Which Pillow Should I Use?
I must have been asked this question about a million times during my time as a physical therapist. 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 a multitude of different ones in my clinics – feather filled, contoured, tri-compartmental, latex, mixed, kapok, foam and probably a few others. After looking on Google, I have 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 these will suit every client.
Research on the optimal pillow is not strong. However Dr. Sue Gordon (a physical therapist at James Cook University in Townsville, Queensland, Australia) has done extensive research on sleep position and waking neck pain. She found that subjects who reported sleeping 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 (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.). 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 fibers, distracts them, and gives them a degree of control as opposed to ‘pain victim’. Might not the same idea apply to pillows and neck pain? It was a long bow, but I drew it anyway.
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 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. My initial impressions however, 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. But at least it has the client taking some affirmative action rather than just complaining about their pillow.
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
*Picture from the New Yorker
Author: CraigAllingham
7 Comments
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Comments
Try using the side sleeper pillow by Sealy PosturePedic. Need a firm pillow to unload the neck and avoid using a pillow when sleeping prone!
[...] Which Pillow Should I Use? [...]
the shaped feather pillow, previously available from Encore(they disappeared), was the most successful amongst my patients. Some patients also benefited from a very small cushion or pad in the axilla i.e. under the lateral border of the scapula in side lying. This effectively straightens the tendency the UTS has to LF.
Any plain pillow as long as it keeps their neck in neutral alignment then take a towel roll and put it in the pillow case so it can support the neck. It’s free, it works and the patient can adjust the thickness to their neck.
Thanks Craig,
I definitely like the idea of switching it up a little. clinically I have found, that just like a good chair, a good pillow needs to be positioned properly. All too often I see that people position the pillows under their shoulders instead of under their neck. It’s surprising how many times I have to re-iterate this simple concept. Also I have used with a lot of success Mulligan’s “folded pillow case” acting like a soft collar. You fold it lengthways in half then thirds, and that has been very useful in patients with acute neck spasms in the upper trap and levator scapula.
Interesting topic. I like the idea of changing pillow every couple weeks. Here are some things that I have picked up to make my patients more comfortable, sleep better, and reduce their pain:
1) Don’t sleep with the pillow(s) under your shoulders. Many patients sleep with pillows under their shoulders and their necks relatively unsupported. This can be especially true if there is a large amount of kyphosis in the thoracic spine leaving the neck in an extended posture.
2) Try supporting your arms. In sidelying use a “huggy” infront of your body that you can rest your arm over. This can take some pressure off of the shoulder and decrease shoulder pain. In supine you can try putting smaller pillows under both arms. Pt.’s many times say this feels like they are floating and find it very comfortable. M any times either of these can be effective in preventing your patient from rolling over as well as helping them to sleep better. This is especially important in cases where rolling on their shoulders while asleep wakes them up due to pain.
3) Don’t foget the legs. Placing 1-2 pillows under the knees in supine and a pillow between the knees in sidelying can help to take pressure off of the back and help the patient to sleep. If it is not a back injury I usually leave this up to my patients, but most of them think it is more comfortable to sleep this way.
As far as what type of pillow I usually tell them that they can use whatever is comfortable as long as it keeps them in a neutral position limiting the forces on their joints. I also inform them of the need to change their sleeping position because if their sleepig position is causing them pain it is going to be much slower in PT because I will be fighting 8 hours of stresses they are putting on their joints in whatever time I have with them.
While browsing through the website I ran across this interesting thread. I have had many patients ask me the same question, which pillow should I use because I am waking secondary to my neck pain. I have told them many of the same things that have already been said on this thread, some had success and some didn’t. Even with the relief that they got from the pillow, often the pain was not abolished or it would return. So I tried a novel approach, for those who had some relief but later it returned I told them to do the simplest thing. I told them to switch the side of the bed that they were sleeping on (if their partner agreed of course) or sleep with their head where their feet used to be. Many stated that they had relief without a return of the pain during their course of treatment. Granted it may return again but now they have something that they can do to remedy the pain. I say this because I wasn’t getting the results I wanted using an orthopedic only approach. Because if they are sleeping in neutral without stressing anything orthopedic, then they shouldn’t be getting pain right? So I looked at it from a nervous system sensitization perspective. I thought maybe there is something associated with the environment that (s)he is sleeping in that continues to trigger a”facilitating” effect on the CNS resulting in pain. There were somatic triggers as well. It could be a multitude of inputs who really knows, but I decided to change something with the environment and see if it makes a difference. There are many ways to manipulate the environment and a pillow is one way of doing that. Now possibly the patient will associate a change in position with pain relief and a down regulation of the CNS so if the pain returns that is all that is needed. I doubt that it will work with every patient but I feel it is worth a try.