Back and neck pain is rising to almost pandemic levels in the UK, with 44 percent of people complaining of pain. That’s a 12% rise on the 2017 statistics. What’s more, the majority of people suffering from neck pain say that it is most likely to prevent them from sleeping well.1 Enter the pillow industry with a massive array of options, all promising to help you get a comfortable nights sleep.

Waking up with neck pain could be due to underlying mechanical problems in your neck and the choosing right pillow can help to ease this pressure enough to find relief.

Research supports the notion that the wrong pillow can aggravate or even cause a painful mechanical problem in your neck, disturbing your sleep. The wrong pillow may also be setting you up for long-term neck pain.2,3

In this article, I will dive into the confusing world of pillows and show you how this most basic of bedtime props could have everything to do with how much you suffer and how well you sleep.

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Which Pillow Is Best For Neck Pain?

Should you go feather or memory foam? Small, medium or large? Firm or soft? Flat, curved or ridged? One or two? What about the one Serena Williams recommends? Should you be sleeping on your front, back or side? Should you place another pillow between your knees? Argh….(its an expensive experiment to run!)

The truth is that there is a dizzying array of different pillow options out there. Its no wonder why so many people are confused about which to purchase, and why so many people own so many pillows. After all, who would give up their search for a comfortable nights sleep after just one or two pillow fails?

Why Is There So Much Confusing Advice About Which Pillow To Buy?

There are loads of pillow options not because there is a right one out there for you waiting to be discovered, but instead because there is no one type fits all available. A pillow like that couldn’t possibly exist, and I’ll tell you why.

The reason for this is because necks come in many different shapes and sizes (even more than there are types of pillows!) Necks are also connected to backs, heads and shoulders of many different sizes. To complicate it even further, all of these various bodies have different structural tension patterns that need to be supported in different ways if they are to rest soundly at night.

Could it be that the deeper cause to all of this confusion is because the ‘experts’ are asking the wrong question?

Instead of trying to figure out “how to create a pillow that is ‘comfortable’”, perhaps they should be asking, “how do we create a pillow that provides support to the unique spine that is going to sleep on it?”

I would argue that the failure to answer this question with a suitable product is precisely why so much confusion exists.

Your Pillow Needs To Support You Not Comfort You

We all want a comfortable pillow. So I’m not saying that you need a rock-hard one that provides

‘extra support’. To appreciate what it means to give a spine adequate support, we need to talk a bit about how spinal bones align and move together.

The human spine is an incredibly complex and fascinating structure. Made up of 33 bones, 139 synovial joints, 31 pairs of nerves and 33 groups of muscles joined together in a complex inter-related system where each part relies upon the other to perform at its best.

The way that these spinal bones align together and move together is essential for both the health of your spine and the pain that you may be feeling.

Spinal Biomechanics

Biomechanics is the study of how these bones should ideally move together in the healthiest, most efficient and most robust of ways.

In the 1970’s Dr Jesse Jutkowitz made an important discovery in the field of spinal biomechanics, which was both very simple and very profound when it comes to understanding how spines work and why things can go wrong.

His discovery was this: Bones can go out of alignment in directions that the body cannot retrieve them from (and self-correct) because there are no muscles or combination of muscles that can do that job.

In simple terms, what this means is that spinal bones can become stuck in certain ways and will remain stuck unless an outside force intervenes.

The key direction that they can get stuck is FORWARDS. There are many ways that this can happen, ranging from accidents, injuries, poor posture and movement habits.

An interesting after effect of the bones getting stuck forward is that they twist in an attempt to stabilise. The twisting of the spinal segment is a defence mechanism to prevent further forward movement to stabilise the altered biomechanics at that level of the spine. The misaligned problem areas of the spine are called Primary Biomechanical Pathologies (PBP’s) by Dr Jutkowitz.

The underlying mechanism of poor spinal alignment has enormous significance when it comes to figuring out how to get comfortable at night.

