best Sleeping Positions for Back & Neck Pain

1.Sleeping on Your Back (Supine Position)

How to do it:

• Lie flat on your back.

• Place a pillow under your knees to support your lower back.

• Use a supportive pillow for head/neck — not too high.
  

Benefits:

• Maintains natural spine alignment.

• Evenly distributes body weight.

• Reduces pressure on joints.

Caution:

• Not suitable for people with sleep apnea or heavy snoring.

• Pregnant women (after 1st trimester) should avoid lying flat on the back.

2.Sleeping on Your Side (Lateral Position)

How to do it:

• Lie on your side with knees slightly bent.

• Place a pillow between knees to align hips and pelvis.

• Keep the head pillow thick enough to fill the gap between shoulder and ear.
  

Benefits:

• Eases back and neck pain.

• Reduces snoring and acid reflux.

• Preferred by most physiotherapists for spinal health.

💡 Variation: Hug a pillow to reduce shoulder stress.

3. Fetal Position (Curled Side Sleep)

How to do it:

• Curl knees slightly toward chest.

• Avoid tight curling that restricts breathing.

Benefits:

• Helpful for herniated disc pain or pregnancy.

• Reduces lumbar tension.

Drawbacks:

• Too tight curling can cause stiffness.

4. Sleeping on Your Stomach (Prone Position)

Why it’s the worst:

• Twists the neck sideways all night.

• Over-arches the lower back.

• Causes shoulder strain.
  

If you must:

• Use a very thin pillow (or none) for your head.

• Place the pillow under hips and lower abdomen to reduce stress on your lumbar region.

Sleeping With Special Conditions

How should I sleep to fix neck and back pain?

• Back sleeping with pillow under knees or side sleeping with pillow between knees.

• Support the neck with a medium pillow.

• Avoid stomach sleeping.
  

How to sleep while pregnant with back pain?

• After the first trimester, sleep on the left side with a pillow between your knees.

• Place a small pillow under the belly for extra support.

• Avoid lying flat on your back.

Should I sleep without a pillow if my neck hurts?

• Usually no. A pillow is needed for neck support.

• If your pillow is too high, try a thinner or cervical pillow.

• Flat pillows often worsen pain long-term.

How to sleep with a shoulder injury?

• Sleep on the non-injured side with a pillow supporting the injured arm.

• Or sleep on your back with a pillow under both shoulders.

• Avoid putting weight directly on the injured shoulder.

Common Sleeping Mistakes to Avoid

• ❌ Using too many pillows under the head → neck bends forward.

• ❌ Sleeping on old, saggy mattress → spine collapses.

• ❌ Curling too tightly in fetal position → restricted breathing.

• ❌ Staying in one position all night → stiffness in morning.
  

Tips for Better Sleep Hygiene

• Maintain a consistent bedtime schedule.

• Keep the bedroom cool, dark, and quiet.

• Do gentle stretches (neck, shoulders, back) before bed.

• Replace pillow every 18–24 months.

• Flip or replace the mattress every 7–10 years.

7-Day Sleep Position Challenge (Physiotherapist Plan)

Day Wise Action

Day 1

Adjust your mattress & pillow height.

Day 2

Try going back to sleep with a pillow under your knees.

Day 3

Sleep on the side with a pillow between your knees.

Day 4

Adjust head pillow to support cervical curve.

Day 5

Stretch neck & back before bed.

Day 6

Practice fetal position gently (not tight curl).

Day 7

Do wall posture self-check in the morning; note pain changes.

Repeat this plan weekly. Within 3–4 weeks, most people notice less stiffness and improved sleep quality.

❓ Frequently Asked Questions (FAQs)

1. How should I sleep to fix neck and back pain?

The two best options are back sleeping with a pillow under your knees or side sleeping with a pillow between your knees. Both positions keep the spine neutral, reduce strain on the lower back, and prevent the neck from bending awkwardly. Make sure your head pillow is not too high or too low — it should support the natural curve of your neck. Avoid stomach sleeping, as it twists the neck and over-arches the lower back.

2. How to sleep while pregnant with back pain?

Pregnant women, especially after the first trimester, should sleep on the left side. This position improves blood circulation to the uterus and kidneys and reduces pressure on the lower back. Place a pillow between the knees and another under the belly for support. Some women also find comfort in a “C-shaped” or “U-shaped” pregnancy pillow that supports the whole body. Avoid lying flat on your back during late pregnancy, as it can reduce blood flow and worsen back pain.

3. Should I sleep without a pillow if my neck hurts?

Not usually. Sleeping without a pillow often leaves the neck unsupported, causing more stiffness. Instead, use a thin or cervical contour pillow that supports the neck’s natural inward curve. For side sleepers, the pillow should fill the gap between the shoulder and ear; for back sleepers, it should support the neck without tilting the head forward. The only case where no pillow might help is if you’re a stomach sleeper — but this position is not recommended for neck or back pain.

4. How to sleep with a shoulder injury?

If you have a shoulder injury, the safest position is on your non-injured side, with the injured arm supported by a pillow in front of you (like hugging it). This prevents the shoulder from rolling forward and reduces pressure. Alternatively, you can sleep on your back with a small pillow under both shoulders to keep them neutral. Avoid sleeping directly on the injured shoulder, as it can delay healing and increase discomfort.

5. What is the best sleeping position for lower back pain?

Sleeping on your back with a pillow under the knees is often best for lower back pain, as it reduces pressure on the lumbar spine. Side sleeping with a pillow between the knees is also excellent, especially if you bend your knees slightly. Both options maintain spinal alignment. Avoid soft, sagging mattresses that let the lower back sink, and avoid stomach sleeping, which increases lumbar strain.

6. Which mattress is best for back and neck pain?

Most physiotherapists recommend a medium-firm mattress. It provides enough support for the natural spinal curves without creating pressure points. Memory foam or hybrid mattresses work well for many people because they distribute weight evenly and support alignment. A mattress that is too soft allows the body to sink, while an overly hard mattress may cause shoulder and hip pain. If your mattress is more than 7–10 years old, it may be time to replace it.

7. Can changing sleep position alone cure my back pain?

Changing sleep position can significantly reduce pain and stiffness, but it may not “cure” the root cause if you have an underlying condition (like a slipped disc, arthritis, or muscle imbalance). Think of sleep posture as part of a complete plan — along with physiotherapy exercises, good sitting posture during the day, and regular stretching. Many people, however, do feel 50–70% better just by correcting their sleeping habits.

8. Is side sleeping better than back sleeping?

Both have benefits. Back sleeping is great for evenly distributing weight and reducing strain, but it can worsen snoring or sleep apnea. Side sleeping is more comfortable for many people, reduces reflux, and is recommended during pregnancy. If you suffer from shoulder pain, side sleeping may aggravate it — in that case, back sleeping is preferable. The key is not which is “best” for everyone, but which position keeps your spine neutral and pain-free.

Final Words

Bad sleep posture is one of the most overlooked causes of back and neck pain. But it’s also one of the easiest to fix. By choosing the right pillow, mattress, and sleep position, you allow your spine to truly rest and heal overnight.

I’ve seen patients who suffered for months with morning stiffness feel better within a week — simply by changing how they sleep.

👉 Tonight, try one small change: add a pillow between your knees if you sleep on your side, or place a pillow under your knees if you sleep on your back.