How to Sleep with Back Pain? A Physiotherapists & Chiropractors Pillow Guide
• by Dr. Adrian Cohen
Last winter, Steve came into our clinic looking worn out. He wasn’t sick or stressed. He was tired, much like the “I haven’t slept in weeks” kind of tired.
“I don’t know what else to do,” he told us. “My back hurts all night. I’ve tried a new mattress, heating pads, even sleeping on the floor.”
Does this sound familiar to you?
If you’ve ever spent the night tossing and turning, trying to find a comfortable position for your back, you’re not alone. Back pain and bad sleep often go hand in hand. But the good news is that the right pillow and sleep position can make a huge difference.
Here’s how to get your spine happy and your sleep back.
Why Does Back Pain Get Worse at Night?
When you sleep, your muscles finally relax, but that’s not always good.
If your spine isn’t properly supported while you sleep, gravity pulls on your joints and muscles in all the wrong ways. And when your back is out of alignment, pressure builds, especially in the lower back. That’s when the pain kicks in.
Some sleep positions, like sleeping on your stomach, can worsen it.
Best Sleeping Positions for Back Pain
We all sleep differently, but here is what we recommend:
Sleeping on Your Back (Best Overall)
This one keeps your head, neck, and spine aligned.
Pro tip:
Put a pillow under your knees. It helps take pressure off your lower back and keeps your spine in its natural curve.
As for your head pillow, make sure it’s not too high or too flat. You want your neck to stay in line with your chest, not craned or crunched.
Side Sleeping (Great for Lower Back & Sciatica)
This one works well if you use the right support.
- Place a pillow between your knees.
- Keep your knees slightly bent (not curled up tight).
- Use a firm pillow to fill the space between your ear and the mattress. This keeps your neck from tilting.
Bonus: Sleeping on your left side can help digestion and blood flow.
Stomach Sleeping (Not Ideal)
This is the toughest on your back. It flattens your lower spine’s curve and twists your neck.
But if it’s the only way you can fall asleep:
- Use a very flat or no pillow under your head
- Place a thin pillow under your hips to ease strain.
“Correct pillow positioning helps a lot in reducing pressure and improving sleep quality. If somebody is a back sleeper, then the pillow should be placed under their knees to reduce strain on the back. For side sleepers, a firm pillow between the knees will keep the hips aligned. And lastly, for stomach sleepers (not recommended for back pain), if they must, then use a very thin pillow or none under the head and one under the pelvis to reduce back strain,” says Manish, physiotherapist at Rejoice Physiocare
The Right Pillow Makes a Big Difference
Your pillow isn’t just there to feel soft. Its main job is to support your head and neck so your spine is aligned – National Library of Medicine
Here’s what to look for based on your sleep style:
Back Sleepers
- Use a medium-loft pillow that is not too thick or too thin.
- Contour or memory foam pillows work well; they support the curve of your neck without pushing your head forward.
Side Sleepers
- You’ll need a thicker, firmer pillow.
- Look for pillows made from latex, memory foam, or ones you can adjust by adding or removing fill.
Stomach Sleepers
- Choose a soft, low-profile pillow, or skip it entirely.
- Focus on transitioning to your side or back over time
We interviewed a physiotherapist at Brentwood Physio who had just finished physiotherapy for back pain on a patient that was having difficulty sleeping due to the pain, she said “We often find that small sleep adjustments, like pillow height or positioning, can reduce back strain a lot. Take your time finding the right pillow, when in doubt ask an expert.”
Other Sleep Tips for Back Pain Relief
You’ve got the right position and the perfect pillow. Now add these into the mix:
- Keep a regular sleep schedule: Going to bed and waking up at a constant time helps your body heal better.
- Stretch before bed: Loosen tight muscles with gentle movements. It prepares your back for rest.
- Use heat wisely: A warm shower or heating pad before bed can relax stiff muscles. Just don’t fall asleep with it on.
When to See a Chiropractor or Physiotherapist
It might be time to check in with a physio or chiro if you’ve changed your pillow and sleeping position, but still wake up sore
Physiotherapist and Chiropractors look at:
- How your spine move during the day
- Your posture and sleep habits
- Muscle tightness and joint stiffness
You might have an issue that’s not just about sleep; it could be how your back works during the day. With a custom physio plan (including exercises and hands-on treatment), most people notice better sleep (and less pain) in just a few weeks.
Final Thoughts
You don’t have to spend every night searching for the “perfect” sleep position while your back keeps aching.
With the right pillow, smarter sleep habits, and guidance from your therapist when needed, you can stop waking up stiff and sore, and finally sleep through the night.
As for Steve, he made a few simple changes, followed his treatment plan, and he’s now sleeping soundly again.
If back pain is wrecking your rest, don’t tough it out. Get the support you need, starting with the right pillow, and maybe a little help from your physio/chiro..