Neck pain – it’s time for a new pillow!

Home / Back Pain and Scoliosis / Neck pain – it’s time for a new pillow!

In my last article, I looked at helping you to choose the right mattress for you to avoid or reduce back pain.

Maureen Dwight

In this blog we will look at how to avoid neck pain by choosing the right pillow.  If  you are having any of the following symptoms you should look to replace your pillow sooner than later:

  • Awakening with neck pain that gets better as the day goes on
  • Neck stiffness particularly in the morning.
  • Your hands go numb at night

Tingling or numbness in the hands at night can often be a sign of poor support or awkward sleeping positions.  It can be caused by straining your neck and this affects the nerves that go into your hands.

Where to start? ( Watch Video – how to choose a pillow )

Companies that sell beds often recommend when you buy a new mattress that you consider your whole sleep system.  I agree that you need to make sure your mattress, pillow and mattress topper are all working together to give you the support you need.  If you need to replace your entire sleep system, then I usually recommend you buy the mattress first.  Add a topper if the mattress is a bit too firm and then finish with finding the perfect pillow.  Your neck and back will both thank you for the effort you put into the support. Most importantly make sure the retailer allows you to return these items if they don’t work.  A pillow can set you back over $100 and I just finished pricing mattress toppers for the cottage and they are $200+ for one that provides enough support.

Consider how you sleep

Which pillow you will choose is largely determined by your sleep habits.  Pillows need to support, as well as mold to you. This can be difficult to achieve, particularly if you don’t always sleep in the same position.  If you sleep on both your back and side it’s much more of a challenge to get the pillow just right as we need more support when we are on our side than when we are on our back.  The key to having a restful sleep and pain free sleep is to keep your neck in line with your body .

Here’s a guide on what to look for depending on what type of sleeper you are: (Watch Video – Choosing a pillow for how you sleep)

Pillow for the Side sleeper

Most people’s pillows need to be thicker when you sleep on your side vs. on your back.  When choosing a pillow it needs to be thick enough to fill the gap between your shoulder and the side of your head.  The broader your shoulders, the wider the pillow.

My rule for getting it just right is to imagine a straight line is drawn down the length of your nose.  Then imagine another line is drawn up the middle of your breast bone.  The two lines should meet in a straight line.  This ensures you don’t have a kink in your neck and wake up stiff or in pain.  If you have too little support your head and neck will drop down. Too much support and you will bend your head and neck upward.

Pillow for the Back sleeper

For most people your pillow will be thinner if you are a back sleeper. The pillow needs to be thick enough to fill the distance between the back of your head and your upper back.

If your upper back is more rounded then you may need to use a thicker pillow until you improve your posture.  Some people prefer to sleep on their back without a pillow but I find this habit is often too flat for most people.  Either too high or two low of a pillow can cause pain.

You can tell if your pillow is too high as your head and neck will be bent down and not in line with your torso.  If it’s too low your chin will poke up toward the ceiling and you may find you are looking slightly backwards.

Pillow for the Stomach sleeper

Although manufacturers sell a pillow for sleeping on your stomach, my recommendation is to break this habit.  Neither your neck nor your back will feel good with this posture over the long term.

This is not an easy habit to break, as many people have used this position for most of their life.  I recommend to begin the transition by lying on your side and placing a large pillow against your belly.  Roll forward until you are ¾ of the way onto your stomach with your torso against the pillow.  This will give you the sense of comfort most people crave. Contact with the abdomen appears to be what most people are seeking.   Providing you don’t roll too far forward you won’t twist your neck.  Consider a longer torso pillow to allow you to bend your top leg and rest it on the pillow.  Alternatively, two pillows can create the same benefit but are more awkward if you change positions a lot.

Pillow for if you flip all night

It’s good to change positions at night and many people sleep on both their side and back.  However, sleeping on both your back and side can be more challenging for getting the pillow right.  If this is your norm its more important to choose a pillow that is made of a more adaptable material (see below) and you will likely benefit from a thicker mattress topper.

Start by choosing the right thickness of pillow for when you lie on your back. Then make sure you have enough mattress topping to allow your shoulders to sink in a couple of inches when you are on your side.  Ensure that the material in the pillow molds to you and adjusts as you change position. Unless your neck is very stiff, this should provide enough support for both positions.  If your neck is very stiff, restoring more movement through treatment and exercise will help you to be able to sleep more comfortably.

Pillows for watching TV or reading in bed

The most common mistake I see is not related to sleeping. How we watch TV or read in bed has a big impact on neck pain.  Many people use too high of a pillow.  Instead of propping your head up, try to position your pillows like a ramp, to create a gentle incline.

How adaptable is your pillow

I have to confess, I don’t like shaped pillows.  These “bumps” on the end of the pillow often don’t fit.  Each of us has our own shape and size to our neck and unless you are fortunate enough to fit the manufacturers specs, their support can be too much or too little.  Instead I prefer to use a non-shaped pillow made out of an adaptable material that will nestle into your neck.  If that’s not enough support, we can roll up a towel or a piece of foam until we find the exact right thickness for you.

Choosing the right material

There are 4 common materials that I recommend for pillows.  There are many reasons to choose one over another, however the most important feature of each one of these types is that they adapt.

Memory foam 

I tend to favour these types of pillows as they are very adaptable. A good memory foam pillow will let you shift positions from back to side with much less concern about the mattress topper. They also tend to last for several years.  The down side is that they are expensive, often $100+. Some people find the foam retains heat. Be careful if you are scent sensitive as some foams off-gas and I see a lot of complaints in the reviews.

Water-based pillows 

This was the first type of pillow that had a high-quality research study which demonstrated improvement in people’s neck pain. It was the one that I used until I moved to a memory foam.  In most designs there is a central water bladder surrounded by outside fiber fill.  If this is the pillow you decide on, make sure that you can add or remove water.  This allows you to customize the support and is really useful as you can add a bit more water when the fiber damps down.

The downside of these pillows is their weight.  Watch your back when you change the pillow case.  Slide it over and keep the pillow in tight to your body when you lift it.  If you are very sensitive to noise at night, this may not be the pillow for you.  Some people can hear water sloshing as they turn over.  Often this can be improved by working the air bubble out before closing the valve.  If you travel with this pillow I would recommend draining the water and refilling when you arrive.


This is an inexpensive, adaptable pillow. The type I prefer has a zipper and comes with extra cereal.  This feature allows you to customize the support by adding or subtracting what you need.

The cons of this pillow is that it doesn’t last as long as I find the heat of the body fuses the buckwheat together.  If you are a se nsitive sleeper there can be a rustling noise as you roll over.  I don’t know of any fixes which get rid of the sound.

Feather and down

Most feather pillows are all down or all feather. The pillow I like best is a combination of down and feather.  A core of feather provides support and the softness of the down surrounding the core allows the material to adapt to your shape.  Feather can be fluffed up and can be cleaned to reduce the matting of the material and restore support.

The downside of this pillow is allergies to feather, expensive, hard to find and sometimes it’s a square shape which requires different bed linen.

When do you need to treat your neck?

Your pillow can’t completely correct your neck pain.  If your neck is stiff, if you are having numbness or if you need further advice on finding the right sleep system, the therapists at the Orthopaedic Therapy clinic can help you sort out how to start getting a good night’s sleep.

Contact us at  416 925 4687 or

This service pro­vides gen­eral infor­ma­tion and dis­cus­sion about therapy, health and related sub­jects. It is not meant to replace advice and/or treatment from your health care professional.