The Pillow Problem

The Pillow problem

One of the most frequent questions we get as physiotherapists is “what pillow should I use?” There are so many different types of pillows whether it be the brands, the shape, what the pillow is made of or how soft or firm it might be. We spend a third of our lives sleeping so finding the right pillow for you can make a world of difference. Having the right pillow can improve neck pain, upper back pain and quality of sleep! There are many factors that you need to consider when choosing a pillow and this is where your physiotherapist can help you. The position you sleep in, how wide your shoulders are compared to your neck and your own preference for comfort will decide the type of pillow you need.

A pillow should supply support, keeping your head and neck in neutral alignment throughout the night and take the load of your head away from your neck. We have three natural curves in our back; the neck and lower back curves forwards while the mid back curves backwards. The head should sit directly on the neck with the chin not poking forwards. The head should also sit level, not tipping towards one shoulder or the other. If we lose this neutral alignment, we start to put more pressure through specific muscles in our neck, shoulders and back to keep us upright against gravity. This will also hold true for poor postural alignment when sleeping, putting pressure through areas that are holding more load or compressed, leading to pain and stiffness when you wake up.


Pillow for Side Sleepers

Lying on your side can help take pressure off your discs, ligaments and muscles and will often be a go-to position for individuals with pain. Here your pillow should be the width of your shoulder to your neck to keep your head from being tipped up or down away from neutral alignment. Often, individuals with broader shoulders may just use two pillows to create this desired effect. This will take pressure off your neck by minimising compression through joints and muscles that were forced into a tilt by a too thick or thin pillow.

You may also find that a feather pillow is more mouldable to suit your needs better. Here you can twist or tie the pillow in the middle to make a butterfly shape, resting the slimmest part of your neck in the middle of it to maintain neutral alignment. Additionally, placing a small pillow between your knees will help maintain your hip and lower back alignment to help to reduce any lower back pain.


bed and pillow

Pillow for Back Sleepers

Here your pillow should supply support for your natural forward neck curve. Here, a thicker pillow base positioned where your neck is slimmest can help maintain neutral alignment by preventing your neck from sloping forwards or backwards. You may find that an additional one will help you to maintain neutral alignment or that rolling up a small towel length-ways and placing it with your pillow where your neck curves forwards will help you to maintain your neck in the midline. You might also use one underneath your knees to maintain your hip and lower back alignment.

Back sleeper pillow


Pillow for Front Sleepers

This position is not the most ideal sleeping posture as the neck is often turned and held in one direction for several hours. Front sleepers are encouraged to place a pillow under their chest or sleep with a shoulder slightly back to place the neck in a more neutral position and avoid over-extension.


Front sleeper pillow


The type and number of pillows will depend again on how wide your shoulders are in relation to your neck to achieve neutral alignment. Feather pillows can be easily moulded for support and comfort. Many people will use an orthopaedic pillow like a memory foam one. This one is designed to give extra support across the curve of your neck to maintain neutral alignment. However, buying an orthopaedic pillow is not always necessary. As mentioned, you may find that adding an extra pillow or placing a small rolled up towel with your pillow will help you to maintain your neck in the midline.

Side sleeper pillow


The important thing to remember is that pillows should also provide comfort. They can be graded soft, medium or firm and the grade you choose should be based on comfort as well as support. Usually, a happy medium between soft and firm is the best bet.

Lastly, they do lose the qualities that supply support and comfort over time and need to be replaced. Often, pillows will have expiry dates written on them but a key indicator of when to change it is when you start to feel neck pain or stiffness upon waking in the morning. Generally, pillows should be replaced every one to two years.