Do you toss and turn at night or wake feeling tired?

Reduced sleep duration and sleep quality are common and the reasons are multi-factorial. Lifestyle factors such as late-night internet use, increased stress and/or working hours and health behaviors including inactivity have been blamed. What if poor pillow selection was also a factor?

Physiotherapists regularly treat people with neck pain. A common story is that patient’s neck pain can be worse at night causing reduced sleep quality. Furthermore these people describe neck pain or stiffness on waking which can then effect their neck movement during the day. The question of whether poor pillows can exacerbate spine degeneration has yet to be answered.

So, what kind of pillow is best for pain?

Physios are often asked what pillow is best for neck pain. There are a huge variety of pillows on the market and finding the best ‘fit’ for you and your neck can be time-consuming and expensive. It can help to look at the latest evidence regarding neck pain and pillows. Let’s consider which of the five main pillow fillers; polyester, feathers, foam, rubber/latex and spring is the best for neck pain; and whether other variables such as pillow shape or the height of the pillow can affect spinal pain in the short or long term.

A recent Meta- analysis by Pang et al (2021) reviewed the literature on the effect of different pillows on neck pain, waking symptoms, neck disability, sleep quality and spinal alignment in nine high quality studies examining a total of 555 adults.

Pillow filling

It is common when choosing a pillow to be attracted to marketing blurb on the package, such as ‘ultimate comfort’ or ‘softness allowing pain-free sleep’. It is no surprise that many of these claims are not backed up scientifically. Pillow users often choose a softer pillow with greater comfort initially. These pillows are filled with feathers, polyester or foam which may lose their structure quickly and do not necessarily provide good neck alignment.

The evidence for people with chronic neck pain is that firmer pillows such as rubber/latex pillows can be initially uncomfortable however they stabilise the spine and reduce unnecessary spinal distortion. Spring pillows filled with inner springs like our mattresses are new to the market and promisingly provide similar support as rubber pillows.

Pillow shape

Pillow shapes are varied and the benefits of one shape over another can be confusing. The contour pillow came onto the market a decade or so ago and was marketed to improve cervical alignment for people sleeping on their back. However, 72%1. of people sleep on their side for most of the night. Traditional contour pillows  (U-shaped with one edge higher than the other) was actually found to cause poor quality sleep. More recently, a contour pillow with a middle wedge was developed to accommodate side and back sleepers. Moreover, studies investigating the benefits of a rolled-shaped/peanut pillow for chronic neck pain sufferers indicated less morning pain and stiffness. Overall, the results for pillow shape determining better sleep quality and less neck pain remain inconclusive.

Pillow height

In basic terms, when lying on your side, the pillow should fill the gap between the shoulder and the side of our head.

Although we all differ in size, a guide for pillow height is between 10-12 cm. This accommodates both back and side sleepers. The good news is that pillow height can reduce the pressure on the neck discs and joints in the short-term. So far there are no studies investigating whether this can prevent spinal degeneration in the long-term.

Just one part of the pain puzzle…

In conclusion, there is evidence that a latex (rubber) or spring pillow of regular or contour shape with a middle wedge of approximately 10cm height may improve your sleep quality and duration. If you already have a comfortable pillow and do not suffer from neck pain then stick with the pillow you have. If on the other hand, you commonly find it difficult to get comfortable during the night or wake with neck pain or headaches then my advice may be helpful.

In many cases, neck pain can be multi-factorial and include factors such as posture or previous neck injury (car accidents or falls). If you are interested in further assessment of your spinal pain, make an appointment at UQHL to see your friendly physiotherapist.


Rebecca Tweedy, (M Phty St., B Phty)
Clinical Educator and Specialist Musculoskeletal Physiotherapist (as awarded by the Australian College of Physiotherapy).


  1. Pang, J. C. ., Tsang, S. M. ., & Fu, A. C. . (2021). The effects of pillow designs on neck pain, waking symptoms, neck disability, sleep quality and spinal alignment in adults: A systematic review and meta-analysis. Clinical Biomechanics (Bristol)85, 105353–105353.
  1. Vanti, C., Banchelli, F., Marino, C., Puccetti, A., Guccione, A. A., & Pillastrini, P. (2019). Effectiveness of a “Spring Pillow” Versus Education in Chronic Nonspecific Neck Pain: A Randomized Controlled Trial. Physical Therapy99(9), 1177–1188.





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