According to the National Institute of Health, an estimated 1 in every 3 people experience neck pain at least once a year. While it often resolves on its own, it can become a recurring problem for many. As a cyclist and a professional tailor (as well as a journalist) I am one of those who suffer regularly from a stiff and/or achy neck.
Georgiy Brusovanik, MD, a spine surgeon at Miami Back & Neck Specialists, has been helping people manage their neck pain for many years. He sees patients who complain of neck stiffness, shoulder blade pain, as well as nerve pain radiating from the neck into the shoulder and arm.
“Patients often blame themselves,” he says, “or their pillow or mattress.” The most common rationale he hears is, “I just slept wrong.” Sometimes, he says patients get labeled as pain medication seekers or, even worse, in his opinion, “receive an erroneous diagnosis like fibromyalgia, migraines, or shoulder dysfunction.”
In his experience, though, the cause of neck pain is most often from an internal disk derangement; either disk herniations or disk degeneration. “Some patients have degenerative changes involving the joints that connect each vertebrae, which can be a cause,” he explains.
Many people (including me) turn to pillows for neck pain, hoping they’ll mitigate the soreness and help manage the stiffness. The thing is, though, according to Raymond Hwang, MD, Senior Medical Director at Hinge Health, a digital clinic for joint and health pain, is that everyone has different anatomy and preferences. What makes neck pain better or worse differs from person to person, so there’s no single correct answer for alleviating it for everyone.
In general, though, the objective, when considering pillows, is to keep your head and neck aligned with your spine, especially when side sleeping. To achieve this, “use a pillow that supports the natural curve of your neck, ensuring your head doesn't tilt up in the air or down toward the mattress too much,” Dr. Hwang explains.
Many people (again, me included) worry their sleep position contributes to neck pain and that they’re doing something wrong. Todd Sinett, DC, an NYC-based chiropractor and founder of Tru Whole Care, a holistic medical practice, says that sleeping positions are rarely the cause or main contributing factor to neck pain. In his opinion, the root causes can be linked to structural, digestive, and emotional issues that affect our spine and back, which, in turn, cause pain in our necks.
Sleeping can become a challenge when you have neck pain, no matter what the underlying cause may be. If pain persists, it is important to see a doctor, chiropractor, and/or physical therapist to suss out the root cause.
Rahul Shah, MD, FAAOS, a board certified orthopedic spine surgeon in New Jersey, recommends having your neck checked out by a physician before selecting a pillow. “While many folks suffer from neck ache because of arthritis, it's important to understand that there are many underlying causes for this kind of discomfort, some of which arise from areas outside of the neck,” he says. If neck pain doesn’t improve in a few weeks, the most important thing is to confirm that the pain relates to wear and tear issues in the neck and not another cause like a growth on your neck, traumatic injury, meningitis, rheumatoid arthritis, or cancer.
Wear and tear issues can be caused by aging in general, as well as stress and repeated movements that can cause the disks in your spine to weaken. Physical strain, which can be a result of poor posture and weak abdominal muscles, is also a frequent contributing factor.
For someone who has chronic neck pain from degenerative causes, Dr. Shah recommends trying different types of pillow geometries. “Begin with a pillow with a cutout donut which tends to help many people with chronic neck pain. If this doesn't help or is uncomfortable, try something else,” he says. There are many types of pillows for neck pain; the trick is figuring out which works for you.
The anatomy of the neck and the role of pillows
Anatomy and where you feel pain
In general, our necks are made up of bones, muscles, nerves, blood vessels, lymphatics, and connective tissue. The cervical spine is the bony portion of our necks. The word cervical comes from Latin and means ‘of the neck.’
There are four sections of the neck:
- The vertebral compartment, which contains vertebrae and muscles
- Visceral compartment where your glands reside (thyroid, thymus) as well as the larynx (voice box), pharynx (throat), and trachea (windpipe)
- Two vascular compartments; one on each side with a carotid artery, internal jugular vein, and vagus nerve which carries signals between your heart, brain, and digestive systems
The neck is divided into two main triangles separated by muscle, the posterior and the anterior, each of which contains multiple smaller triangles.