Every Neck Is Unique And As Such Every Neck Needs Unique Support

A person who has neck pain or back may have several of these PBP’s and abnormal tension patterns throughout their whole body structure as a result.

This likely explains why many people with mechanical pain have asymmetries in posture; one hip flexor being tight, or one shoulder being higher than the other, for example.

It should be noted that spinal misalignment is not the only important factor in pain syndromes, the way that the brain perceives these problems is hugely important as well (this is a topic that I will cover in an upcoming article on chronic pain).

The Best Position To Sleep In Is On Your Side

Lets first look at the side-lying position, which is the most common way that people sleep and also the best for properly supporting your neck and back. There are however some classic mistakes that are frequently made.

Pillow Too High Or Too Low

If the pillow is too small or too hight and fails to provide adequate and specific support to the head and neck, then the spine will have to compensate somehow by further twisting to try and regain stability. If this extra mechanical tension causes increased pressure upon an already inflamed and compensated area of the spine (such as it commonly would with an underlying neck pain problem), then it will be difficult if not impossible to get comfortable.

It stands to reason that if you take a healthy pain-free neck and subject it to eight hours of sleep per night on a pillow that is too small and unsupportive that there could be enough abnormal mechanical stress placed upon the back by the shoulder twisting forwards. Over time, with this sort of unnatural pressure, PBP’s could be created leading to neck, back, arm pain or headaches.

A simple clue that your pillow (and of course your mattress) could be wrong is waking up feeling worse anywhere in your body then when you went to sleep. This includes feeling stiff, sore, headachy, locked up or fuzzy headed, but it could be an aggravation of any body structure symptom.

If you are a side sleeper, your pillow needs to be the correct height to support the unique biomechanics of your entire spine. When it is ‘just right’ it prevents the body from falling either forwards or backwards, and allowing it to rest in ‘perfect balance’.

Back Sleeper Pillow Mistakes

The most common mistake that back sleepers make is using a pillow that is too high which pushes the head forwards and may aggravate underlying problems. The higher the pillow, the higher the mechanical stress that gets placed on your neck.4

Your spine needs to be in as neutral a position as possible to relax. This means that if you sleep on your back, your head needs to be nearly flat for the spine to align correctly. Something that becomes impossible to do with almost every commercially available pillow.

This essential element of biomechanics appears to be poorly understood in the literature. Most of the studies available only look at different types of pillows, and the ones that look at pillow height, neglect to compare against the biomechanically correct neutral position.

We must, therefore, rely on common sense and empirical evidence to come up with the best answers. I will show you how you can perform your own mini science experiment to work out what your ideal pillow height is.

It is worth mentioning that many people have ‘anterior head carriage’, which is a degenerative postural condition where their spine curves too far forwards pushing the head out in front of the shoulders.

In this scenario, it can be quite uncomfortable to lie flat, so a very thin pillow may work to provide adequate support to the neck. However, if you have a stooped posture, you will find it easier to perfect your pillow situation in the side-lying position.

Sleeping On Your Front Is Also A Mistake

Arguably for as long as time itself doctors and chiropractors have been advising people not to sleep on their fronts. Most front sleepers know this, yet they cannot stop themselves from doing it.

Interestingly there is research to show that sleeping on your front reduces incidences of sleep apnea and snoring, but this will come at the cost of harming the neck and back.

When I was eight years old, my dearest mother took me to the local chiropractor. Upon discovering that I was a front sleeper, he gave some very creative advice to solve to change my habits. He advised us to buy some sewing elastic and cut it to a length that would tie around my abdomen.

His next suggestion was to get 3 plastic hair rollers (which are the round spiky tubes, a bit like toilet rolls, that used to be all the rage in the 80’s. It wouldn’t surprise me if they no longer even make them!) and thread them through the elastic so that they are effectively tied to the front of my abdomen, ready and waiting to spike me if I rolled onto my front. Now I don’t ever remember the waking up because I had set off the trap, but I do remember that from the very first night of wearing it I never again slept on my front.

