Having the right bed pillows is not only comforting, they play an important role in supporting the intricate structures of the head, neck, shoulders, hips, and spine. When used well, pillows help in alleviating or preventing many common forms of back and neck pain, as well as shoulder, hip, and other forms of joint pain.

Pillows serve to keep the upper body in alignment during sleep, relieving pressure and counterbalancing the points in the body. The pillow should adjust to fit one's unique shape, curves, and sleeping position and alleviate any pressure points.

See Spinal Anatomy and Back Pain

Pillow Support Is Crucial for Spine Problems

For those with spinal disorders, the right type of support can be especially important in helping the spine rest comfortably. Sufficient and restorative sleep are the body's chance to heal itself from the postural, physical, and nervous challenges of the day.

See Addressing Pain and Medical Problems Disrupting Sleep

Pillow fillings vary in their level of support. Most down or feather pillows offer little structural support compared with pillows filled with firmer materials.

One research study compared the support provided by 3 different types of pillows:

  • A roll-shaped orthopedic pillow filled with polypropylene capsules
  • A contour-shaped memory foam pillow made of polyurethane
  • A feather pillow made of 100% goose down.

The orthopedic pillow was found the best for spinal alignment and the feather pillow fared worst. 1 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 J Spine. 2015 Sep; 12(3): 135-138. Published online 2015 Sep 30.

See Pillow Types to Consider

While research can be helpful, individual comfort and support should be the deciding factor. Trying out a pillow for a week should be enough time to decide whether the pillow is beneficial.


Aligning Pillow Height with Sleep Position and Body Size

The human neck curves slightly forward (to sustain the weight of the head when upright), and it’s important to maintain this curve when in a resting position.

See Cervical Spine Anatomy

If the pillow is too high when sleeping sideways or on the back, the neck is bent abnormally forward or to the side, causing muscle strain on the back of the neck and shoulders. This type of position may also cause narrowing of the air pipe, resulting in obstructed breathing, and sometimes snoring, which can hinder sleep. Conversely, if the height of the pillow is too low, the neck muscles can be strained.

See Pillows for Neck Pain

Body size and preference are likely to influence pillow size, but usually the pillow should maintain a height of 4 to 6 inches to support the head and neck (and shoulders when lying on the back). One small research study comparing three foam pillow heights found that a pillow height of approximately 4 inches offered the best spinal alignment and greatest comfort, leading to the least muscle activity. 2 Gordon SJ, Grimmer-Somers KA, and Trott, PH. Pillow use: the behavior of cervical stiffness, headache and scapular/arm pain. J Pain Res. 2010; 3: 137-145. Published online 2010 Aug 11.

Often selection of which type of pillow will work best depends on one's sleeping position. Pillows for each type of sleep position are profiled on the next page.

Dr. John Schubbe is a chiropractor with more than 31 years of experience treating and managing spine pain. He practices at Schubbe-Resch Chiropractic & Physical Therapy Centers in Appleton, WI.

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