So much of what we learn about what pleases our body and what doesn’t please our body is taught through pain. Often many of the seemingly safe habits that we have adopted our whole lives are actually detrimental to our health in some way.

Many of these habits negatively affect our spine and do so quietly and asymptomatically until a particular moment occurs that is the “ straw that breaks the camel’s back”. Understandably, if we have sat in a chair in a certain way for years and we start to feel back pain we may easily overlook the lack of support of the chair or the poor posture as being the cares. Similarly, if we have slept face down on our belly our whole lives and never had any problem, then when pain in the neck or numbness and pins and needles down the arms to the hands occurs, our sleeping position isn’t the first factor that receives our attention.

There’s an analogy of the frog in the water that is slowly brought to the boil. As the water is increasing in temperature gradually, the frog fails to perceive the increase in temperature. If it stays in the water it will actually die due to the fact the water is boiling before the frog even knows it. Many problems related to our health occur in this way, and problems of the spine caused by poor sleeping position are one of them.


Correct posture

If we understand what correct posture is and apply that to everything that we do during our lives, including our sleep positions, we will soon be able to identify whether or not the one that we favour is detrimental to our spinal health or not. In order for a spine to function correctly during its life it needs to be maintained aligned (straight just like a column – vertical column) and at the same time it also needs to have its spinal curves maintained. While this is not always an easy task, it is a necessary one if we are to minimise the wear and tear on joints caused by a loss of spinal function in the articulations. Correct spinal alignment means that when we look at somebody’s spine from the back it is perfectly erect and not curved to the left or the right. The words “ vertebral column” are actually derived from the work “ column” which refers to a structure that is upright and erect. To determine whether spinal curves are preserved we would look from the side and see that the centre of gravity line, that falls from the ear through the shoulder, hip, knee and ankle, falls perfectly and joins these five points. When spinal curves are lost the centre of gravity line falls either forward (more common) or behind the anatomical centre of gravity line.

Sleep positions

Applying these rules to our sleep position we can quickly identify that sleeping facedown would not be bio-mechanically favourable to spinal health. This is due to the fact that the neck must be rotated to either the left or right side to enable us to breathe. Many people who sleep in this position observe that with time they find it difficult to turn to one particular side and this is because certain muscles chronically shorten when they sleep with their head turned to the other side night after night. Sleeping face down also accentuates certain curves in the spine, especially the lumbar curve, jamming it’s articulations. It is very common that people who sleep this way wake up with a stiff neck and lower back due to this reason. It is also very common to hear that people who are accustomed to sleeping this way, cannot sleep any other way. That doesn’t mean that this sleep posture should be maintained. People who smoke for decades would also say that the body needs to smoke, and therefore find it incredibly difficult to stop. Changing sleep position is equally as difficult but must be done if spinal degeneration is to be avoided.

The importance of a good pillow

People often ask what pillow is the most recommended for sleeping face down. There isn’t one. There is no pillow that will be able to compensate for spending the whole night with the head turned to the left or right. There are occasional examples when people are recovering from certain illnesses or even pain in other areas of the body that requires them to sleep face down because this is the only position that they can find that is pain-free. This is okay of course if it is for a short amount of time and they should revert back to a normal sleeping position as soon as their problem has been resolved.

Pillows are made for supporting the neck and not the head. Most of the population is using a pillow that is not adequate for the health of the spine. In other words, using a pillow that does not maintain spinal alignment during the night.

Sleeping on your back is healthy

Sleeping on our back is the most preferable sleep position for maintaining this alignment however it becomes very difficult if we are using a pillow that is too high as it increases flexion in the neck. With time it causes discomfort as it poses a threat to the health of the nervous system and therefore stimulating the person to turn on the side during the night. Many people try to sleep on their backs and say that they sleep better when they do, but do not recognise the difficulty that a high pillow may cause them in trying to do this. In these cases the best recommendation is to use a lower pillow which supports the neck and does not elevate the head excessively. Pillows made from viscoelastic or “memory” foam are great for this reason. There are many body processes that have been shown to function at the most optimal level when somebody is sleeping on their back. Heart rate variability, respiration and heart rate respond positively as well as the amount of deep and REM sleep. If you are somebody who snores when they sleep on their back, you might find that sleeping with a lower pillow resolves this. Airways open in this position on a low pillow, as opposed to being reduced in diameter when the head is flexed and rested upon a higher pillow.

Side sleepers

Now let’s go to side sleepers. If you are a side sleeper, think about how easy it is to curl your body forward when you are on your side. This means flexing your neck and possibly your hips, raising your knees up towards your abdomen. Sleeping 6 to 8 hours a night in this position is an enormous amount of time to have important areas of your spine held in a flexed position. Numerous studies have shown that sustained shortening of the iliopsoas muscles, which occurs in this position, can actually put excessive loads on the lumbar intervertebral discs. Very few people would think about this position if they have been diagnosed with intervertebral disc degeneration such as protrusions or hernias, but this is a real possibility for those people. If you are a side sleeper and simply cannot sleep in any other position please be conscious of keeping your body straight. You may try slightly flexing your upper leg over your straight bottom leg. This will minimise torsion of the lumbar spine. You can also use a cushion under the upper knee to help. At the same time you should be aware of keeping your neck in line with the rest of your back and not flexing with your chin towards your chest when your head is resting on the pillow.


When we sleep we dream and we go off to far away places. Understandably our body is not transmitting and coordinating the fact that certain positions may be harmful for our health. This is why it is imperative that we analyse our sleep position, as we are sleeping for a third of our lives, and this is more than a sufficient amount of time to do considerable damage. Damage that may be accumulating night after night and only manifested self after decades and decades of life. Habits are always easier to change the earlier in life that we discover them. Nobody wants to reach a stage in life, where they deserve to be active and unaffected by spinal spinal problems, and recognise that something that they were doing unconsciously their whole lives has left them with irreparable damage. It is worth looking at your sleep position to at least remove one possible factor that may strongly affect the degree of and health and consequent happiness that you enjoy in the future.