Why positions matter so much when pain is long term

When pain is short lived, you can often “put up with” an awkward chair or a lumpy pillow for a few nights. When pain or stiffness are part of your daily life, the way you sit and lie down stops being background detail and becomes one of the main characters.

Your joints and muscles are constantly sending messages to your nervous system about:

• How bent or twisted they are.
• How long they have been held in that position.
• Whether they feel supported or as if they are slipping, rolling or sliding.

A “rare” piece of knowledge many people are never told is that your body cares more about how steady and supported a position feels than how fancy the furniture is. A simple, well-placed cushion can sometimes do more than a brand-new chair used in an awkward way.

Checking your chair height – the starting point for easier standing

One of the most important – and most overlooked – details is chair height. A chair that is too low makes it hard to stand up, so you may:

• Rock forwards repeatedly before standing.
• Push heavily through your hands or furniture.
• Twist or collapse slightly to one side.

Over time, this puts extra strain through knees, hips, back and shoulders. A simple home test:

• Sit right back in your usual chair with your bottom towards the backrest.
• Place your feet flat on the floor, hip-width apart.
• Look at your hips and knees – ideally, your hips should be level with or just above your knees, not lower.

If your hips are noticeably lower than your knees, you may find it safer and easier to:

• Add a firm cushion or folded blanket under your bottom (not a soft pillow that sinks).
• Temporarily use a slightly higher, firmer dining chair with arms, instead of a deep sofa.
• Ask your GP or occupational therapist about proper chair raisers if you are struggling to stand.

Using cushions and pillows as “wedges”, not just softness

Cushions are often seen as decoration or softness. For long-term pain and stiffness, think of them as wedges and blocks that change angles:

• Under the bottom: A firm cushion that is slightly thicker at the back than the front can gently tilt your pelvis forward and make standing easier.
• Behind the low back: A small cushion in the curve of the lower back can reduce slumping, which some people find helpful for back or hip pain.
• Under the knees when lying on your back: A pillow under both knees can ease pulling on the low back and hips.
• Between the knees when lying on your side: A pillow or folded blanket between the knees (and sometimes ankles) can stop the top leg dragging down and twisting the spine or hips.

The aim is not to lock yourself into a perfect shape, but to reduce the “hanging” feeling where one part of your body is unsupported and your muscles must cling on all night.

Side sleeping with hip or knee pain

Many older adults prefer to sleep on their side. If your hip or knee complains:

• Place a pillow between your knees so the top leg is supported at the same height as the bottom leg.
• If your hip still feels sore, add a soft layer (like a folded blanket) on top of the mattress under the painful side to spread pressure.
• Keep your knees slightly bent, not tightly curled – think “softly bent” rather than “foetal position”.

If you have had a hip replacement, always follow your surgical team’s positioning advice first – this page cannot replace that. If you are unsure, ask them or your physiotherapist to show you safe side-lying positions for your particular surgery.

Armrests, hands and shoulders – the “hidden helpers”

Arms and shoulders play a huge role in comfort and safety, especially when standing up or turning in bed:

• Chairs with arms: These allow you to push up using your hands, reducing strain through painful knees or hips.
• Hand position: When standing, place both hands on the arms of the chair, bring your nose over your toes, then push up. Leaning on one side or on a walking frame placed too far in front can be less stable.
• Bed rails and grab handles: If recommended by a professional, these can help you roll and sit up with less twisting.

A “rare” tip from therapists: your body likes symmetry. Whenever possible, use both arms equally when standing, and avoid constantly using the same arm of the sofa to hoist yourself up – this can overload one shoulder over time.

Making the bed work with you, not against you

Beds are often either too soft and low, or too hard and high. Before buying anything new, try:

• Check the height: Sit on the edge of your bed as you did with the chair test. Are your hips roughly level with your knees? If you are sinking far below knee level, consider a firmer base or a thinner mattress topper.
• Sliding versus sticking: If you struggle to turn, smooth cotton sheets or satin pyjamas can help you slide. If you slide too much, a non-slip mat near the edge can give your feet a better grip when standing.
• Sitting up: Use pillows behind your back in a gentle slope, not a sharp “V”, so your head is above your stomach but your neck is not bent forward tightly.

If you are waking with sudden new pain, breathlessness or dizziness when lying flat, speak to your GP urgently. Changes in sleeping position can help some conditions, but new symptoms always need professional assessment first.

Lighting, clutter and flooring – the quiet enemies of comfort

Positions are not just about the angle of your joints. Your surroundings can make every change of position feel tense or relaxed:

• Lighting: Good lighting near the bed, chairs and stairs reduces the instinct to hold your body rigid “just in case”. Consider a bedside lamp you can reach easily, or motion-sensor night lights for hallways.
• Clutter: Clearing space around your favourite chair and the route to the toilet at night reduces the need for sudden twists and sideways steps.
• Rugs and mats: Loose mats can make you brace your legs every time you stand up. Removing or securing them with non-slip backing can help joints and reduce fall risk.
• Footwear: Supportive slippers or shoes with a back and good grip turn each step into a more stable position for ankles, knees and hips.

Our falls-related pages on the PHAT site talk more about home safety, but even small changes – moving a coffee table, securing a mat – can change how relaxed your muscles feel when you sit and stand.

Linking positions with pacing and the “volume control” idea

Two of our other pages connect closely with this one:

• “Why Long-Term Pain Behaves Differently from New Pain” – explains how your nervous system can become over-protective, like a volume control stuck too high.
• “Pacing – Doing Enough Without Overdoing It” – describes how to break the boom-and-bust cycle with steadier activity.

Positions are another way you talk to that over-protective system. A steady, supported position says: “You can ease off a little – I am not about to fall or twist.” Over weeks and months, repeating that message in your favourite chair and your bed can help the alarm feel less frantic.

How PHAT Zoom classes can help you explore safer positions

In our PHAT Zoom exercise sessions, we pay close attention to positions:

• We offer both seated and standing options, and you are encouraged to choose what feels safe that day.
• We remind you to sit back in the chair, plant your feet and use the backrest for support.
• We encourage you to notice the difference between “a stretch that feels useful” and “a strain that feels like too much”.

Many people then carry those ideas back into their living rooms and bedrooms – adjusting cushions, chair choice and pillow height – so that everyday life begins to feel more like the safer positions used in class.