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by Mark Huntsinger
Even though we spend one-third of our lives sleeping, it is one of the most overlooked aspects of wellness for many people. Sleep quantity and quality affects almost every part of our health from mental and brain health to the efficacy of our immune systems to the modulation of inflammation and healing in the body. As a doctor of physical therapy, I most often deal with the health of the spine and peripheral joints in relation to sleep and usually I assess each of my patient’s sleeping positions the first time I see them.
The only time our bodies are in one or a few positions without moving for an extended period of time is when we sleep. If joints are overly compressed or stretched in positions during this extended period of time, injuries can occur, a person can become more susceptible to injuries, or pre-existing injuries can be prevented from healing. In a compressed state, circulation can be impaired to the joint surface, the joint capsule, or the nerves surrounding the joint. In a stretched state, joint capsules, muscles, nerves, and ligaments can be strained. In order to maximize wellness, people should learn how to optimize their sleeping positions.
If people prefer sleeping on either their side or their back I don’t usually encourage them to change positions, I teach them how to keep their spines in neutral using an arrangement of pillows in their preferred position. This minimizes any prolonged stress on joints, muscles, joint capsules, nerves, tendons, and ligaments. However, I never recommend anyone sleep on their stomach and I encourage stomach sleepers to learn how to sleep on their side or back. Stomach sleeping inherently puts the joints of the neck and lower back into an asymmetrical, non neutral position that can lead to acute injuries like the kink in the neck most people have experienced, a sore lower back, or movement asymmetries that affect movement throughout the day and can lead to degeneration in the spine in the future due to increased pressure from asymmetrical joint mobility. Many people are hesitant to change from sleeping on their stomach, it’s comfortable, they fall asleep fast etc, but I like to have them imagine sitting at their desk, working on the computer for 8 hours straight, neck rotated, looking as far to the side as possible. This is similar to sleeping on your stomach. Not many people would think it would be okay to sit at their desk like this.
Sleeping on your back is probably the best position for all of the joints in the body to keep them in a neutral position throughout the night. I recommend wrapping the sides of the pillow loosely around the neck with the forehead slightly higher than a person’s chin, having a pillow underneath the knees, and having a pillow or two under the elbows and forearms. Wrapping the pillow around the neck prevents the neck from rolling too far to either side, the pillow under the knees keeps the hips and knees from pulling on the lower back, and the pillow under the elbows keeps the shoulders from pulling on the neck. Besides these benefits of keeping the joints of the body in nice neutral positions, sleeping on the back also is good for reducing gastrointestinal problems made worse by pressure on the intestines from side and stomach sleeping, reducing shoulder problems from the pressure of side sleeping, reducing strain on the TMJ joints of the jaw, and can also reduce wrinkle formation on the neck and chest made worse by side sleeping.
Many people struggle both falling asleep on their back, and staying on their back throughout the night for a variety of reasons including feeling vulnerable and experiencing increased snoring. I have also heard of some people getting sleep paralysis while sleeping on their back. Because of this, many people find sleeping on their side to be the best position for them. I recommend bunching the pillow between the neck and shoulder, putting a pillow between the knees, and having a hug pillow for the arms. Bunching the pillow keeps the neck in a neutral position, the pillow between the knees prevents the hips and knees from pulling on the lower back, and the hug pillow prevents the shoulders from pulling on the neck. Besides the benefit of being pretty good for all of the joints and being the easiest position to fall asleep in for many people, sleeping on the side can be the easiest position to transition from stomach sleeping. Sleeping on the left side can also be beneficial for people with gastrointestinal problems including GERD and IBS due to the position of the stomach and intestines while on the left side.
My recommendations for both side and back sleeping involve more pillows than many people are used to. If you find yourself switching positions often and waking up with the pillows pushed away or on the floor, try to go back to sleep in the recommended positions. If you stick with using these pillows, your body will adapt to them within two weeks. Because the same amount of pillows are used for both side and back sleeping, try to train your body to take the pillows with you when rolling over if you like to sleep in both positions.
Sleeping in optimal positions is one of the easiest things we can do to affect joint health. With optimal joint health and minimal aches, pains, and injuries, it becomes much easier to achieve a higher capacity for wellness in all areas including fitness, nutrition and mental well-being.
Bio: Mark Huntsinger PT, DPT is a doctor of physical therapy practicing in Los Angeles, CA. Dr. Huntsinger’s concierge practice focuses on working one on one with his patients in order to rehabilitate their injuries and maximize their function. He gives extra attention to educating his patients to perform activities of daily living in the safest way for their specific diagnoses. One of these activities is sleeping in the best possible ways for joint health, and also overall wellness. You can follow Dr. Mark Huntsinger on TikTok and Instagram where he gives sleep tips and other tips to help maximize your wellness.