The reason that I tell this story is that ‘front sleepers’ will often fiercely defend their sleeping position by claiming it is so comfortable, or they can’t stop themselves from doing it. I’m not saying that its easy to avoid sleeping on your front, but if you set yourself the intention of breaking the habit then you can absolutely do it.

The Front Sleeper Neck Stress Test

Humour me for a minute; sit upright, run your head to the left as far as it will go, now turn it just a little bit further. Good, now see you in 8 hours! Obviously, this is not going to be a good thing. So spare a thought for your neck joints and muscles next time you find yourself rolled onto your front.

While necks can turn to 80 or 90 degrees, they are not meant to stay there for long periods of time. Sleeping on your front could risk developing or aggravating headaches, neck pain, back pain, shoulder pain or arm pain.

A Note On Snorers

We often have patients report that their snoring stops once they have some structural correction chiropractic care and they get their sleeping position mastered. This is lightly too be due to the reduced mechanical pressure on the airways once everything is aligned and supported correctly.

Your Pillow Has Got To Be Just Right

Your pillow height must fall in the Goldilocks zone for your body. Nothing else will do.

Our research with patients at SpineCentral has shown that regardless of whether or not you are a side or front sleeper that the difference between a pillow height that is ‘just right’ and a pillow height that is dead wrong (which is any other height) can be as little as 1-2mm.

That’s a tiny difference, but we have found it to be true upon testing.

So What’s The Answer, Which Pillow Should I Buy?

This is not an easy question to answer, because there is no widely available commercial product out there that allows you to fine-tune the height and support to such a degree of specificity.

There are some brands that are trying to solve this problem. I recently came across one called the Pancake pillow. They’ve almost got it right with their several layered pillow that can be adjusted to change its height. However, it is a classic example of the right idea wrong execution, of which there seems to be many in the world of health.

With the pancake pillow, the pieces that stack together are individually too big to allow you to fine tune to the height required. The material itself is also too soft and squidgy, so your head will sink into it too far causing an uneven twist to be placed on your spine. 

So not only does it need to be the right height, but it also needs to be the proper density. An issue that has been shown to be true in at least one study, where soft feather pillows lead to higher incidences of waking up in the night as well as neck, back and shoulder pain. Latex pillows, which are firmer were shown to result in fewer wake-ups and fewer painful symptoms.5

This is getting complicated! Thankfully, there is a simple solution to get you started.

The Easy DIY Towel-Pillow Solution

You can use towels to build a pillow height that is just right for you. All you do is keeping adding or removing layers of towels until you find the Goldilocks zone for your body. Start with a couple of folded towels that are roughly the height of the distance between your neck and shoulder, then test it out by lying on your side, and follow these simple rules:

Side-lying pillow rules: If it is too low you will feel your body rolling forwards, so add another single layer of towel and test it again. If it is too high, you will feel your body moving backwards, so remove a layer of towel and test again.

Keep going until you find the balanced midpoint in between, which is precisely where you need to be. You will know when you have found it because your body will feel still and there will be no tension in your spine. Often your eyes will also feel heavy and want to close within about 30 seconds of staying in this ‘perfect position’.

What you will notice is that even one layer of the towels makes a difference. This is how you discover that your spine is a precision instrument and needs to be precisely supported in order to be able to relax.

It can take ten to twenty minutes of testing to find the perfect height, so stay patient and keep going until you get it right!

If you prefer to sleep on your back, follow this simple technique: Take a small towel, fold it in half, then take one end and fold it again to meet the middle (half way) point of the towel. This will create a stepped pillow thereby half of it is two layers deep, and half of it is four layers deep.

Your head goes onto the thinner layer, and the thicker layer goes under your neck. You should only feel a slight touch of the towels on your neck. If you feel it pushing your neck up then the towels are too high, so start again with a thinner towel until you get it right.

