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 balanced, and 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.
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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).
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Example of poor sleep positioning
Diane only sleeps on her left side, like so:
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:
Here’s another example, excessive curvature on the top:
And here’s what adding knee support does:
Basically nothing. (For the back; we’re not talking about the knee!)
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Why this positioning is unfriendly to the lower back
Notice the asymmetry between sides:
Here’s a rough trace of Diane’s spine:
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:
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.
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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:
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Did you see the position her spine and trunk was put in? If not, here are a couple still shots to better illustrate:
Look familiar?
Let’s really elucidate:
Flipped vertical:
Looks an awful lot like…
Hopefully you can see how the position someone sleeps in can end up being replicated during the non-sleeping hours.
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The adjustment
Here’s how we even out those lines. Going from this,
to this,
equals this,
and this,
which is much better than this,
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.
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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).
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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:
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Eileen
April 16, 2013
gonna try it!!!!! thanks Brian!!!!
Alex Sandford
September 5, 2013
Hi Brian, I have pelvic tilt from getting rear ended in a car accident and it’s definitely been aggravated by how I sleep – on the side and hiking a leg up like the woman in the top photo. How can I correct my sleeping posture at night if I hike a leg up like her? Do you have suggestions on what to use, how to do it? You show the bottom woman using a yoga / gym mat – have people had much success with using a yoga mat? Thanks!
reddyb
September 5, 2013
Hey Alex,
I have an ebook dedicated to this here: http://b-reddy.org/2012/08/06/sleep-with-less-pain-tonight/
Things beside a yoga mat (can use just a pillow too) come into play, such as the hardness of the mattress you’re sleeping on.
Tricia
April 11, 2015
Hi Alex,….just had an xray of my 13 year old daughters spine. Turns out it is curved at the bottom. Just saw your post. Do you have any experience with possible scoliosis curvature? Thanks!..nervous mom.
reddyb
April 13, 2015
Hey Tricia,
I figured I’d chime in. I’ve worked with a decent amount of people with scoliosis. Other than a little lower back pain here and there, which is so common it’s hard to say the scoliosis had anything to do with it, they were fine.
An Nguyen
February 8, 2017
Hi Brian,
I purchased your e-book on sleeping positions almost a year ago and unfortunately I haven’t had very much success in staying in one position for long when I’m sleeping. I usually lay on my back with pillow support (I even went extreme and propped up my knees on a piano chair so that my hips and knees were flexed to 90 degrees-it was the best I could do to flatten my back, but I realized I have sway back ad my thoracolumbar junction is extended whereas my lumbosacral region is mofe flexed; regardless it was uncomfortable and I’d always end up kicking the chair away). The main issue is I’m always moving at night so the support under my knees is usually gone, and my hips abduct, externally rotate, and hyperextend (relative to neutral hip rotation but the tibia is also externally rotated relative to the femur). How do I go about correcting my alignment when I’m asleep (for 6-8 hours a day) when I’m in the same shitty position as I usually in when I’m awake and standing? (Also have tried changing how I sit, walk, and stand after reading the other manual I purchased. Standing is the easiest to “adjust”, while walking is an extremely difficult task for me. Sitting by far has been the worst because no matter what hip angle I’m at, my spine flexes so much I have to lean back in order to alleviate pain and counterbalance myself. Also tried to roll a towel and place at the right region although I still notice my hips displaced in front of my body.) I want to be anle to at least correct sleeping as having no gravity compressing my spine makes pain/bad movement patterns more manageable.
reddyb
February 10, 2017
Hey An,
I’m not sure I’m clear on what you’re asking here, but the best I can-
-In terms of making sleep changes, the fact is most are going to be uncomfortable with the change. They’re going to want to revert to their old pattern, move the support, etc. Some people make the change and they’re fine. Where others and some nights of not as good sleep are going to happen. Short of ambien or Jameson, that’s how it is. Frankly, this is how most activity of daily living changes are. They’re work, and not fun.
