Copyright ⓒ PAIN LAB All contents, images, logos, and texts are copyrighted by PAIN LAB. Distribution and reprinting are allowed with citation. (Logo must be inserted and used together, and editing and processing of other contents are prohibited.) Recently, many experts have recommended these positions for patients with back pain when sleeping. The gist is to sleep with a towel under the lower back to maintain lordosis in the lower back. However, I am skeptical about this method. Other doctors all say the same thing, so what is the basis for my saying that? The position I mentioned is actually recommended by the Mayo Clinic in the United States, which is considered the best hospital in the world. I will explain in detail later. It is common sense that it is good to maintain lordosis while sleeping. So, some say that you have to sleep hard to maintain appropriate tension in the lower back, so that the lumbar spine becomes lordosis, or that you have to place a towel under the lower back to maintain lordosis. Then, this question arises. When I didn't have back pain or when I was young, I didn't feel uncomfortable sleeping without a towel. Was it because lordosis was not maintained at that time? Do you have to place a towel under the back to maintain lordosis? No, I don't. When I had severe lower back pain in the past, it also interfered with my sleep. So I tried various methods. In my case, when I slept with a towel under my lower back, it hurt so much in less than an hour. And even if I managed to sleep, my lower back pain was so bad when I woke up in the morning. But I'm not the only one who experienced this. It's not just me. There are many patients who sleep with a towel under their lower back who say their lower back hurts. If you have difficulty sleeping with a towel under your lower back, take the towel off your lower back and put a blanket under your knees to support it. You can support your lower back with a pillow or towel, but since they are small, they tend to fall out quickly while you sleep. So I think a thin blanket or small blanket is better. Even if you sleep like this, supporting the back of your knees without a towel under your lower back, you will see significant improvement. The Mayo Clinic in the United States does not recommend putting a towel under your lower back. Instead, they recommend placing it under your knees like I do. If you sleep with a towel or blanket behind your knees and have back discomfort, try changing the height of the support under your knees. It is best to find a height that is comfortable for your body type. If you sleep with the towel under your shins like this, your pelvis will return to neutral and your lower back muscles will relax. From the perspective of providing traditional treatment rather than surgery, it is very important for patients to sleep without pain. In the early days, when I had never experienced back pain, I recommended that patients with lower back pain sleep with a towel under their lower back. Some people said it was okay, but there were so many people who couldn't sleep because the pain was so bad. So why do some patients have more back pain when they sleep with the towel under their back? First of all, in patients with a herniated disc, the disc is pushed out and pressing on the nerve. Also, in cases of stenosis, the nerve in the lower back is pressed as the nerve canal narrows. In this case, if you sleep with a towel under your lower back, the force applied to your lower back can increase. This is because your body weight presses on it while you sleep. In addition, if you have acute lumbago or posterior facet syndrome or if there is inflammation around the sacroiliac joint, the pressure from the towel on your lower back can worsen these symptoms. Patients with lower back discomfort tend to relax their lower back, whether intentionally or unintentionally, in their daily lives. In such cases, they shift their weight support to the lower body. The parts of our body that can receive the most support are the hamstrings and quadriceps femoris. Students, office workers, or people who drive a lot tend to have tight hamstrings. Of course, their buttock muscles are also weak. People with bad lower backs tend to have shortened hamstrings. If you contract and relax the hamstrings, your athletic ability will decrease, but if the hamstrings become tight, they will perform an excellent supporting role when standing. It does that, and in general, people with shortened hamstrings tend to have their pelvis tilted back, causing their lumbar spine to become posterior. And people with shortened hamstrings may also experience more lumbar lordosis when they lie down. Also, you said that their buttock muscles are weak. The gluteus medius and minimus are weak, and the hamstrings are too tense, so their feet fall to the sides. However, this movement can actually put more strain on their lower back. That's why it's a good idea to place a blanket or pillow behind your knees when you sleep to reduce the tension on your hamstrings. To summarize, placing a blanket behind your knees and your calves releases the tension in the hamstrings and restores normal lumbar lordosis. Some people might have this problem. I have an anterior tilt, so what do I do? Don't overthink it. Sleeping with a towel behind your knees reduces tension in the front quadriceps or psoas and the back hamstrings to some extent. In the process, the pelvis is positioned in a neutral position overall, preventing the lower back muscles from becoming tense. It can greatly reduce the burden on the lower back. Of course, I'm not saying that there are no people who have seen results from sleeping with a towel behind their lower back and behind their knees. However, for the reasons I explained, there is a higher probability that you have seen results from sleeping with a towel behind your knees together rather than supporting it on your lower back. For those who have severe lower back pain and find it difficult to sleep looking up at the sky, I usually recommend sleeping on your stomach. However, sleeping on your stomach itself increases abdominal pressure, which inevitably puts a strain on your lower back. For those people, instead of supporting your stomach, you can reduce the burden on your lower back by putting a thin blanket under your groin and lower abdomen. Don't forget, you're not supporting your stomach, you're supporting your groin and lower abdomen. Some people say this is too uncomfortable. There is also a way for people to sleep on their side. It is as shown in the picture below. This is a way to maintain lordosis in the lumbar spine by supporting a thin towel on the lower back. However, patients with bad lumbar discs or stenosis can put pressure on the blanket and eventually cause pain. If you sleep with the blanket behind your knees like this, your pelvis will be in a neutral position and the muscles in your lower back will be relaxed. If you find it uncomfortable to sleep like this, try adjusting the height of the blanket behind your groin a little. People with weak gluteus medius and tight hamstrings may spread their feet like this when they just lie down. However, this posture puts more tension on the lumbar spine. If you support the groin area so that the tips of your feet do not spread apart, the tension in your lower back will also be relieved. If you have such bad lower back pain that it is too hard to sleep looking at the sky, sleeping like I mentioned, with your groin and lower abdomen as the method, can be a solution. If you sleep with your stomach too close to your body, the abdominal pressure will be applied and the pain in your lower back may get worse. If any of you have lower back pain, try putting a thin blanket behind your knees and supporting it while you sleep. It will get much better. That was Pain Lab :) #lowerbackpain #sleepingposition #lowerbackpain