If you are used to sleeping on your back with a big pillow under your head, this will feel weird at first. It will feel too low. That’s ok, trust the process and pay attention to how your spine feels. You should notice that it is relaxed and not under any stress or strain.

Remember that if your pillow is too high when you lye on your back that it may put a forwards pressure on your vertebrae forwards and stress your spinal mechanics, making it difficult for your spine to relax and more likely that you will get neck or back pain during the night.

The Drawbacks Of Using Towels As Pillows

What you will discover is that there are two issues with using towels. Firstly they can get ruffled up in the night, and you will have to get up to rebuild your pillow. Secondly, the towels can compress throughout the night and end up not being the perfect height any longer. You could either use towels that are denser and less springy or you can keep an extra layer or two spare to add on during the night if it does shrink and you wake up.

If you get the towels just right, you may want to place them inside of a pillowcase to keep the whole thing together.

Going To Sleep On Your Side And Waking Up On Your Back

A common problem that can happen is falling asleep on pillows set up for side lying only to role over during your sleep and wake up with your neck craned forwards.

The simplest solution is to set up both kinds of towels, so that should you wake up like this you can shimmy over to the smaller towel set up and fall straight back to sleep again.

The Best Pillow On The Market

There is a pillow available from the Institute of Advanced Biostructural Correction which is arguably your best option.

It is made up of several different sized blocks of foam, which makes it very easy to build your pillow. The benefit of foam its that is of adequate density to provide both support and comfort and because it holds its shape it will not distort in the night. When you get the size right, you put it in a pillowcase and it is job done. You will have your pillow ready to go every night.

The downside to this option is that these pillows are expensive for what they are, which is just simple blocks of foam, but they do solve a significant problem which I believe makes them well worth the cost.

Finding these pillows for sale is another challenge. We occassioanlly have them in stock at SpineCentral, but they sell out very quickly.

Conclusion

As human beings, we spend up to a third of our lives asleep, and the importance of good quality sleep is undeniable.

If you get your pillow choice wrong, you may suffer from poor quality sleep, more incidences of waking up in the night as well as aggravation of underlying mechanical problems that can result in neck pain, back pain, arm pain and headaches.

If you support your spine correctly with the right pillow, you can look forward to many hours of optimised and comfortable sleep.

Achieving this ideal scenario with commercially available pillows can be a very costly and frustrating process since the industry has become awash with a vast array of shapes, sizes and materials, which all claim to support a good nights sleep.

A quality comfortable and pain-free nights sleep could be your new standard if you adopt the simple towel method that I showed you above.
By fine-tuning the night time support of your spine, you may also be able to prevent unnecessary pain and posture problems in the future.

Now, I’d like to hear from you. Do you suffer from neck pain, back pain, shoulder or arm pain at night? Is your sleep restless? What has been your experience with the commercially available pillows on the market? Place your answers in the comments box below.

 

References

1. State of the nation’s back health revealed. British Chiropractic Association. 2018. https://chiropractic-uk.co.uk/state-nations-back-health-revealed/

2. Liu S-F, Lee Y-L, Liang J-C (2011). Shape design of an optimal comfortable pillow based on the analytic hierarchy process method. Journal of Chiropractic Medicine. 2011;10:229–239. doi: 10.1016/j. JMCA

3. Wang et al. (2014). Effect of pillow size preference on extensor digitorum communis muscle strength and electromyographic activity during maximal contraction in healthy individuals—a pilot study. Journal of the Chinese Medical Association. 2014;78(3):182–187. doi: 10.1016/j. JMCA

4. Ren, S. Et al. (2016).  Effect of pillow height on the biomechanics of the head-neck complex: investigation of the cranio-cervical pressure and cervical spine alignment. PeerJ. 4: e2397.

5. Gordon, S. Et al. 2010. Pillow use: the behavior of cervical stiffness, headache and scapular/arm pain. J Pain Res. 3: 137–145.