Sitting and Sleeping Comfortably with SI Joint Pain

The sacroiliac (SI) joints are crucial for activities that involve the spine and legs moving together, such as walking, getting up from a lying-down position, and transitioning from standing to sitting. ¹ Buchanan BK, Varacallo M. Sacroiliitis. [Updated 2022 Sep 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK448141/ ^{, 2} Eshed I, Miloh-Raz H, Dulitzki M, et al. Peripartum changes of the sacroiliac joints on MRI: increasing mechanical load correlating with signs of edema and inflammation kindling spondyloarthropathy in the genetically prone. Clin Rheumatol. 2015;34(8):1419-1426. http://doi.org/10.1007/s10067-015-2976-0 When the SI joints become inflamed and painful, these activities become difficult to perform, and additionally, long periods of inactivity, such as sitting or sleeping can make the pain worse. ¹ Buchanan BK, Varacallo M. Sacroiliitis. [Updated 2022 Sep 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK448141/

How to sit comfortably with SI joint pain?

Here are a few effective ergonomic adjustments and changes that can help minimize SI joint discomfort when sitting:

• Choose a chair that keeps the spine neutral. Choose a chair that supports your lower back and keeps it in a neutral position. Sitting in a neutral position helps to activate the paraspinal muscles on each side of your spine, which hold your body upright without taxing other muscle groups. A chair with adjustable lumbar support can help maintain the spine's natural curve. Avoid chairs with hard and flat seats, as they may increase the soreness in the SI joints. ³ Roffey DM, Wai EK, Bishop P, Kwon BK, Dagenais S. Casual assessment of occupational sitting and low back pain: results of a systematic review. The Spine Journal. 2010.10(3):252-261. https://doi.org/10.1016/j.spinee.2009.12.005
• Introduce gentle pelvic movements while sitting. With your feet flat on the floor, gently rock your pelvis from side to side and forward and backward. Try gentle rotations around the pelvic clock, both clockwise and counterclockwise. By introducing these concepts of dynamic sitting, or micro-movements, the nerve endings in the sacroiliac joints become stimulated and feel better.
• Use a supporting cushion. If you have a hard chair, using a cushion can help distribute the weight evenly and reduce pressure on the SI joint. Using a cushion made of a supportive material, like memory foam, or one that has a cutout or contour. ⁴ Urits I, Burshtein A, Sharma M, et al. Low Back Pain, A Comprehensive Review: Pathophysiology, Diagnosis, and Treatment. Current Pain and Headache Reports. 2019.23(23). https://doi.org/10.1007/s11916-019-0757-1
• Maintain good posture. Sitting with a slouched posture can put pressure on the SI joint and worsen the pain. Sit upright with your back supported by the chair and feet flat on the floor, and avoid crossing your legs or ankles.
• Take frequent breaks. Sitting for a prolonged period of time can stiffen the back muscles and aggravate back and SI joint pain. Take frequent breaks to stand up, stretch, and walk around. These breaks can help improve blood circulation and reduce hip and lower back stiffness. ¹ Buchanan BK, Varacallo M. Sacroiliitis. [Updated 2022 Sep 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK448141/

If you continue to experience pain while sitting after these adjustments and you have a desk job, it may be useful to consider a standing desk that allows you to switch between standing and sitting.

How to sleep comfortably with SI joint pain?

Sleeping with SI joint pain can be challenging, but it is essential to maintain good sleep hygiene to ensure that your body can heal. Here are some adjustments you can make to minimize discomfort and enjoy a restful night’s sleep.

• Adjust your sleeping position. When you sleep with SI joint pain, it is important to support your lower back area when lying down. Everyone is different, and it may take some experimenting to find the right sleeping position for you.
  • Sleep on your back. Sleeping on your back can effectively reduce pressure on your SI joint by keeping the spine in a neutral position. ⁵ Cary D, Briffa K, McKenna L. Identifying relationships between sleep posture and non-specific spinal symptoms in adults: A scoping review. BMJ Open. 2019;9(6):e027633. http://doi.org/10.1136/bmjopen-2018-027633 Try placing a soft pillow or rolled-up towel under your knees to help support your lower back and promote proper alignment of the spine.
  • Side-sleeping with a pillow between your legs. Laying on your side can help reduce pressure on your SI joint. ⁶ Skarpsno ES, Mork PJ, Nilsen TIL, Holtermann A. Sleep positions and nocturnal body movements based on free-living accelerometer recordings: association with demographics, lifestyle, and insomnia symptoms. Nat Sci Sleep. 2017;9:267-275. http://doi.org/10.2147/NSS.S145777 Try sleeping with the painful side up and placing a pillow between your knees to help keep your pelvis in a neutral position and reduce strain on your lower back. ⁷ Chun-Yiu JP, Man-Ha ST, Chak-Lun AF. The effects of pillow designs on neck pain, waking symptoms, neck disability, sleep quality and spinal alignment in adults: A systematic review and meta-analysis. Clin Biomech (Bristol, Avon). 2021;85:105353. http://doi.org/10.1016/j.clinbiomech.2021.105353 The size of the pillow should help to place your hips apart, at the same width as your shoulders.
  • Avoid sleeping on your stomach. Sleeping on your stomach can strain your SI joint and neck. ⁵ Cary D, Briffa K, McKenna L. Identifying relationships between sleep posture and non-specific spinal symptoms in adults: A scoping review. BMJ Open. 2019;9(6):e027633. http://doi.org/10.1136/bmjopen-2018-027633 Sleeping on your back or side is preferred when dealing with lower back pain.

See Mattresses and Sleep Positions for Each Back Pain Diagnosis

• Choose the right mattress. A medium-firm to firm mattress can provide the necessary support to the lower back and hips. However, if the mattress is too hard, it can cause pressure points and exacerbate the pain. Choose a mattress that conforms to your body shape and provides even support. ⁶ Skarpsno ES, Mork PJ, Nilsen TIL, Holtermann A. Sleep positions and nocturnal body movements based on free-living accelerometer recordings: association with demographics, lifestyle, and insomnia symptoms. Nat Sci Sleep. 2017;9:267-275. http://doi.org/10.2147/NSS.S145777
• Try heat therapy. Applying heat to your lower back and hips can help alleviate pain and inflammation. You can use a heating pad, hot water bottle, or a warm bath before bed to help relax your muscles and ease your pain. ⁸ Haghayegh S, Khoshnevis S, Smolensky MH, Diller KR, Castriotta RJ. Before-bedtime passive body heating by warm shower or bath to improve sleep: A systematic review and meta-analysis. Sleep Medicine Reviews. 2019;46:124-135. http://doi.org/10.1016/j.smrv.2019.04.008

• Practice good sleep hygiene. Good sleep hygiene is important for everyone, but a good night’s sleep is essential when recovering from back pain. Establish a regular sleep schedule, create a relaxing bedtime routine, and avoid caffeine and alcohol before bed.

It’s important to note that changing to a different sleeping position may be uncomfortable at first and may take a few days to adjust. When changing your sleeping position, it’s important to stay persistent and continue practicing good sleep hygiene.

SI joint pain can be a frustrating and painful condition, but you can use various strategies to help alleviate discomfort and sit and sleep more comfortably. Choosing the right chair or mattress, using cushions and pillows, and adjusting your posture can help reduce pressure on the SI joint and relieve pain.

If you continue to experience SI joint pain despite these strategies, it’s important to consult a physician to determine the underlying cause of your pain and develop a personalized treatment plan.