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Best Sleeping Positions for Sacroiliac Joint Pain Relief

Date: October 7, 2025

Finding a comfortable sleeping position when you have sacroiliac (SI) joint pain can feel impossible. The wrong posture can trigger sharp aches that travel from your lower back to your hips and thighs, disrupting your rest. 

The right position, however, can ease pressure on the joint, reduce inflammation, and help you wake up with less stiffness. The best sleeping position for sacroiliac joint pain relief usually involves supporting your spine’s natural curve and preventing your hips from twisting. With a few practical adjustments and the right pillows, restful sleep becomes possible again. Let's dive into the best sleeping positions for sacroiliac joint pain relief .

Understanding Sacroiliac Joint Pain

The sacroiliac joints sit where the base of your spine meets your pelvis. These small but powerful joints transfer weight from the upper body to the legs, stabilizing you when you walk, bend, or stand. When inflammation or misalignment occurs, even small movements can cause deep pain on one or both sides of the lower back.

SI joint pain can stem from several causes such as arthritis, pregnancy, injury, or prolonged poor posture. Sleeping in awkward positions that twist the pelvis can worsen symptoms overnight. People often describe the discomfort as a dull ache that intensifies when they roll over or get out of bed.

The key to sleeping comfortably with SI joint pain is maintaining alignment between your spine, hips, and legs so the joint remains neutral rather than strained. Good sleep posture supports recovery by reducing mechanical stress on this sensitive area.

Best Sleeping Positions for Sacroiliac Joint Pain Relief

Everyone’s body is different, so finding the right position may take some trial and error. However, certain postures consistently reduce tension on the sacroiliac joints and promote proper spinal alignment. Supportive pillows and a medium-firm mattress often make these positions even more effective.

Side Sleeping with a Pillow Between the Knees

Side sleeping is one of the most recommended positions for SI joint pain relief. When you lie on your side, the pelvis can easily rotate or tilt, which puts uneven stress on the sacroiliac joint. Placing a firm pillow between your knees helps keep your hips stacked and your spine aligned from shoulders to knees.

If your pain is worse on one side, try sleeping on the opposite side to reduce direct pressure on the affected joint. You can also tuck a small pillow under your waist to support your midsection and prevent sagging.

This position keeps the pelvis stable and reduces strain on the lower back, promoting even weight distribution throughout the night.

How to Set It Up:

  1. Lie on your side with both knees slightly bent.
  2. Place a supportive pillow between your knees so they remain hip-width apart.
  3. Hug a second pillow to your chest for upper-body balance.
  4. If you notice a gap at your waist, fill it with a small cushion for spinal support.

This setup minimizes twisting and works especially well for individuals with one-sided SI pain or hip tightness.

Back Sleeping with Knee Support

Sleeping on your back allows your weight to spread evenly, relieving direct pressure from the sacroiliac area. However, lying flat can sometimes cause your lower spine to arch excessively, irritating the joints. Placing a pillow or wedge under your knees flattens that curve and keeps your pelvis neutral.

Some people prefer using a contoured memory-foam pillow under the knees to maintain stable support. Others find that slightly elevating the legs with an adjustable bed base eases pain further.

Back sleeping with knee elevation helps reduce the compressive forces that aggravate sacroiliac joint inflammation. It also promotes circulation and minimizes morning stiffness.

Try this setup:

  • Use a medium-firm mattress that supports the natural curve of your lower back.
  • Place a thick pillow under your knees and another beneath your head and neck.
  • Keep your arms relaxed at your sides or rest them on your abdomen.

If you tend to snore, slightly raising your upper body with an adjustable bed or wedge pillow can make breathing easier while preserving hip alignment.

Modified Fetal Position for Comfort

A modified fetal position can work for people who prefer curling slightly while sleeping. It relieves tension in the lumbar region while keeping the hips relatively aligned. To avoid straining the sacroiliac joint, avoid curling too tightly. The key is a relaxed curve, not a deep hunch.

Placing a pillow between the knees and one behind your back for support keeps your pelvis from rotating. Some people also benefit from hugging a long body pillow, which prevents rolling into awkward angles during the night.

The modified fetal position reduces lower-back tension while maintaining hip symmetry and promoting deep relaxation.

Quick Comparison: Best Positions for SI Joint Pain

Sleeping PositionBenefitsIdeal For
Side with Pillow Between KneesAligns hips and reduces rotationOne-sided or pregnancy-related SI pain
Back with Pillow Under KneesEvenly distributes weight, relaxes spineBilateral SI pain or stiffness
Modified Fetal PositionComforts lumbar area, prevents twistingRestless sleepers or those needing full-body support

Using these setups consistently can make a noticeable difference in how you feel when you wake up. The right position not only relieves pain but also improves sleep quality by keeping muscles relaxed.

Avoiding Positions That Make SI Joint Pain Worse

While supportive postures can soothe your joints, certain sleeping habits can make symptoms worse. Being mindful of these can prevent overnight flare-ups and long-term irritation.

