Sleep issues are closely related to pain, and showcase something called a bi-directional relationship. This means that sleep issues can lead to back pain, and back pain can cause problems with sleep. If you are not getting the recommended number of hours of sleep, or your sleep quality is poor, it heightens activity in the centres of the brain that are responsible for pain perception. This places you at a higher risk for developing a pain condition, or magnifying pain if you are already experiencing it. On the other hand, living in pain can create sleep issues – back pain patients are commonly woken up throughout the night when they attempt to roll over in bed, lie awake at night with difficulty falling asleep due to pain, and generally experience a poor quality of sleep as a complication of their pain picture.

Pillows can be a very useful tool in the management of back pain. This article will discuss the use of pillows in bed, as well as a couple of suggestions for where pillows can be used elsewhere to support the recovery from back pain.

Pillow use in bed

  1. When sleeping on your back, try placing a pillow underneath your knees, allowing the legs to rest with a passive slight bend – this helps to bring the lumbar spine into slight flexion, unloading the joints and opening up space between them so they are not being compressed and serving as a pain trigger.
  2. When sleeping on your side, place a pillow between your knees and draw the knees slightly toward the chest in a modified fetal position. In addition to flexing the lumbar spine, the pillow placement here preserves the space between the knees allowing the sacroiliac joints of the pelvis to be supported. This can be especially useful for women as our pelvic structure tends to be more broad and in order for the knees to rest together in a side lying position, the muscles and tendons of the buttock and outer thigh are placed under tension which can lead to pain. Maintaining some space between the knees can help to reduce pulling in the soft tissue structures and make for a more comfortable night’s sleep.

Pillow use in other settings

  1. On your couch or in other chairs lacking a lumbar support: The lumbar spine is not “flat” in its neutral position. It has a slight lordotic curve – you can identify this by lying down on your back on the floor, and sliding your hand into the space between your low back and the floor. We want to maintain this curve in a seated position in order to minimize stress to the spine. This is why some chairs are designed with an outward projecting cushion on the back rest that should fit nicely against your body – you can also find this feature build into vehicles that have an inflatable lumbar support that can be customized. For couches and chairs with a flat backrest however, the lumbar spine is not supported in its neutral position. This leads to pulling on the spinal ligaments that can create back pain after you have been sitting for a period of time. You may notice you have more back pain after watching a movie on the couch than you do during the work day – if that is the case, try this simple trick. Place a throw pillow in that space behind your low back and rest overtop of it. This will maintain that slight spinal extension and reduce your risk of injury in the moments right after you get up off the couch.
  2. During your yoga practice: There is a special pillow designed as a prop in the yoga practice called a “bolster”. This cushion is a long cylindrical pillow that can be used in a variety of ways to support your body and allow the postures to be accessible and restorative. One of my favourite ways to use this prop is in a seated forward fold. Placing the cushion behind the knees allows the tension to be relieved from the posterior chain that connects all of the soft tissues on the back body. You may notice in a forward fold that you feel this line of tension that can run from the back of the head all the way down to the toes. When you bend the knees in this shape, it adds slack to this taut band, removing some of the tightness in the back of the legs, and allowing the pelvis to tilt more effectively and for the emphasis of sensation to be placed on the low back. I walk through a demonstration of this posture and describe in detail how this modification works in this video. Take a peek, try it out, and let me know how you are using pillows to ease back pain at home!