I must have been asked this question about a million times during my time as a clinical physio.  Plus another half million at various social events!  Perhaps I am exaggerating, but it sure is a common question from clients with neck pain; especially neck pain that interrupts sleep quality.

In my attempts to find the ‘perfect pillow’ I have recommended and sold many different pillows in the clinic – feather filled, contoured, tri-compartmental, latex, mixed, kapok, foam and probably a few others.  I have just had a look on Google and pulled up a whole new range from which to choose – Euro pillows, boudoir pillows, Lap pillows (shaped like a lap!), Pirate pillows (true), traction pillows, pillows filled with silk or wool, pillows that play music and even one that has an inbuilt alarm that lights up as it wakes you!  None of which will probably help my clients.

Research on the optimal pillow is not strong.  However Dr. Sue Gordon (a physio at James Cook Uni in Townsville) has done extensive research on sleep position and waking neck pain.  She found that ‘subjects who reported that they slept mostly on their side were significantly less likely to report waking cervical pain or waking scapular or arm pain compared with subjects who slept in any other position (1).  This is useful, but still doesn’t address the ‘which pillow’ question.

So I got thinking – a lot of my advice to clients when trying to change pain patterns associated with position is to ask them to avoid sustained positions.  To move the body area that is painful.  This alters postural loads, changes lengths of structures, pumps fluid through the area, dampens the incoming pain signal by stimulating proprioceptive afferent nerve fibres, distracts them and gives them a degree of control as opposed to being a ‘pain victim’.  Might not the same idea apply to pillows and neck pain?

For the last year or so my response to the ‘which pillow’ question has been ‘your next pillow’.  My advice is to have two or three different pillows and to rotate between them on a two to four weekly cycle.  My idea is to prevent them using the one pillow style for long enough to adapt to the particular support mode and posture associated with that pillow, and instead introduce a different support/posture interface on a regular basis.  The short turnaround seems to reduce the initial discomfort of a pillow change and the regular change might be the equivalent of a postural position change in (say) a workplace situation.

This is in no way a thorough study on pillows and neck pain.  But my initial impressions are that this system firstly does no harm and secondly can improve waking pain and sleep quality in some clients.  Whether this occurs at a higher rate than placebo or another intervention I cannot say.  I will leave this up to a research minded colleague to determine.

Meanwhile I would be interested in any feedback from clinicians out there as to whether they have tried anything similar, or indeed a different strategy that has proved effective. Feel free to leave a comment, below.  Meanwhile, Dr. Gordon has some useful information on pillow types, selection and sleep facts on her website – www.wakeupbetter.com

1. Gordon S.J., Grimmer K.A., Trott P.  2007  Sleep position, age, gender, sleep quality and waking cervico-thoracic symptoms. Internet J. Allied Hlth Sci. & Prac. Vol 5 No. 1.