Herniated disc: how should you sleep, and how should you get up?

If you tried sleeping on a hard floor and keep waking before dawn with your back aching

Key points in 30 seconds

1. When you lie flat on your back, disc pressure is about one-fifth of what it is when standing. Night is recovery time, when the disc rests and soaks up water again.
2. The advice "if your back hurts, sleep on something hard" has weak evidence behind it. In a study of 313 people, those on a medium-firm mattress were about twice as likely to improve.
3. When lying on your side, put a pillow between your knees. When lying on your back, put one under your knees.
4. When turning over, roll your shoulders and pelvis together as one unit, like a log.
5. In the morning, don't spring up. Roll onto your side → lower your legs and push yourself up to sitting with your arms → sit for a moment → stand up using your leg strength.

What we often hear

• "I heard that if your back hurts, you should sleep on something hard."
• "When I try to turn over, I get a jolt down my leg, so I hold my breath."
• "Just getting out of bed in the morning takes forever."
• "I don't know what position I should sleep in."

After a herniated disc diagnosis, there's one piece of advice you're sure to hear: if your back hurts, sleep on something hard.

So you left your bed and tried sleeping on a thin mat on the floor. But you wake up every morning before dawn with your back aching against the floor, hold your breath when you try to turn over because of a jolt down your leg, and groan for a long time trying to get up in the morning. Are you sleeping the wrong way, or is the advice wrong?

We've written about what to sleep on, what position to sleep in, how to turn over and how to get up when you have a herniated disc, focusing on what has evidence behind it.

What state is the disc in at night?

Let's start with the good news. Night is when the disc rests.

In a study that measured the pressure inside the disc directly, the pressure when lying flat on your back was about one-fifth of the pressure when standing. Sleep is the most comfortable time of day for the disc.

During that time, the disc soaks up the water that was squeezed out during the day, and swells back up. So sleeping well is itself part of treating a herniated disc, and when pain breaks up your sleep, it breaks up your recovery too.

Is sleeping on something hard good for your back?

The evidence is weak.

There's a study that replaced the mattresses of 313 people with long-term back pain with new ones, one group getting firm mattresses and the other medium-firm, and compared them for three months.

• Both groups improved on the new mattresses.
• But the medium-firm group was about twice as likely to have less pain in bed and less trouble with daily life.

The researchers concluded that the belief that firm mattresses are good for the back had spread without evidence.

To be honest, this study included people with back pain that didn't spread down the leg. It can't be applied directly to people with a herniated disc whose leg pulls. Still, there's no reason to believe "the harder the better" and endure aching nights on the floor.

The standard is a medium firmness that feels comfortable to your body, and a surface where your hips don't sink in deeply when you lie down. If you have an old mattress that sags in the middle, that sag is bending your lower back all night, which is a sign it's time to replace it.

What position should I sleep in?

Remember just three things.

First, when lying on your side, put a pillow between your knees. When you lie on your side, your top leg drops forward and twists your pelvis, and that twist travels up to your lower back. Putting a pillow or cushion between your knees keeps your pelvis level so your lower back doesn't twist. This is the first position we recommend for people with a herniated disc.

Second, when lying on your back, put a pillow under your knees. In the same pressure study, the lowest value among the positions measured was lying on your back with the knees slightly bent. Supporting under your knees lets your lower back rest comfortably without arching off the bed.

Third, if sleeping on your stomach is uncomfortable, avoid it. Lying on your stomach means turning your neck to one side and arching your lower back. Some people are fine with it, but if you're stiffer in the morning while you have disc pain, that's a sign the position doesn't suit you.

What do I do about the jolt when I turn over?

If you turn your shoulders first or twist at the waist as you turn, the disc gets twisted.

Turn your shoulders and pelvis together as one unit, the way a log rolls. Bend your knees slightly, bring both hands together in front of your chest, and turn your shoulders, lower back and pelvis all at once. You'll have to think about it at first, but in a few days it becomes second nature.