Neck pain derives from a variety of disorders or diseases that can involve tissue, nerves, bones, joints, ligaments, or muscles, which is why it’s important to see a physician if you suffer from chronic neck pain.
Neck pain falls into two basic categories: axial, which is predominantly felt in the cervical spine (sometimes spreading to the shoulders), and radicular, which is nerve-related and creates a feeling of shooting pain up and down one of your arms.
Role of pillows
When it comes to pillows and neck pain Grant D. Shifflett, MD, a board certified orthopedic spine surgeon in California, says that the goal is to maintain a neutral spine position, meaning that if you drew a line through the middle of your head, face, and down the center of your spine, it would all be one straight line.
“Not,” he explains, “a jagged or a hockey stick-shaped line because your neck tilts off to one side or the other.” To determine whether you’re in this neutral spine position likely requires someone observing you while you're lying in bed with a pillow. To learn more, read our guide on the best pillows for neck pain relief.
Sleep positions
If you sleep on your side, your pillow must support your neck adequately to prevent any awkward tilting or angles. “That may be a thin pillow for one person and a fat pillow for another,” Dr. Shifflett says. The pillow could have many contours and textures. It doesn't really matter. At the end of the day, if you have a pillow that puts your spine in neutral alignment, particularly when sleeping on your side, you're going to more adequately manage the pain.
A similar thing applies to back sleepers because, Dr. Shifflett explains, people have different angles of their cervical thoracic junction, meaning their postures differ. “It may be mechanically more favorable to have a higher pillow than you would think because there's less stress on your neck,” he says. People with flatter spines or flatter cervical thoracic junctions will likely need a thinner pillow. If you’re a back sleeper in need of tips, read our guide on how to sleep on your back.
What does all of this mean?
Pillow selection really is trial and error. Dr. Shifflett and the other experts I talked to stressed that you can’t subscribe to a one-size-fits-all scenario. Selecting a proper neck pillow that works for you is likely going to require some individual concentrated research. In other words, just like Goldilocks, you’re going to have to try out different types of pillows to find the one that is just right for you.
“It doesn't have to be the fanciest, most expensive pillow, either,” Dr. Shifflett says. Experiment with different sizes, heights, thicknesses and contours, and play around until you feel like your spine is neutral — ideally, as stated above, with a buddy or partner who can confirm when you achieve optimal neutrality.
Pillow types and neck pain
Contour pillows
Dennis Pfisterer, DO, Chief of Orthopedics at Holy Name Medical Center in Teaneck, New Jersey, usually recommends a contour pillow for people experiencing neck pain. Contour pillows feature a slight dip in the middle meant to mimic the curve of your upper spine and neck. Your head rests in the hollow (in this instance, a good thing), which in turn supports your neck.
“As many people change positions while sleeping, a contour pillow can help maintain spinal alignment while in different positions,” he says.
Latex and memory foam pillows
Speaking of contours, latex and memory foam pillows will mold to the shape of your head and neck. Typically firmer than other options, they provide more structured support and distribute pressure more evenly.
Dr. Pfisterer recommends something that will hold its thickness throughout the night. Using too flat of a pillow or too many pillows can add unnecessary strain to the neck.
John Gallucci Jr., MS, ATC, PT, DPT, an expert in sports medicine, rehabilitation, and injury prevention and CEO at JAG Physical Therapy in New Jersey, suggests latex-filled pillows because they conform to the contour of your head and neck.
Feather and down pillows
This is not to say that a feather or down pillow will not work for you. Again, there's no one-size-fits-all solution. Dr. Hwang often recommends down or feather pillows which also conform to the shape of your head and neck and provide support. They do collapse over time, though, so may potentially need to be replaced more often.
“Ultimately,” says Dr. Hwang, “it may take some trial and error to find the “right” pillow.” Neck pain varies from person to person, and what is comfortable for one person may feel like hell to another.
Pillow geometry
“Specific pillows are not inherently superior to one or another,” says Dr. Shah, “If someone has a reasonably durable pillow that does not lose its form or contour, then I initially recommend finding the correct geometry (height and shape) of the pillow.” Consider things like: Does an overstuffed pillow work better? How about a pillow with a cutout donut?
