Waking Up Sore? Your Slide-Sleeping Position May Be the Problem

By Ashley Christensen PT, DPT, PRPC

As a physical therapist that has serviced this community for over 17 years, I get a lot of questions about how to reduce pain while maintaining the position that they love: side-sleeping. More than 60% of adults spend most of the night sleeping on their side, making it the most common sleeping position. While side sleeping can have several benefits, the way we position ourselves can also contribute to neck, shoulder, hip, and low back pain. The good news is sometimes a few simple modifications can make a big difference.

Side sleeping has some advantages and disadvantages. For people who experience nighttime acid reflux, sleeping on the left side may help reduce symptoms. Side sleeping may also be more comfortable for some people with breathing or snoring concerns. But, there can be drawbacks. When we stay in one position for several hours, poor alignment can place unnecessary stress on the neck, shoulders, hips, and lower back.

The goal isn't to have to sleep in a position you don't like, it's to make that position work better for your body. Try these modifications:

• Support your neck. Your pillow should fill the space between your shoulder and your head so that your neck remains in line with the rest of your spine. A pillow that is too thin allows the head to drop toward the mattress, while one that is too thick pushes it in the opposite direction.

• Place a pillow between your knees. This can help keep the pelvis and hips more neutral and reduce rotation through the lumbar spine. For some people, extending the pillow down toward the ankles provides even better support.

• Consider a body pillow. Hugging a longer pillow while also supporting the legs can reduce the tendency for the upper trunk and pelvis to rotate forward during the night. It can also give the top arm somewhere to rest instead of allowing the shoulder to fall forward.

• Pay attention to your bottom shoulder. Avoid sleeping directly on top of the shoulder with the arm trapped underneath you or overhead for prolonged periods. Positioning the shoulder slightly forward and keeping the arms comfortably supported can reduce unnecessary compression.

• Don't curl up too tightly. A relaxed bend at the hips and knees is perfectly fine, but an extremely tight fetal position can leave the hips and spine flexed for hours. Aim for a comfortable, supported position rather than forcing yourself into a rigid posture.

• Don't forget the mattress. Your pillow can only do so much. A mattress should allow enough cushioning for the shoulder and hip while still providing enough support to keep the spine relatively neutral.

There isn't one "perfect" sleeping position for everyone. Your body type, shoulder width, mattress, existing injuries, and medical conditions all play a role.

A simple way to think about it is this: if someone looked at you from behind while you were sleeping on your side, ideally your head, neck, spine, and pelvis would appear relatively well aligned rather than bending or twisting around your pillows.

However, if you consistently wake with neck, shoulder, hip, or back pain despite modifying your sleeping position, your sleep setup may not be the entire problem. A physical therapist can help determine whether mobility restrictions, muscle weakness, joint irritation, or another musculoskeletal issue is contributing to your symptoms. Sometimes better sleep starts with better positioning, and sometimes your body is telling you there is something else that needs to be addressed. For any of your musculoskeletal issues, contact Healing Arts Physical Therapy.