Many patients ask me if their neck, back or shoulder pain could be caused, or at least made worse, by their sleeping position, mattress or pillows. In this article, my aim is to give some general advice to those wanting to get the best night’s sleep they can, and hopefully overcome any symptom aggravation sleeping may be causing them.

What’s the best sleeping position?

So arguably the gold standard position for sleep is on our backs, but sleeping on your side is generally acceptable too.

The worst sleeping position for your musculoskeletal system is laying on your front. That’s because in this position our necks need to be severely rotated to keep the airways open, and this made even worse if you use a pillow. Our lower backs sag in to the mattress, and the lordosis curve becomes even deeper compressing the spine.

What about pillows?

People with shoulder pain may find laying on their front preferable to on their sides – and for those people I recommend laying on their back, hugging a small pillow to give their shoulders support.

But laying on your back can also be uncomfortable if you have lower back pain – in which case you may like to place pillows under the knees to give support to the lumbar curve.

You would think using a pillow under your head would be quite straight forward, but more often than not those who wake up in pain are using their pillows incorrectly. Pillows are for under your head, not to be crammed up under your neck, collar bone or shoulder. The idea is that the mass of the pillow occupies the difference in space between the width of your head and the width of your shoulder – if you keep any pillow under your shoulder, you negate this effect instantly.

The best way to choose a pillow if you sleep on your side is to hold the pillow to your ear standing in front of a mirror. If the pillow reaches the tip of your shoulder, it is the correct depth. If it is far past the shoulder, the chances are it is too thick – equally if it doesn’t reach the tip of the shoulder, you may like to try two pillows. By this rule; the broader your shoulders the deeper a pillow you need.

But I’m still in pain!

Sometimes aches and pains are just not that simple! It’s time to book in with your osteopath for an assessment to see if there is something you might be missing – for example inflammatory conditions are often worse upon first waking in the morning and frequently trick people into thinking their symptoms are linked to sleep, when they may be caused by something else.

Your osteopath can test different muscles, ligaments and joints to locate the likely source of your pain, and advise you from there.