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Neck pain, sleeping posture, sleeping better, rye neck, acute torticollis

Published: August 16, 2019

While sleeping the main purpose of your pillow is to support the natural curvatures of the spine by providing sufficient support under the head and neck. However your sleeping position plays a key role in determining which pillow is best for you1. 


Pillows for Different Sleeping Positions


For back sleepersyour pillow should typically be lower than those for side sleepers; however your body size will influence this height. A recent study has shown that a pillow height of ten centimetres for back sleepers offers optimal spinal alignment and greatest comfort, leading to the least muscle activity2. To further alleviate any back strain while sleeping on your back a pillow or two can be placed underneath the knees to help flatten the lumbar lordosis which eases the pressure on facet joints. This tends to be the most comfortable sleeping position for individuals who suffer from lower back pain or following spinal surgery. 


The pillow heights for side sleepersare higher than those for back sleepers but once again this will vary between individuals. Whilst sleeping on your side your ears, shoulders and hips should be aligned. A firm pillow placed in between the knees can assist in keeping the spine in a neutral position. Without support between the legs, the upper leg will rotate down which pulls the pelvis downwards, therefore increasing the stress on the hips and lumbar spine. Placing the top leg too far across the pillow can also cause the lumbar spine to twist and should be avoided; the legs should remain aligned, one directly over the other with a firm pillow in between. If you have a smaller waist in comparison to your hips, a small pillow or rolled towel can be placed under your waist to help support the spine in a neutral position.  


Sleeping on your stomachcan put the neck and back in a very stressful position. If this position is preferred the pillow for your head should be relatively flat or your head should rest on the mattress to reduce neck strain. Another relatively flat pillow can be placed under the abdomen or pelvis to help keep the spine in a more neutral alignment. Certain patients with spinal conditions or following spinal surgery may be advised against sleeping on their stomach by their doctor or physiotherapist.  


If you’re a person who sleeps in a variety of positionsthroughout the night, you should look for a pillow that has both high and low areas to support your head, neck and shoulder in both side-lying and back-lying. Using a single height all-purpose pillow may result in it being too high for sleeping on the back or too low for sleeping on the side. It is also important to remember when turning in bed to not twist or bend at the waist but move your entire body as a whole while keeping the ears, shoulders and hips aligned.     


Types of pillows 


Contoured pillowsare designed to keep the cervical spine in a neutral alignment by filling the spaces under the head and neck3. The deeper depression where the head lies allows extra support of neck and can benefit people with neck pain. They can be used by either side or back sleepers and generally are designed to have a higher contour on one side and a lower contour on the other to allow for adjustable heights. The classic or traditional pillowswhich are rectangular in shape are also an alternative for people who may not want or require a contoured pillow. 


Memory foampillows are designed to conform to the head and neck by creating and indentation and therefore holding it in place. It is known for its ‘slow recovery rate’ and has been used in the health care system to successfully reduce pressure and sore spots. Some memory foam pillows also come with a gel inlay which helps with pressure relief and disperses heat. Latex pillowsare naturally anti-microbial and hypoallergenic as well as moisture, dust mite and mould resistant while providing excellent support and gentle pressure. 


There are no recommended standards for pillows that are soft, medium or firm which leaves it up to customers’ preference and comfort. 


Overall the pillow shape, height and content can play a very important role in spinal posture, pillow temperature and comfort while sleeping4. Choosing the right pillow can be difficult, so if in doubt you can book a Free Initial Assessment to get a pillow fitted to ensure it fits your needs. 



Cai D, Chen HL. Ergonomic approach for pillow concept design. Applied ergonomics. 2016 Jan 1;52:142-50.

Kim HC, Jun HS, Kim JH, Ahn JH, Chang IB, Song JH, Oh JK. The effect of different pillow heights on the parameters of cervicothoracic spine segments. Korean Journal of Spine. 2015 Sep;12(3):135.

Jeon MY, Jeong H, Lee S, Choi W, Park JH, Tak SJ, Choi DH, Yim J. Improving the quality of sleep with an optimal pillow: a randomized, comparative study. The Tohoku journal of experimental medicine. 2014;233(3):183-8. 

Gordon SJ, Grimmer-Somers KA, Trott PH. Pillow use: the behavior of cervical stiffness, headache and scapular/arm pain. Journal of pain research. 2010;3:137.



Written by Ebony Burgess-Gallop, Physiotherapist