Stomach sleeping, while a favored position for some, is widely acknowledged by health professionals as a poor choice for spinal health. This position forces the neck into a rotated or hyperextended state and causes the lower back to arch, which can lead to morning stiffness and pain. The goal of using pillows when sleeping on the stomach is not comfort alone, but a calculated strategy to minimize the strain that this posture places on the spine. By making specific adjustments to where you place a pillow, it is possible to mitigate the adverse effects and maintain a more neutral alignment throughout the night.
Addressing the Head and Neck
The primary challenge of stomach sleeping is the unnatural rotation or sharp upward tilt of the cervical spine, which is the neck region. To counteract this constant twisting, the pillow used for the head must be as thin as possible, or even eliminated entirely. The ideal head support is an ultra-low loft pillow, often defined as one that compresses to less than three inches in height.
A thin pillow made of easily compressible materials like soft down or shredded foam allows the head to rest close to the mattress surface. This minimal elevation helps keep the head and neck in closer alignment with the rest of the spine, reducing the angle of rotation. If a pillow is too thick, it pushes the head upward, causing hyperextension that stresses the neck’s delicate structures. Many stomach sleepers find it beneficial to use no head pillow at all.
Proper arm positioning can further support the head without compromising the shoulder joint. Instead of tucking one arm beneath the head or pillow, which can pinch nerves and restrict blood flow, arms should be kept down by the sides or draped around the head pillow. If the head is turned to one side, you can place the arm on that side down straight and position the opposite arm with the elbow bent up toward the head. Keeping the arms relatively flat helps prevent shoulder impingement and ensures that the upper body remains stable.
Supporting the Lower Back and Hips
Once the neck is addressed, the focus shifts to the lumbar spine, which is the lower back. When lying face down, the weight of the abdomen and pelvis causes the midsection to sink into the mattress, exaggerating the natural inward curve of the lower back, a condition known as lumbar lordosis or “swayback.” This excessive arching places significant pressure on the spinal joints and discs.
To prevent this sinking and excessive arch, a second pillow must be placed directly under the lower abdomen and pelvis. This placement serves to elevate the midsection, effectively lifting the belly and hips to flatten the spine’s curve. The pillow should be positioned from roughly the area below the belly button down toward the hips, providing a stable platform for the heaviest part of the body.
The pillow used for this pelvic support should be thin to moderate in thickness and possess a moderate firmness. Unlike the head pillow, which must compress fully, the abdominal pillow needs enough structure to maintain its shape and provide consistent lift throughout the night. This simple adjustment prevents the overextension of the lower spine, which is a major contributor to morning back pain for stomach sleepers.
Selecting the Correct Pillow Characteristics
The physical properties of the pillows are crucial for stomach sleepers. The head pillow should be soft to medium-soft, allowing it to easily compress without pushing the head up. Recommended materials include soft down, down alternative, or shredded foam, as they are highly moldable and compressible.
Conversely, the pelvic support pillow requires a moderate level of firmness to resist the weight of the torso and provide the necessary lift for the lower back. This support pillow must be sturdy enough to maintain the elevation of the hips and abdomen, helping to keep the entire spine in a straighter line from neck to pelvis.