Sleeping Posture

More time is spent in bed than in any other place. The importance of good posture in bed is evident.

We spend the majority of our time every day doing very specific tasks, in very specific positions. Regardless of how minor the cumulative forces from the tasks may be, if they occur enough, with high enough repetition, overuse or repetitive strain injuries are almost inevitable. To minimise these negative effects, we can modify the way we interact with our environment, or rather, the way our environment interacts with us, while still ensuring that these tasks are completed as efficiently and effectively as possible. This positive control over the environment is called ergonomics. This broad term can be further categorised into physical, cognitive and organisational ergonomics. The first of these, physical ergonomics deals with the minimisation of the body’s physical and physiological stress, and is the primary focus of this chapter. Basically, physical ergonomics involves redesigning an environment to better suit the body.

Perhaps the environment in which we spend more time than any other is in bed. Up to a third of your life is spent in bed, so it makes sense that this be the most important environment to modify to maintain a neutral spine position. Some basic guidelines apply. You should either sleep on your side or back, but never on your front, as the neck rotation required on your front takes you out of the neutral spine position. When sleeping on your side, your bottom leg (that closest to the mattress) should be straight, with the top leg bent at 90 degrees at the hip and the knee. This position will ensure that the spine is neutral. In both sleep positions, neck position should be maintained by a supportive pillow, with a supportive mattress maintaining the spinal curve of the lower back.

The overriding premise is to maintain neutral spine.

What many people experience however is lower back pain while sleeping and upon waking. Often, these are people who sleep on their back and have tight hip flexors. Here’s a good way of understanding the effect of tight hip flexors on your back. Stand up straight. Bend forward at the hip and grab a big handful of the skin and fat at the front of your hip. Now stand up straight. Hurts huh? This little experiment is emulating the effect of tight hip flexors (the muscles at the front of your hip that lift your leg forward).

If your hip flexors are tight, when you lie on your back, they fulcrum off your glutes (‘arse’ for the uninitiated) and arch your back. Arched back = loss of neutral spine = uneven joint loading = pain.

Here’s what to do. Firstly, sleep with a pillow under your knees. This will take the tension out of your hip flexors and restore the back to neutral. This is a quick fix – a bandaid solution. A more permanent solution comes from stretching your hip flexors. Do it as much as possible.

Dan Williams

Dan Williams


Dan Williams is the Director of Range of Motion and leads a team of Exercise Physiologists, Sports Scientists, Physiotherapists and Coaches. He has a Bachelor of Science (Exercise and Health Science) and a Postgraduate Bachelor of Exercise Rehabilitation Science from The University of Western Australia, with minors in Biomechanics and Sport Psychology.

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