For the patient with neck pain, getting a good night’s sleep is vital for recovery and lowering the risk for transition to chronic neck pain. Likewise, for the individual with a history of neck pain, sufficient quality sleep is important to reduce the risk for recurrence. With respect to the cervical spine, the choice of pillow can be a critical factor in this regard, so let’s take a look at what considerations one should make when selecting the best pillow and why this can be a challenging process.

In 2021, researchers looked at current trends and research methods regarding the ergonomic considerations for pillows with the understanding that the head and neck require proper support to reduce stress on the cervical spine, the intervertebral disks, and the muscles in the neck, upper back, and shoulder regions. The research team noted that many studies use subjective participant reports as a way characterize the effectiveness of a pillow on supporting the head and neck, which may not provide the most accurate and meaningful data.

However, they did report on experiments that used more objective means. In one study, participants laid on a pressure-sensitive mat with 1,024 sensors to measure pressure distributions of the head, neck, chest, waist, and hips. The authors of this study noted that as the thickness of the pillow increased, there was a corresponding rise in cervical and cranial pressure. Additionally, a study that utilized electromyography (EMG) showed greater muscle activity while side laying when a pillow was 5 cm or 14 cm thick than a 10 cm thick pillow. Other research has shown that a pillow too high or low can also affect spinal alignment as seen on x-ray.

With respect to materials, one study found that a pillow that better maintains its shape (a springy foam material, for example) may be better for relieving neck pain than a softer pillow more prone to flattening, especially as the night progresses.

One problem that the neck pain patient (or anyone for that matter) will encounter when choosing the appropriate pillow for sleep is that sleep is a dynamic process in which unconscious sleep posture change occurs about 24 times a night, mostly between supine and lateral positions to relieve fatigue. Even if a pillow appears to properly support the head and neck when laying on one’s back, the same pillow may not be the best fit when they transition to sleeping on their side.

In the future, we’ll likely be able to purchase a pillow that can dynamically alter its thickness at various points based on the individual’s sleep position. But until then, the consumer is forced to find a pillow that best fits their anatomy and changing sleeping postures. The current research suggests that a proper height and firmness are important considerations. Another pillow characteristic to consider is the shape of the pillow, whether rectangular, u-shaped, or b-shaped. Fortunately, the neck pain patient can consult with their doctor of chiropractic for suggestions based on their unique case history. Their chiropractor may stock specialized pillows at the office or can order them on behalf of the patient, if necessary.