Could THIS Bedtime Posture Could Be Contributing to Your Neck & Back Pain?
Key insights: 60-second read
- Sitting up in bed creates unnecessary hinges in your spine – the position you relax in at night can increase the load on specific parts of your neck and back, opening the door to dysfunction over time.
- Your pain onset is rarely the start of the problem – it's often the "last straw" after weeks, months, or years of accumulated stress from things like poor postural habits.
- The position matters more than the activity – reading, using your phone, or watching TV in bed isn't the issue; it's the spinal hinging that creates isolated load.
- A patient with 7 years of thumb pain resolved it by fixing his neck – his bedtime posture had created a hidden neck dysfunction that expressed itself as thumb pain, showing how far-reaching spinal issues can be.
- Simple changes can protect your spine – lie on your side, cross your legs, or use pillows for support. If you can't maintain a neutral spine in bed, consider doing the activity elsewhere.
Do you ever find yourself sitting up in bed, relaxing, using your phone, or reading a book? If this sounds like you, despite how enjoyable these things can be, you may be inadvertently setting your neck and back up for dysfunction down the track.
This is especially relevant for anyone who deals with headaches, neck pain, or lower back pain – and who is struggling to understand why it's there and why it persists despite their best efforts. Depending on the position you're in, and where you're sinking and hinging through your spine, you might be doing yourself a complete disservice.
The good news is we can do something about this. Let's talk about how to optimise your bedtime posture and improve your spine's chances of feeling great long-term.
On this page
The Problem with Sitting Up in Bed
As a physiotherapist who treats a lot of neck and back dysfunction, I'm always trying to take a step back and understand which basic day-to-day things set people up for failure over time.
Irrespective of what spinal dysfunction you may be dealing with, there's often one thing that links most people's spinal dysfunction together: how you position your tissue day in, day out over weeks, months, years, and decades. We're talking about postures and shapes – specifically, stationary sedentary postures in the form of sitting. Whether that's driving, sitting on the couch, doing computer work, or standing and bending forward – if we create an unnecessary spinal hinge, we start to isolate load through specific parts of our spine over time.
"The moment you hurt yourself or develop pain is rarely the start of something brand new. For the majority of people, the onset of pain should be considered the last straw."
The moment you hurt yourself or develop pain is rarely the start of something brand new – except in cases of acute accidents or trauma. For the majority of people, the onset of pain should be considered the last straw. What you were doing at the time may be incidental – just the thing that finally tipped your tissue over its threshold of coping and into tissue damage or pain.
And when trying to distil each issue down to its apparent root cause, there's a sneaky one that gets missed a lot: sitting up in bed at night.
A Real Story: Thumb Pain from a Neck Hinge
I'll never forget a conversation I had with a patient who came in complaining of thumb pain he'd had for the previous seven years. He'd bounced around many health professionals, been given thumb-specific exercises, and tried many things – but was left dejected because nothing had resolved his thumb pain.
As someone who values the bigger picture, I actually looked at his neck. As it turned out, his thumb pain was a consequence of hidden neck dysfunction at the spinal levels that supply and control the function of his thumb. Once we freed up his neck and improved its function, his thumb pain ultimately resolved.
But what was really important about this conversation was understanding why a specific part of his neck had become dysfunctional in the first place. He was adamant that his daily shapes and postures were good, and something he actively focused on. And while many people do actively attend to their posture, any presence of neck or back dysfunction does speak to something potentially being missed. Something likely still has to be going on in the background - without them realising.
And as it turned out, the missing piece that he hadn't been attending to was the three hours a night he was sitting up in bed, looking down, reading a book.
These daily (or nightly) shapes were overloading his neck, and this was expressing itself as pain and tightness in his thumb over time.
Key Concept: If your neck or back symptoms persist, and you identify as someone who sits up in bed each night, you may be doing your body a great disservice without realising it.
Ultimately, any thumb or neck treatments may have been helpful from a symptomatic perspective. But until he got himself out of these nightly positions into better, more neutral spinal shapes – where he hadn't created a hinge in his neck for three hours every night – his thumb pain would always have the potential to hang around.