Once you identify geometry (and assuming that you don’t have an allergy to the material), Dr. Shah suggests a trial-and-error approach to see which material — foam, latex, feather — feels better to you.
How to choose the right pillow for neck pain
Material
“Look for latex or down pillows,” says Dr. Gallucci. Both of these materials will conform to the neck. The key feature should be that it can be easily molded and won’t lose its shape. But you don’t want one that is too firm.
Firmness
A too firm pillow keeps the neck flexed overnight and can result in stiffness. They are also usually less accommodating to varying head positions. Extra soft pillows, on the other hand, sag and may result in malalignment during sleep.
“Each type of pillow has its pluses and minuses,” says Dr. Brusovanik, who advises to simply focus on comfort and not get too caught up in looking for a specific shape or material.
Other features
As well as a pillow that allows proper spinal alignment and offers support, you ideally want something that feels good and can be washed easily, says Dr. Sinett.
Again, there is no formulaic answer or magic sleeping position for all. According to Dr. Sinett, the combination of what you eat before bed, how late you eat it, the number of pillows you use (he says you really only need one), and your emotional state before bedtime means more than the position you put your body in. As someone who just woke up from a night after a long stressful day, I definitely attest to the role emotional stress can play. There are also scientific studies that support this.
Correct pillow positioning for neck pain
Back sleeping
“If you’re sleeping on your back (or side), the general goal is to have your head parallel to the bed,” says Anjali Agrawal, DC, family chiropractor, holistic health practitioner, functional nutritionist, and founder of Back In Balance in California.
Some people find that they require no pillow when sleeping on their backs, though you may need something to support your neck.
Side sleeping
As for side sleeping, Dr. Agrawal gave this advice: Make sure that your head doesn't point towards or away from the bed but rather is in line with your relaxed neck. You want your chin and nose parallel, not tucked towards your chest or leaning up.
And, you want your pillow to support your neck: People tend to smash their pillow down so that it fits under their neck. “If this is you, you need a new pillow because your pillow really should be supporting your neck but not giving you a major head lift,” she explains..
Stomach sleeping
Dr. Agrawal says it’s really challenging to sleep on your stomach without hurting your neck. This is because, in this position, you have to turn your head to breathe.
“As creatures of habit, we tend to turn our heads to one specific side. This repetitive motion is not safe and can lead to injury,” she says..
Mattress firmness
How firm your mattress is can also affect what kind of pillow will work best. If you sleep on a firmer mattress, you should find a softer pillow, and vice versa.
“These dynamics allow your body to find a naturally relaxed but supportive position where your vertebrae are stacked,” says Dr. Agrawal. Another tip to help keep your spine aligned is to sleep with a pillow between your knees. This helps keep your knees hip-distance apart rather than concave, which creates imbalance and physical stress not just at the hips but throughout the spine and neck, as well. This topic is also covered in our guide on knee pillows.
Common mistakes in pillow usage:
Using too many pillows
When sleeping with neck pain, many people try to manage it by using multiple pillows, Dr. Gallucci says..
Although pillows can help, they can also hurt. Using too many over flexes the muscles, compresses the spine, and aggravates the muscles in the surrounding area, such as your shoulders. “Doing this results in even worse neck stiffness and pain,” he says.
Living with the pain
The most common mistake, according to Dr. Brusovanik, is living with the pain. Neck pain is no different than any other pain; “normal” is living without pain, he explains. “If I had pain for more than a week, I would get a neck MRI and solidify the diagnosis. There is always a reason for pain,” he continues.
Not listening to your body
When looking at specific positions and/or pillows, people need to keep an open mind, says Dr. Shah. “There are many "correct" positions and pillows and the most important feedback to pay attention to are your individual symptoms,” he says.
A good rule of thumb is to assess your symptoms for a minimum of 15 minutes and ensure that any intervention (new pillow, position, etc.) doesn’t elicit more neck discomfort.
