Posture Part 1: It's Just not for Sitting Anymore... | Modern Manual Therapy Blog - Manual Therapy, Videos, Neurodynamics, Podcasts, Research Reviews

Posture Part 1: It's Just not for Sitting Anymore...

It's obvious to you regular readers the importance I place on posture. What I learned from MDT is used daily, but it's not just for sitting! The benefits of quality sleep are numerous and obviously affect more than the neuromusculoskeletal issues we see our patients for.

I think that posture is often overlooked in lying, especially when patients c/o night pain that isn't from a red flag. Here are my recommendations for the ANLs that are passive rather than active. 

Sleeping posture support rules

  • support all unsupported areas proximally first
  • have the patient show you how they sleep first then modify that position with pillow support
  • have them lie in the supported position for 5-10 minutes, then remove the pillows, I'm sure they'll agree the supported position is much better!

Sleeping on a Cloud
For Supine

  • pt sleeps with cervical roll pillow for lordosis support
  • a pillow up to the buttocks for under the thighs, and under each arm


  • cervical roll pillow for the neck
  • a pillow between the thighs, hips and knees flexed to comfort, but equally to avoid spinal rotation
  • bottom arm flexed to 90 or lower, elbow flexed to 90
  • upper arm in a "sling" position over another pillow for support up to the axilla
  • for persistent shoulder problems, have them sleep with a sling over the supported pillow to keep resting position all night, allowing for rotator cuff healing and avoidance of impingement

half-prone, half-sidelying side view

half prone, half sidelying top view
Half prone/sidelying

  • for the stubborn prone sleepers!
  • prone sleeping always makes me cringe! Unless you have a cervical face hole for your mattress, it's probably not great for you to lie in a vertebral artery test position that we only hold for 30 seconds clinically, much less 6-8 hours of sleep
  • pt is half prone/sidelying
    • top leg is flexed at hip/knee to comfort
    • lower leg is mostly extended
    • pillow is placed under the top leg up to the inguinal area
    • bottom arm is behind the patient
    • top arm is over a pillow
    • another pillow is under the waist to get "that prone feeling" of pressure on the stomach
    • they may or may not use a pillow under the head depending on how neutral their cervical spine is
After teaching one of these methods to those with night pain, difficulty sleeping, or pain upon waking, patients have come back the next visit often feeling much better. Some who stated they toss and turn for most of the night have woken up in the same position! Many of those micro-movements that turn into tossing and turning are a result of unsupported sleep.

Mattress age should also be considered. I once had a patient in her 90s tell me her mattress was over 50 years old! That was a record for me! She said they didn't make them like they used to. A standard recommendation is that your mattress should be replaced every 10 years. 

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