How to Fix Your Bedtime Posture
In simple terms, we want to remove any long-term, persistent habits of spinal hinging and focus any bending through the areas that are designed to tolerate them - your hips, elbows, knees, and shoulders. Here's how:
Option 1: Cross Your Legs
If you're someone who likes to sit up in bed in a long sitting position, do you have the flexibility to cross your legs? Crossing your legs relieves pressure on your back when compared to having your legs out straight. Straighter legs increase neural tension – which can be all the more difficult to maintain if your back is tight. It's also much harder to stay up straight, and you'll be forced to round your back when looking to feel comfortable.
Option 2: Lie on Your Side
If crossing your legs doesn't work for you, lie down on your side with your book or device out in front of you. This takes all the tension out of your spine. You're well supported, it's far more sustainable, and you're not compromising your spinal position in that "death by a thousand cuts" way over time.
Option 3: Use Supportive Pillows
If you want to stay sitting up, use pillows to fill any gaps you might be sinking into behind you. Sit up nice and tall, with a pillow or two behind your back to support a neutral spinal position. This allows you to relax without sacrificing your spinal health.
Option 4: Take the Activity Out of the Bedroom
If what you enjoy doing doesn't conform to these shapes easily, we may need to have a mature conversation about taking that activity out of the bedroom. Can you do it before you get into bed, in a way that allows you to maintain a more neutral spinal position? This is especially important for activities that don't lend themselves to side-lying or supported sitting.
"If you do suffer from any spinal dysfunction, the shapes and positions you put that tissue into consistently throughout the day – whether you are acutely aware of it or not – matters."
The main point I wanted to get across is this: if you suffer from any spinal dysfunction, the shapes and positions you put that tissue into consistently throughout the day – whether you are acutely aware of it or not – matters.
Sitting up in bed is just another one of those relatively non-threatening things that slips under the guard. But it's something we can spend a lot of time doing, and it ultimately sets our tissue up to fail over time.
By making simple changes – crossing your legs, lying on your side, using supportive pillows, or taking the activity out of the bedroom – you can protect your spine and improve its chances of feeling great long-term.
If you found this helpful, please consider subscribing to the Your Wellness Nerd YouTube channel for more content like this.
- Grant
Frequently Asked Questions
Is sitting up in bed really that bad for my neck and back?
It's not the activity itself that's bad – it's the position you're in. Sitting up in bed often creates a hinge in your neck or lower back that loads specific tissues unevenly. Over weeks, months, and years, this can lead to dysfunction and pain. The key is to find a position that keeps your spine neutral.
What's the best position for reading in bed?
Lying on your side with your book or device propped up in front of you is ideal. This keeps your spine neutral and takes all the tension out of your neck and back. If you prefer to sit up, use pillows to support your back and keep your spine tall and straight – but avoid rounding forward.
Can poor bedtime posture really cause pain in other parts of my body?
Absolutely. As the story in this article illustrates, a hidden neck dysfunction from bedtime posture can express itself as thumb pain, headaches, or other seemingly unrelated symptoms. The nerves that control your arms and legs originate in your spine, so dysfunction in your spine can affect areas far from the source.
What if I can't get comfortable in a neutral position in bed?
If you can't find a comfortable neutral position, consider doing the activity before you get into bed, in a chair or on a couch where you can maintain better posture. Alternatively, experiment with different pillow setups – a wedge pillow or a reading pillow can help you sit up more comfortably while keeping your spine supported.
One key insight from this video
"The moment you hurt yourself or develop pain is rarely the start of something brand new. For the majority of people, the onset of pain should be considered the last straw. If you can't explain some of your dysfunction despite all the good things you're doing, and you spend time sitting up in bed, you may be doing your body a great disservice without ever realising it."
Want personalised advice for your neck or back pain?
If you would like help making sense of your pain, injury, or general musculoskeletal dysfunction, you can book with Grant either in Port Macquarie or via an online telehealth consultation.
