by Maureen Ambrose, PT, DPT, OCS, COMT

Optimal Sleep Position

  • What position is best for sleep?
  • What kind of pillow should I be using?
  • I wake up with neck/back/hip pain or headaches.

These are questions and concerns that a physical therapist will discuss with nearly every type of patient. Although most common in spinal patients, sleep can be an issue with shoulder, hip, headache, and post-operative patients due to difficulty finding a position of comfort. When recovering from an injury, sleep is a crucial time of restoration and healing of injured tissues. If a patient is tossing and turning all night or waking up with pain, then they may be placing excessive strain on the affected body region during their sleep.

sleep position side


Most of the following information is related to optimal positioning in the side-lying position, as the majority of people are side sleepers (for at least a portion of the night).

Starting at the neck, it is crucial for side sleepers to have a pillow that is high enough to span the distance between the shoulder and head. This will maintain a neutral cervical spine curve and prevent excessive forward shoulder positioning. Often, for those with broad shoulders, 2 pillows will be necessary or you may use the higher side of a contour pillow (as shown above). The chin should be slightly tucked down to prevent strain at the base of the head.

In the trunk, consider adding a small towel roll or bolster pillow to prop up your waist. The bolster will fit just below the ribs and above the hip bone, creating a neutral lumbar curve. This is especially helpful if you wake with mid or low back pain or have pain when turning in bed.

The above photo also shows a pillow between the knees, which keeps the pelvis from rotating.

Consider this option if you have lateral hip pain that limits how long you can sleep on your side.


Back sleepers make up the next most common position. A very small pillow under the knees can be helpful in those with acute back pain. However, this is not recommended as a long term solution as it can lead to hamstring muscle tightness.

Stomach sleepers make up the smallest percentage, and it is a position to avoid especially in lumbar and cervical spine patients diagnosed with stenosis or spondylolisthesis. A pillow under the trunk from hips to ribs is necessary to achieve a neutral spine. To avoid extreme neck rotation when on your stomach, consider placing your temple region on the end of the pillow and having your face angled towards the bed.

If you struggle with pain while trying to sleep or pain upon waking, discuss your concerns with your physical therapist. At Physical Therapy First, our thorough examination and evaluation allow the therapist to develop a customized treatment plan to improve your quality of life – including when you’re asleep.