Stomach Sleeping

Lying on your stomach twists the pelvis and strains the lower back. This position forces one side of the hip to lift higher, putting uneven tension on the sacroiliac joint. Over time, it can lead to chronic tightness and nerve irritation.

If you cannot avoid stomach sleeping, place a thin pillow under your hips and use a very flat pillow or none at all under your head. This helps reduce the spinal curve, though side or back sleeping remains the better option.

Uneven Mattress or Pillow Setup

A sagging mattress or an overly soft bed can sink your hips too deeply, causing misalignment through the night. The same happens if you use pillows that are too high or too flat. A medium-firm mattress with adaptive foam or hybrid support is ideal for maintaining even pressure on the spine and pelvis.

If you notice more pain in the morning, check for dips or wear spots on your mattress and consider adding a firm topper or replacing the mattress entirely.

Twisting Movements in Bed

Turning abruptly or sleeping with one leg bent across the other can trigger sacroiliac joint irritation. To minimize twisting, keep both legs together when rolling over and move your upper and lower body simultaneously. You can also use a long body pillow to prevent your top leg from sliding forward during the night.

Avoiding poor sleeping positions is as important as finding the right ones. Maintaining consistency each night trains your body to stay in a neutral alignment, which reduces inflammation and supports healing.

Additional Tips for Nighttime SI Joint Relief

Comfortable sleeping positions are just part of the solution. Lifestyle and bedtime adjustments can further ease pain and help you rest better.

Stretching and Mobility Before Bed

Gentle stretches before bedtime relax tight muscles around the hips and lower back. Focus on the glutes, hamstrings, and hip flexors. Try movements like:

  • Knee-to-chest stretch: Pull one knee toward your chest while lying on your back, hold for 20 seconds, and switch sides.
  • Piriformis stretch: Sit with one ankle over the opposite knee and lean forward slightly to feel a stretch in your outer hip.

These light stretches increase flexibility and reduce tension that can pull on the sacroiliac joint during sleep.

Choosing the Right Mattress and Pillows

Your mattress can either support your recovery or worsen pain. Choose one that balances comfort and firmness, ideally medium-firm, so it conforms to your body without sagging. Memory-foam or latex hybrids tend to offer the best combination of contouring and stability.

Pillows should maintain neck alignment and support the natural curve of your spine. A contoured cervical pillow or wedge can be helpful for back sleepers, while side sleepers should choose a pillow thick enough to keep the neck in line with the shoulders.

Investing in proper bedding is one of the most effective ways to reduce nightly SI joint discomfort.

Use Heat or Ice Before Bed

Applying a heating pad or warm compress for 15 minutes before sleep can loosen tight muscles and improve circulation. For acute inflammation, a brief cold compress can calm the joint and minimize swelling. Alternate between heat and ice if needed, depending on how your body responds.

Maintain Healthy Sleep Hygiene

Small changes in your bedtime routine can enhance rest and minimize tossing and turning:

  • Go to bed and wake up at consistent times.
  • Avoid heavy meals and caffeine close to bedtime.
  • Keep your bedroom cool and dark.
  • Limit screen time to reduce muscle tension from prolonged sitting or phone use.

Creating a calm environment allows your muscles to relax fully, reducing the likelihood of nighttime joint flare-ups.

Morning Transition Tips

How you get out of bed matters too. Rolling to one side, bending your knees, and using your arms to push yourself upright prevents sudden pressure on the sacroiliac joint. Stretch gently once you stand to awaken the supporting muscles before walking.

Combining proper posture, supportive bedding, and nightly self-care practices maximizes pain relief and helps restore a natural sleep rhythm.

How To Relieve Hand Pain at Night with Simple Techniques

If your lower back is not the only area disturbing your sleep, nighttime hand pain can be just as disruptive. Many people who find relief from sacroiliac joint pain later struggle with numbness or tingling in their wrists or fingers. These symptoms often result from nerve compression, poor circulation, or repetitive strain.

The same principle that applies to your lower back alignment applies to your hands and wrists. Keeping your joints neutral during rest prevents unnecessary pressure. Wearing soft wrist splints at night, doing gentle hand stretches before bed, and avoiding sleeping with wrists bent under your pillow can make a noticeable difference.

Applying a warm compress before sleep or gently massaging your hands with lotion can also improve circulation. If you use your hands heavily during the day, consider alternating heat and cold therapy to calm inflammation.

Improving sleep posture throughout your body, not just your lower back, is the foundation of overall joint health. With consistent habits and mindful positioning, you can reduce discomfort from both sacroiliac joint pain and nighttime hand aches helping you sleep soundly and wake up ready to move freely again.

About Dr. Sean Ormond
Dr. Sean Ormond in black medical uniform and black fog background
Dr. Sean Ormond is dual board-certified in Anesthesiology and Interventional Pain Management. He completed his anesthesia residency at Case Western University in Cleveland, Ohio where he served as Chief Resident, followed by an interventional pain management fellowship at Rush University in Chicago, IL. Following fellowship, Dr. Ormond moved to Phoenix and has been practicing in the Valley for a few years before deciding to start his own practice.
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