How to Sleep With SI Joint Pain: 4 Tips for Restful Nights

Key takeaways:

• Sacroiliac (SI) joint pain can make it difficult to sleep. Avoid positions where your hips or legs are twisted or asymmetrical. These positions can increase strain at the SI joint.

• To sleep with SI joint pain, you'll want to keep your hips and spine properly aligned. Try sleeping on your side with a pillow in between your knees or on your back with a pillow under your knees.

• Additional treatment, like physical therapy, can help relieve SI joint pain. Stretching and applying heat can help, too.

Table of contents

How to sleep

Best sleeping positions

Find the right mattress

Stretch before bed

Use heat therapy

When to see a doctor

Bottom line

References

Kiwis/iStock via Getty Images Plus

The sacroiliac (SI) joint connects the lower spine to the pelvis. While this joint has very little motion, it plays an important role in stabilizing the hips and spine. Medical conditions, injuries, pregnancy, or awkward positions over time can stress the SI joints, causing pain that makes it hard to fall asleep. Changing the way you sleep, and other self-care tips, can help alleviate discomfort. Continue reading to learn more below.

How do you sleep with SI joint pain?

SI joint pain and stiffness are often worse at night. It's possible that the way you sleep is to blame. When you have SI joint pain, it's important to find a position that supports your spine and pelvis to maintain good alignment. To sleep better at night with SI joint pain, try out some of the following tips for pain relief.

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1. Try a new sleeping position

Unsupportive or asymmetrical sleeping positions can make SI joint pain worse. Try changing the way you sleep to keep your spine and hips aligned to reduce pressure. Consider the following two options.

Sleep on your side with a pillow between your legs

When you have SI joint pain, sleeping on your affected side can make pain worse. It's best to sleep on your other side with your painful SI joint facing up to decrease compression. When sleeping on your side, you'll also want to use a pillow in between your knees. This positioning helps keep your pelvis and hips in good alignment. This is especially important because twisting at the hips can make SI joint pain worse.

• Lie on your unaffected side with your painful side facing up. Slightly bend your knees. Maintain a neutral spine without bending or arching your back.

• Place one or two pillows under your head to support your head and neck. Your head should stay level with your spine without bending too much toward one side.

• Place one or two pillows between your knees to keep your legs spaced about hip-width apart. Your hips and knees should be level with each other. Keep your hips, knees, and ankles stacked on top of each other.

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Sleep on your back

If side sleeping is uncomfortable, sleeping face up can provide relief. Sleeping on your back keeps your weight evenly distributed. This can help decrease pressure from being felt through one side of the body. Sometimes laying flat can strain the low back, so putting a pillow under your knees is recommended. This helps decrease your legs from pulling on your pelvis and lower back, which can make this sleeping position more comfortable.

• Lie flat on your back and place one pillow under your head to support your head and neck. Make sure that you shift your weight so that equal pressure is felt between your right and left sides.

• Place one or two pillows under your knees to maintain a slight bend in your knees. Your hips and ankles should be aligned while your knees will be lifted slightly higher. If needed, also place a small pillow under your lower back to support its natural curve.

2. Choose a supportive mattress

Sleeping on a supportive mattress is important for minimizing strain at any of your joints when you sleep. Sleeping on a couch or a mattress that's too soft or too hard cannot support your body properly and can make SI joint pain worse. The type of mattress that works best for you will depend on what position you sleep in and may take some trial and error. There's not much research available regarding the best mattress for SI joint pain.

3. Stretch before bed

Stretching the lower back and hip muscles around the SI joint can decrease tightness around the area. You can perform these SI joint stretches before you go to bed and when you wake up in the morning. If you're really stiff, apply heat to the area to loosen things up before stretching.

Knee to chest

The knee-to-chest stretch helps improve the mobility of your hips and lower back.

• Step 1: Lie on your back with your legs extended.

• Step 2: Lift one leg, keeping your knee bent and bringing your knee closer to your chest.

• Step 3: Grab behind your thigh and pull your leg closer to your body.

• Step 4: Hold this stretch for 5 to 10 seconds, then relax.

• Step 5: Repeat 10 times on each side.

Lower trunk rotation

This movement improves the ability of your spine and hips to rotate. This can help ease tension from an irritated SI joint.

• Step 1: Lie on your back with your knees bent and feet flat.

• Step 2: Keeping your knees bent and squeezed together, drop your legs over to one side. Let your knees fall down toward the floor. You should feel a stretch along the side of your body.

• Step 3: Hold this stretch for 5 to 10 seconds.

• Step 4: Gently return your legs back to the starting position. Then, drop your legs over to your other side.

• Step 5: Hold for 5 to 10 seconds. Then relax.

• Step 6: Repeat 10 times on each side.

Seated piriformis stretch

The piriformis is a hip muscle that helps rotate and stabilize the hip. With SI joint pain, this muscle can get tight and spasm. Stretching the piriformis can help ease tension around the SI joint.

• Step 1: Start in a seated position in a chair or at the edge of the bed.

• Step 2: Cross your affected leg over your other leg, resting your ankle on your opposite thigh.

• Step 3: Relax your thigh, allowing your knee to drop down toward the floor.

• Step 4: Lean forward over your thighs to increase the intensity of the stretch.

• Step 5: Hold for 30 seconds, then relax.

• Step 6: Repeat three times on the affected side.

4. Use heat therapy

Applying heat to your SI joint can help ease tension. Try using a heating pad for 10-20 minutes at a time along your lower back and/or hip. You can also try taking a warm bath or shower before bed.

When should you see a healthcare professional for SI joint pain?

SI joint pain from an awkward sleeping position or straining movement typically resolves in a few days. Talk with your healthcare professional if your pain lasts longer than 1 or 2 weeks, or you have additional symptoms like numbness or weakness in your leg. Injuries, pregnancy, or medical conditions can cause ongoing SI joint pain that may require additional treatment.

Physical therapy can provide you with corrective exercises and hands-on treatment. These methods can improve the alignment of your pelvis and sacrum to reduce SI joint pain. Other treatments, like wearing an SI joint belt, avoiding high-impact exercise, and corticosteroid injections, can provide additional relief.

The bottom line

SI joint pain can make it difficult to get a good night's sleep. For a more restful night, try sleeping on your unaffected side with a pillow between your knees or on your back with a pillow under your knees. These positions can help reduce stress and pressure on the SI joint. If your pain doesn't go away after a week or two, talk with your healthcare professional. You may need additional treatment like physical therapy to manage your SI joint pain.

References

American Family Physician. (2022). Sacroiliac joint dysfunction and back pain.

Aranke, M., et al. (2022). Minimally invasive and conservative interventions for the treatment of sacroiliac joint pain: A review of recent literature. Orthopedic Reviews.

View All References (5)

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AskDoctorJo. (2017). Trunk rotation stretch - ask Doctor Jo [video]. YouTube.

Hammer, N., et al. (2015). Pelvic belt effects on health outcomes and functional parameters of patients with sacroiliac joint pain. PLOS One.

Hoo, J. S. (2022). Why is my sacroiliac joint pain worse at night? Cornell Center for Comprehensive Spine Care.

Newman, D. P., et al. (2022). Sacroiliac joint dysfunction: Diagnosis and treatment. American Family Physician.

Slobodin, G., et al. (2018). Sacroiliitis - early diagnosis is key. Journal of Inflammation Research.

GoodRx Health has strict sourcing policies and relies on primary sources such as medical organizations, governmental agencies, academic institutions, and peer-reviewed scientific journals. Learn more about how we ensure our content is accurate, thorough, and unbiased by reading our editorial guidelines.

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