Easy example is someone who sits slumped over at their desk for years. For them to then start trying to sit up straight at their desk is going to suck. Their upper back will burn from fatigue, their concentration will be hindered, but changing habits aren’t always enjoyable.
One thing not covered in the manual because of its rarity is using a lumbar support while sleeping. If you feel your back shouldn’t be flexed while laying down, or the position is not just uncomfortable because it’s different but uncomfortable because it’s painful, then you can try this. Lower back pain while supine, with the legs up, due to a flattened spine is exceedingly rare, but it does happen.
-If you want to prevent the hips from externally rotating while asleep, you could place some supports (e.g. pillows) next to your knees to prevent that rotation. I’m not sure what / why you’re trying to change here. This isn’t a change someone usually needs to make. If somebody’s hips externally rotate on them consistently, then I’d instead be looking at things like this: https://b-reddy.org/2013/05/09/talking-about-hip-retroversion/
-If spinal flexion is a problem for you while sitting, and you’ve tried a lumbar support, then you want to increase the height of the chair. Specifically to where the hips are at *less* than a 90 degree angle. Once flexing the hips to 90 degrees and all bets are off as to whether a person has that amount of hip flexion. Where if they don’t, they round the spine. But at or less than 90 degrees and someone almost always can keep the lower back from flexing.
If you want more help sitting up straight / not leaning back, the firmness of the chair is crucial. You can’t have one that has a lot of give to it. If a chair doesn’t get the job done, you can sit against a wall:
-If you want to make sure the hips don’t hyperextend while sleeping, you don’t need to support the knees to 90 degrees of hip flexion. You just need a small support so the knees have a tiny amount of bend in them. That should be enough.
An Nguyen
February 11, 2017
Thank you so much for the response. With all that information you’ve given me I’ll be making some more adjustments around the house!
Regarding retroversion, it looks like my hips are retroverted. I wasn’t entirely sure before but I’ve done the prone hip rotation test and indeed notice a difference between IR/ER.
reddyb
February 12, 2017
You’re welcome! Glad it was helpful.
Heather Simpson
February 26, 2017
Hello, fascinating, especially the pictures to demonstrate! My left hip is hiked and seems to be shifted left and there is definitely a distinctive curve much more in my left waist then my right. I sleep exactly like the person in the photo 5/6 (wearing black) and use a cushion to prop my knee (she is showing her knee propped on a foam roller). I frequently turn over in the night and take my cushion with me so the other knee can be propped on it. If I were to try and use something under my waist instead, to minimise the curve, would I still use the cushion to rest my knee on? I can’t imagine sleeping without that. Also, if the curve is more excessive on one side (my left waist) do you think I should only have a cushion under my waist when I am sleeping on the left side or use it for the right as well? I really don’t know know whether my hip hike is just lateral slide to the left or whether it is in anterior tilt and rotated round to the front. It’s a real issue. Anyway, I’m going to delve deeper into your articles! Thank you.
reddyb
February 28, 2017
-Using a knee and torso support is fine to do, yep.
-I tend to go by how a person feels. Some will have pain laying on one side but not the other; then that pain will diminish / be gone with the support on the painful side. It’s rarely an issue having the support be used on both sides, but it can be imperative to use it on the one. In other words, let pain be the guide.
You’re welcome!
Stephanie
August 7, 2017
I tried to place something like a rolled towel or pillow in the past under my curved side ( I got mild scoliosis) my deepest curve is my right waist line. So when I sleep on my left side, which is not often, I keep my right leg long( like is getting pulled away) left leg bend 90 degrees, this way my waste line becomes longer, my hip get pulled away and my spine straighter diminishing the pressure. I most sleep on my right side anyway, sometimes with both legs long.
b-reddy
August 8, 2017
Nice idea! Only thing I might add to that is placing a support under the right knee. Sometimes having the top leg out with nothing to support it can cause the knee some extra stress, as it’s getting pulled down by gravity.
Idea of what I mean:
Stephanie
August 8, 2017
Sorry I forgot to mention that I do place a pillow below my right leg , otherwise is sure uncomfortable 😣