Relationship Between Sleep Posture and Low Back Pain: A Systematic Review

Abstract

Purpose: This systematic review aims to evaluate the relationship between sleeping postures (supine, prone, side-lying, and variable) and LBP, focusing on their impact on the prevalence, aggravation, or alleviation of symptoms.

Methods: A pre-detailed study protocol (PROSPERO ID: CRD42024628738) was used for search through databases including PubMed, Scopus and ScienceDirect following PRISMA guidelines. Observational studies from 2005 to 2024 examining the relationship between sleeping posture and LBP were included. The NIH Quality Assessment Tool evaluated study quality and risk of bias.

Results: A review of six studies found that the supine position supports spinal alignment and is associated with lower LBP prevalence, while prone sleeping increases LBP risk due to lumbar strain. Side-lying is the most common posture, with supportive alignment reducing pain and poor alignment worsening it. Variable positions showed minimal association with LBP.

Conclusion: This review emphasises the role of sleep posture in managing low back pain (LBP) by recommending supine and supportive side-lying positions for better spinal health. Prone sleeping, linked to pain, should be avoided. Ergonomic interventions, such as proper bedding and posture education, are suggested for LBP relief.

Keywords: chronic pain; low back pain; prone position; side‐lying position; sleeping posture; spinal alignment; supine position.