No two necks are the same, so how do we know what kind of pillow to use?

Neck pain is a very common complaint – we all experience it from time to time. It can range from morning stiffness to severe pain, affecting sleep and concentration.

There is a very strong correlation with sleep quality and our experience of pain. Therefore, I discuss this with all my patients to see if we can work in improving it.

The topic of pillows comes up in nearly of those with neck pain.
Here, I have tried to answer the most common questions I hear in clinic:

1) “How many pillows should I use?”

The ideal neck position is to try and keep the spine neutral (as shown in the image above). With this in mind, there can be some variety with the number of pillows. A thicker pillow will most likely achieve this position, so you will only need one.
If you prefer to use thinner, softer pillows then two may also create a neutral spine.
Ideally, two should be the maximum. Going above this increases the bend in the neck which may lead to some stiffness or irritation.
2) “What position should I sleep in?”

Try to fall asleep lying on your side or your back. If you are on your side, make sure the pillow is tucked into the small of your neck – make sure your shoulder IS NOT resting on the pillow. This can create extra height, leading the neck to bend to the opposite side. The gap between the side of your face and the shoulder should be filled with the support of the pillow.

We have little control over what we do when we are asleep. If you are the kind of person that wakes up on your front – you can try also hugging a pillow when on your side. This acts almost as a barrier, making it more difficult to turn. The same goes for a pillow between the knees (and this is good for your lower back/pelvis position, win win!!)

3) “Should I use a memory foam pillow?” 

Memory foam pillows are a form of vicso elastic foam, creating a pillow that is dense but works on distributing the pressure on your head as you lie down. They can be purchased as a ‘normal’ pillow shape, so you do not have to get one which slopes up at the front. 

They work wonders for some and do nothing for others. Some websites offer a trial period, as you would do with a mattress. This could be worth looking into as they are a bit pricey. 

Typically, if you are someone who stays relatively still at night or sleeps predominantly on your side, they can be fantastic. You get a great sense of support over the neck and the height will keep you in a neutral position.
If you move a lot of frequently end up lying on your front, you may not manage with the height/density. For you, two smaller pillows that still keep the neck neutral but allow for more movement, could be more appropriate. 

There is no concrete evidence on memory foam being superior to other pillows, so this comes down to personal preference. 

4) “Is lying on my front bad?”

Lying on your front does put quite a lot of strain on the neck, as you spend a lot of time with the head at it’s end of range rotation. 

Some people have done this for years without any issues, so it is not something to be overly concerned about. However, if you currently have pain around the neck, it is certainly worth making some changes to your sleeping position using the steps mentioned above, to minimise this where possible.

5) “Should I sleep with no pillow?” 

I would personally not advise sleeping with no pillow. Your neck is likely to end up side bending excessively to compensate for the height of the shoulder if you are on your side. As we all move to some degree at night, it is important to have a pillow to try and support the neck when this happens.  

**Please note, this is a guideline only** – If you have been suffering with neck pain, it is still important to have this assessed, treated and managed by a trained medical professional. 

Thanks for reading!


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