Pillow recommendations
I’ve included a few recommendations from the experts I spoke to. Most clinicians refrain from endorsing specific brands and/or pillows as finding the correct one for each person is so individual (as they all said multiple times and I’ve mentioned throughout). That being said, look for pillows that offer a trial period.
Snuggle-Pedic Adjustable Shredded Memory Foam Pillow
Snuggle-Pedic Adjustable Cooling Pillow - Shredded Memory Foam Pillows for Side, Stomach & Back Sleepers - Fluffy or Firm - Keeps Shape - College Dorm Room Essentials for Girls and Guys - Standard
Dr. Shifflett likes to keep things simple and prefers a pillow with removable and adjustable contents like this one from Snuggle Pedic.
“So, not just fluffy little feather pillows but pillows that actually have some material that is malleable, moldable, and can fit to the contour of your head while also being adjustable,” he explains. Enter the Snuggle Pedic pillow.
Having tried pillows that were really thick and had neck support and ones that were really thin and u-shaped around the base of the skull, he likes the Snuggles Pedic the best since he was able to adjust the height without disturbing the structural integrity of the pillow. “It was able to go to a lower height that fit me really well and helped a lot with my comfort,” he says.
It features a washable bamboo viscose cover and ‘Kool Flow Tech’ for breathability and comfort.
- Cover: Bamboo viscose
- Fill material: Shredded memory foam
- Trial period: 4 months
- Price on publish: $56.99
Mediflow Water Pillow
Mediflow Water Pillow
Dr. Agrawal recommends the Mediflow Water Pillow because you can control how much water an individual needs to level the neck and head. Plus, it's machine washable and has a 30-day money-back guarantee.
The Mediflow contains fiberfill and an inner support layer that you fill with water to create a pillow that is the perfect level for you. Use 2 liters for soft support, 3 for medium, and 4 to 5 for firm support. In a study conducted by Johns Hopkins University, water-based pillows outperformed other types in pain relief, sleep quality, and comfort.
- Cover: Cotton or aloe vera
- Fill material: Fiberfill
- Trial period: 1 month
- Price on publish: $59.20
Sissel Soft Orthopedic Pillow
Sissel® Soft Orthopedic Pillow
The Sissel Soft Orthopedic Pillow is another good pillow to try. Made from memory foam, it slowly adjusts to your shape on a soft but stable base. It comes with two covers; a cotton foam core cover and a washable ivory zippered velour one. The Sissel features a raised, contoured ‘shelf’ on one side to support your neck and a lower area to rest your head. It works for both side and back sleeping.
Tempur-Pedic makes a similar pillow available for $89.00
- Cover: Cotton, velour
- Trial period: 1 month
- Fill material: Memory foam
- Price on publish: $90.00
Frequently asked questions (FAQs)
Is it better to sleep on a hard or soft pillow for neck pain?
As Dr. Brusovanik says, each type of pillow has pros and cons. Soft pillows sag and may result in a misaligned spine and neck during sleep. Hard pillows may make accommodating various head positions difficult from the start. He advises patients to focus on what pillow is most comfortable for them in both the back and side sleeping positions.
Is it better to sleep without a pillow for a stiff neck?
Dr. Gallucci says that if you have a stiff neck and are a back sleeper, sleeping without a pillow is okay. When lying face up without a pillow, your head rests in a natural position. “However,” he continues, “if you sleep on your side, it’s better to use a pillow, specifically one made from memory foam, so the head remains upright and in line with the rest of your spine.”
What kind of pillow is best for side sleepers with neck pain?
For side sleepers with neck pain, Dr. Hwang recommends a contoured or cervical pillow designed to cradle your neck and keep it aligned. Look for ones made with memory foam which will mold to the shape of your neck and head, providing the best results.
Can too firm pillows cause neck pain?
Pillows that are too firm don’t allow the head to sink properly into said pillow. If you have neck pain, Dr. Gallucci suggests looking for a pillow that is both responsive and supportive.
“A responsive pillow will conform to the shape of your head and provide pressure relief, while a supportive pillow will maintain its shape and provide support for your neck,” he explains.
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