How should I get up in the morning?

The disc soaks up water overnight and is most swollen in the morning. If you spring up and curl your back at this moment, you're putting the most pressure on it at its weakest moment of the day. So there's an order to follow.

1. First, roll onto your side like a log.
2. As you lower both legs off the side of the bed, push against the bed with your arms to raise your upper body. Like a seesaw, so the weight of your legs going down helps lift your upper body.
3. Sit on the edge of the bed for a moment. Don't stand up right away.
4. When you stand, fold at the hips by pushing them back, and stand up using your leg strength.

Step 4 is the movement described in When you bend forward, your hips should fold, not your lower back.

If you sleep on the floor, this process is much harder. Getting up from the floor means you have no choice but to bend deeply and twist your back, so while you have disc pain, a bed or a raised mattress is the better choice.

If pain wakes you at night

On nights when your leg pulls and wakes you up, change position instead of toughing it out. Lie on your side with a pillow between your knees, or lie on your back with support under your knees. Jotting down what time you woke up and in what position is a big help at your visit.

The following aren't things to solve with positioning.

• If the pain keeps getting worse night after night even when you change position, and you have a fever or are losing weight for no reason, other causes need to be checked, so don't put off seeing a doctor.
• If your bladder or bowel habits have changed, sensation in your buttocks or groin has dulled, or your foot is getting weaker and weaker, you need a surgical evaluation right away. If you come to us, we'll tell you the same thing.

How we work

First, we look at what your nights are like. We ask what position you wake up in, how long it takes to get up in the morning and what you sleep on, and examine leg strength, sensation and warning signs. If needed, we look at the disc in partnership with the radiology clinic on the 2nd floor of the same building.

Second, we protect your nights. We manage the leg pain and lower back tension that wake you at night with acupuncture and pharmacopuncture (herbal acupuncture), and work on the movement of a stiff pelvis with Chuna (Korean manual therapy). We have you practice sleeping positions, turning over and getting up right in the exam room, and correct them as you go. If pain has broken down your sleep itself, we also put together bed retraining. The goal is for your nights to support the time your body needs to reabsorb the disc.

Third, we check with a record of your nights. At set points, we compare how many times pain wakes you at night, how long it takes to get up in the morning, and your leg pain score. We don't treat without evidence.

What changes

A night when you don't hold your breath turning over before dawn. A morning when you roll onto your side and sit up slowly at the sound of the alarm, without groaning. Night becoming recovery time for the disc again.

That's what we aim for.

Which position is comfortable and how fast you recover differ from person to person, depending on where the herniation is, how severe it is and your body type.

Today's takeaway

If you have a herniated disc, sleep on a comfortable medium firmness rather than something hard, with a pillow supporting your pelvis. And in the morning, roll onto your side and sit up before you stand.

There are two things to try tonight.

• One pillow between your knees when lying on your side, one pillow under your knees when lying on your back.
• Tomorrow morning, instead of springing up, roll onto your side, sit up, and then stand.

Write down how many times you woke up at night and how long it took to get up in the morning for a week, bring it with you, and we'll look at the rest together. We're open until 8:30 p.m. on weekdays, and on weekends and public holidays too.

How herniated discs can be reabsorbed on their own, and the evidence behind it, is summarized in the director's column A ruptured disc can shrink on its own.

For questions or appointments, message us in English through the messenger at the bottom right of the page, or call +82-53-716-1175.

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References

1. Kovacs FM, Abraira V, Peña A, et al. Effect of firmness of mattress on chronic non-specific low-back pain: randomised, double-blind, controlled, multicentre trial. Lancet. 2003;362(9396):1599-1604. PMID: 14630439
2. Wilke HJ, Neef P, Caimi M, Hoogland T, Claes LE. New in vivo measurements of pressures in the intervertebral disc in daily life. Spine. 1999;24(8):755-762. PMID: 10222525