An example of how important your sleep positioning can be

Posted on April 16, 2013

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One thing I harp on is the importance of everyday daily movements and how -when it comes to getting out of pain- these are much more important than your exercise routine. I’ve droned on and on about this. You can read more in Why you’re still in pain, Get unbalanced to get balancedand How to be a good client / An update on Jeremy. 

Based on the emails and comments I get, I will continue to drone on and on, UNTIL THE ENTIRE WORLD LISTENS TO ME. Because either I haven’t done a good enough job or the message hasn’t gotten through.

Specifically regarding sleeping, I’ve mentioned it’s very hard -if not impossible- to undo 6, 7, 8, or however many hours it is you sleep in a crappy position without…changing the position you sleep in.

I thought I’d show a more specific example how someone’s sleep positioning can affect other facets of movement.

Enter Diane.

Diane is an 83 year old woman. She is in pretty good shape, still sharp mentally, and calls me babe.

When Diane first started her chief complaint was this burning sensation she would get from the back of her leg down to her knee. Essentially, sciatica type pain. Diane’s official diagnosis from a doctor was “spinal stenosis.”

The interesting thing about Diane is she was really only getting this irritation when sleeping. Pretty much every night the burning would wake her up, she’d have to walk around for a while / stretch out a bit, then go back to sleep. Having this happen every night was driving her crazy, but during the day she didn’t have many symptoms, if any.

Here’s the mistake Diane and many others make: She came in looking to “strengthen” things like her lower back and knees. For probably close to 10 weeks I pleaded with Diane our best course of action was not to focus on strengthening things, but to change the postion she slept in.

No, there’s nothing wrong with getting stronger, but you don’t go to point C in the hope there’s a detour to point A. No, if you’re able you go right to point A. We go right to what’s causing the issue: How she sleeps.

Apparently I need to work on my persuasion skills. Diane proceeded to tell me she had been sleeping “that” way for probably 50 years, and it wasn’t going to change. Off to get the epidural shots she went, and back to me with pain about 3 days later she came.

Finally, she decided to try my suggestion.

Some principles of sciatica / radiating pain

Before going into Diane’s sleeping, a couple (very) brief words on sciatica / radiating nerve pain.

Sciatica and any type of radiating / burning pain is very often coming from the spine. While you may feel the burning far out on the body, like the knee, toes, or fingers, the source is much more proximal, like the neck, or (with sciatica) the lower back, where all the nerves start.

When there is an issue at the lower back, it is nearly always the lower back is moving too much and too often. I’ve written about this extensively, so check out the lower back pain category for more.

Back to Diane: She has radiating pain from her lower back / butt to her knee, she feels this primarily when sleeping, therefore, I’m going to have her illustrate the position she sleeps in and look at her lower back. The main thing I’m looking for is if the lower back is excessively positioned in any direction, such as extension or rotation (twisted).

Example of poor sleep positioning

Diane only sleeps on her left side, like so:

Diane sleep bad with pain sciatica

First, an assumption many will make is “She needs to throw some pillows between her knees!” While this certainly can help, it’s not the solution. Remember, her pain is starting from the back, and throwing a pillow between the knees isn’t going to correct this line:

Diane side lying with line on top

Here’s another example, excessive curvature on the top:

photo 4 (6)

Sarah sleep no knee support with top line

And here’s what adding knee support does:

photo 5 (4)

Basically nothing. (For the back; we’re not talking about the knee!)

Sarah sleep with knee support with top line

Why this positioning is unfriendly to the lower back

Notice the asymmetry between sides:

Diane side lying with lines top and bottom

Here’s a rough trace of Diane’s spine:

Diane spine outline

Rather than go into anatomy talk mode, take a look at what this positioning looks like in standing, on an X-Ray. For all those with the lateral pelvic tilt questions, here you go:

Marielle Lower back X Ray lateral tilt

An excessively curved, twisted or bent spine is an unhappy spine. Truth be told, Diane really isn’t that bad. (The other girl pictured above is much worse, and not coincidentally, at the ripe age of 24 had to adjust how she slept to avoid issues.) However, add up 50 some odd years of sleeping with a spine in that position, and it’s going to get pissed off eventually.

Application to daily life / How sleeping can screw up other movements

Diane has radiating pain into her knee when sleeping, and while sleeping we’ve discerned her trunk is excessively laterally flexed to her right.

Watch what happens when she performs a squat / sit to stand / getting out of a chair motion:

Did you see the position her spine and trunk was put in? If not, here are a couple still shots to better illustrate:


Diane lateral tilt squat portion

Diane lateral tilt squat up portion

Look familiar?

Diane sleep bad with pain sciatica

Let’s really elucidate:

Diane side lying with lines top and bottom

Flipped vertical:

Diane vertical shot of sleeping lines

Looks an awful lot like…

Diane lateral tilt squat up portion with linesHopefully you can see how the position someone sleeps in can end up being replicated during the non-sleeping hours.

The adjustment

Here’s how we even out those lines. Going from this,

Diane sleep bad with pain sciatica

to this,

Diane sleep better less pain

equals this,

Diane sleep better less pain with both lines

and this,

Diane sleep better less pain spinal line

which is much better than this,

Diane spine outline

Now this isn’t perfect, we’re still a bit asymmetrical (in the opposite direction), but it’s a hell of a lot better. And for Diane, as she plays around with this each night trial and erroring, it’s better for her to be a little too far in the opposite direction than the direction she’s been in for 50+ years.

The complainers

I know, changing how you sleep is not an easy task. It’s a pain in the ass to have to think when you’re at the one point in the day you just want to turn your mind off. And I know, you “toss and turn” and whatever.

I don’t care.

I know plenty of people, myself included, who suffered a major injury and were forced to sleep in a certain manner afterwards. After I dislocated my elbow I had to sleep wearing a sling and could only sleep on my back. If I turned over on my side or stomach I would either cause myself writhing pain and or increase the chances the elbow could come out of the socket again. So guess what? I slept on my fucking back.

To quote Diane:

I mean, I’m not exactly the most comfortable when sleeping…but now I can actually sleep rather than wake up constantly all night. And my leg doesn’t hurt anymore.

Over time the new positioning will become more and more comfortable, but to bitch about this in the interim, that is, to bitch about some discomfort when you just alleviated months, years, or DECADES of pain, is a complete joke. If you have this attitude, you deserve to be pain.

When I dislocated my elbow I also couldn’t wipe my ass anymore. What do you think I did?

Option A “Waa I can’t wipe my ass, I’m a righty, not a lefty, waaa”

Option B “I better learn how to use my left hand quickly.”

Either walk around with feces in your pants all day (be in pain) or suck it up and learn a new habit (change how you sleep).

Finishing up

When it comes to alleviating pain while sleeping you don’t need epidurals, cortisone shots, ambien, a $20,000 dollar mattress, etc. You need to change the position you sleep.

Laslty, do not forget the implications of what doing something for one third of your life can have on the other two thirds.

For more on sleeping without pain check out my ebook or pick it up here: Add to Cart

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