Choosing the Right Pillow

Your neck needs to be well supported and in a neutral position when you are sleeping. If you wake during the night or in the morning with a stiff, painful neck you may need to change your pillow and/or your sleeping posture.

One of the most important things to think about is whether the pillow that you are currently using is the correct height for you. Pillow height may vary depending on whether you sleep on your back or side or change frequently from one to the other.

For example, if you sleep on your side the pillow needs to be thick enough to take up the space between the end of your shoulder and cheek.

Image of the regions of the spineThe spine is designed to follow a particular path from the base of the skull to the pelvis. The picture right shows the different spinal regions and their natural curvature. Maintaining this curvature is often difficult.

As the body ages, the shoulders and pelvis tend to round and tilt forward, exaggerating the thoracic and lumbar curvature. The head also drifts forward, causing strain in the cervical and upper thoracic vertebrae.

Having your neck in a neutral position when sleeping means that your head is neither pushed too far forwards or backwards, when lying on your back, nor tilts too high or low when lying sideways.

If you are lying on your back your head should be nicely level and maintaining what we refer to as the cervical lordosis. This will minimise any abnormal stress on the joints and muscles of the neck, thoracic spine and shoulders.

Sleeping on your stomach is not recommended – it places your spine in an awkward ‘wound up’ position. The lumbar curve is exaggerated putting increased pressure in the low back.

When sleeping on your stomach, the neck has to be rotated 90 degrees to the right or left and side flexed on a pillow placing the neck in an extreme position of torsion and compression for a prolonged period of time.

The arms usually go above the head for this position further compromising the neck and increasing the possibility of nerve impingement.

For those who cannot refrain from this position at least place a pillow under your hips or purchase a body or stomach pillow.

Finding the right pillow can be a frustrating and daunting process.

Some flat foam pillows can be too stiff causing your head to be thrust forward compressing the upper cervical vertebrae. A feather pillow can compress too quickly causing your head to sink too far into it – again aggravating the joints in the neck.

Contour pillows are the best for most people and those made from ‘memory foam’ are ideal for those who change position regularly from side to back.

The memory feature allows contour adjustments by changing shape in response to the pressure of your head and body temperature.

One study found that a plain flat memory foam or latex pillow was the best option for those who had most difficulty finding a suitable pillow.

An inexpensive way to see if a contour pillow will help is to use your pillow and roll up a towel to the thickness of about one and a half to two inches thick and place it under your neck for support.

This will give your neck the support it needs and if you have the level correct, it will also have your neck placed in a neutral position.

If you are still having pain when you wake up you may need to address other factors that may be aggravating your neck.

The most common reason for neck pain and neck related headache is poor posture.If you sit in a slouched position at your computer for hours on end this will most definitely aggravate your neck.

There are many pillows available on the market. The Australian Physiotherapy Association has developed a range through Tontine to promote correct spinal alignment.

The Independent Living Centre in Weston (24 Parkinson St) provides a more personalised pillow assessment service and is able to recommend a range of pillows on the market. This service is free but you do need to ring and book an appointment time. The phone number is (02) 6205 1900.

Another web site you may find useful is

This site is owned by Professor Gordon of James Cook University and has information regarding current research into sleeping postures, pillows, tips for buying pillows and general sleep facts etc.

A quote from her web site:

Sleep is that golden chain that ties health and our bodies together.

Thomas Dekker, English dramatist (1572-1632).

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About the Author

Jennifer Kellett established Hawker Place Physiotherapy in 1991 and is the principal practitioner of the family run practice. Jenny has served the local communities of Belconnen and North Canberra with commitment and pride for over 26 years. She is a strong advocate for maintaining fitness, health and well being across all age groups and has a keen professional interest in combining Pilates with weight training for treating postmenopausal women at risk of osteoporosis.

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