Lower Back Pain at Night? Why You Can Only Sleep Curled Up on Your Side

The woman in the photo has found the only position that works: on her side, knees bent up. If you have this kind of back pain, you know it well. Lying on your back makes your lower back ache. Lying on your stomach is impossible. So you lie on one side with a pillow between your knees. After a while you stretch your legs out, then pull your knees back up towards your chest, then turn to the other side. Night after night.

Then in the morning you get up, walk around, and feel fine. By afternoon, standing in a queue or sitting through a long meeting, the ache creeps back.

What's really going on: a tilted pelvis

Your pelvis is the base your spine sits on. When the muscles around it are out of balance, usually tight at the front of the hips and weak in the buttocks and tummy, the pelvis tips forward or twists slightly. This puts your lower back in a deeper arch than it should be, squeezing the small joints at the back of your spine.

That explains the pattern:

• Lying flat on your back or stomach pushes your back into that arch, so it aches.
• Curling your knees to your chest flattens the arch and takes the pressure off, so it eases.
• Walking keeps the pelvis moving, so the pain often disappears.
• Standing still or sitting long lets the pelvis settle into its tilt, so the ache returns.

This type of back pain is often missed because scans can look normal. It's about how your pelvis sits and moves, which shows up in a hands-on assessment, not on an X-ray.

Signs this is your type of back pain

• You can't get comfortable on your back or stomach at night
• You sleep on your side, often with a pillow between your knees
• You keep shifting, stretching your legs out, then curling up again
• Pain eases when you walk but returns when you stand still or sit long
• Mornings feel stiff, but you loosen up once you're moving

Tips for a better night tonight

• On your side: keep the pillow between your knees, and bend them a little more
• On your back: put a pillow or two under your knees to flatten the arch
• Avoid sleeping on your stomach for now
• Before bed, lie on your back and gently hug one knee, then the other, to your chest

How Katasi Physiotherapy fixes it

Our orthopaedic physiotherapist checks how your pelvis sits, how it moves when you stand, bend and walk, and which muscles are pulling it out of balance. Then we:

• Release tight hip and back muscles with hands-on therapy and dry needling
• Realign the pelvis with gentle joint mobilisation
• Strengthen your buttock and tummy muscles so the pelvis stays level
• Coach you on sleeping, sitting and standing positions

Many people sleep better within the first few sessions.

Read more: Back Pain and a Tight Front Hip When You Stand Up? and Hip Pain When Sitting on a Low Couch or Chair?

See a doctor first if

Your back pain at night stays the same no matter what position you're in, or comes with fever, unexplained weight loss, sweating at night, a history of cancer, numbness, or loss of bladder or bowel control.

Book in Westlands

Stop shifting all night and start sleeping through. Visit Katasi Physiotherapy at Kerai Office, Mogotio Road off Muthithi Road, Westlands, Nairobi. Call or WhatsApp 0705 717 353 to book. Open Monday to Friday 7am–6pm and Saturday 8am–4pm.