The knee is not made to be fully extended for prologed periods of time. It’s not a resting position for the knee, that’s why many prefer to sleep on the side in a more “fetal”-like position. It makes the hamstring (big muscle system on the back of the leg) never fully rest because it’s very extended as well. In general, no muscle likes to be fully extended. It doesn’t really hurt to have unextended muscles for prologed periods of time (see. fetal position) compared to classic supine position. So, back to the back pain, the hamstring is stiff and extended and pulls on the hips and lower back, making it possibily uncomfortable, especially if held for hours or patients with knee or back pain. Putting a pillow beneth the knee lets the hamstrings relax and ease the pull on the lower back making rest more comfortable.
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