How to Pick a Pillow – Tips From a Physical Therapist

young woman napping with good sleep posture

Few things in life affect us as dramatically and regularly as sleep does. A bad night’s sleep not only leaves us feeling achy, sore, tired and grumpy, but not getting enough good sleep can also lead to a higher risk of injury, and a compromised immune system and is linked to many chronic health problems.

The good news is something as simple as swapping out your pillow could make a difference!

Everyone has their own personal preference when it comes to pillows. Some like firm and flat while others are drawn to soft, tall options. But did you know that your body type and the position in which you sleep should be considered when picking a pillow?

A person’s pillow should function to keep their head, neck and spine all in neutral alignment. This means that your ears should be in line with your shoulders and your chin in line with your sternum. By keeping things all lined up, your pillow works to keep neck and back pain at bay while supporting proper posture – a crucial aspect of your overall health and wellness.

As musculoskeletal and movement experts, physical therapists are passionate about proper sleep positions!

Do you sleep on your back? If you sleep on your back and wake up with neck pain and/or headaches, we promise you’re not alone – and we can help!

When the head rests too high due to a pillow that’s too tall or lofty, you’re pushing your neck into an unnatural, craned position. Prolonged periods in this posture while sleeping leads to tight, stiff neck muscles as they fight to protect your head. Headaches in this situation are inevitable, along with that nagging neck pain.

Conversely, if the pillow you sleep on is thin and flat, it will lack the support you need to keep your head in a position that supports the natural curve of your spine.

man sleeps soundly in good sleep posture on his back with a good pillow

Back sleepers, then, should choose a pillow with medium to low height to keep the head in a neutral position. If you’re really committed to finding a pillow that works for back sleeping, consider a cervical pillow, which slopes down in the center to cradle the head and neck in a way that keeps the spine in a neutral position all night long for the restful sleep you deserve.

Make sure to also pick a pillow that will stand up to the pressure of your head throughout the night and won’t flatten as the hours pass, leaving you out of alignment again. Back sleepers need a pillow with medium firmness.

Do you snuggle into bed at night comfortably positioned on your side? If you sleep on your side, you may find yourself waking up with tight shoulders, a stiff neck and possibly even a headache.

A pillow that lacks enough support and is too short to keep the head, neck and spine aligned can wreak havoc on a side sleeper as their head flops uncomfortably toward the shoulder. When this happens, the trapezius muscle (which connects to your head, neck, shoulder blades, and clavicle) becomes tight on one side, creating a muscle imbalance, and leading to discomfort. Additionally, without a lofty pillow to help hold the head up, the shoulder winds up with the pressure of holding all your body weight.

While back sleepers can get away with a medium-firm pillow, side sleepers really need firm support to ensure their head doesn’t sink down as the night goes by.

Using the proper pillow for your side-sleeping position can help restore the muscles supporting the neck and ensure they’re in the correct position, eliminating that morning pain and tightness.

young woman sleeping on her side

Another consideration for side sleepers is leg position. Those who sleep on their side tend to shift their legs around into different positions throughout the night, which twists the spine and can cause strain on the lower back and hips. If you wake up with pain in your low back and/or hips, consider adding a pillow between your legs. Either a normal pillow or a body pillow will work.

Finally, if you feel pain in your upper to mid-back, between your shoulder blades, hugging a pillow in between your arms in front of you may help. This option helps to put the shoulders into a more neutral position, which takes the pressure off the muscles of the upper and middle back. With a properly sized body pillow, you can support both your hips and your arms for a comfortable and restful sleep.

A lot of stomach sleepers experience pain in the neck and back. Plenty of sleep experts advise against this sleeping position because of the stress it places on the spine and back and shoulder muscles. Habits are hard to break, however, and so instead of stressing all night about avoiding laying on your stomach, be mindful of your pillow choice and how it supports you while you sleep.

Many stomach sleepers don’t need a pillow at all, but those who do should opt for one that has low height and soft support. Think one to two inches at most and consider that a pillow that’s even slightly too tall will crane your head upward, prohibiting proper spine alignment, forcing bad sleeping posture and making waking up with pain a regular occurrence.

Stomach sleepers may also experience low back pain due to the way the spine sags away from neutral position when laying prone. Adding a small pillow under the hips or low belly can alleviate this problem and melt that low back pain away.

A woman sleeps on her stomach with her head turned to the side

Many stomach sleepers actually sleep halfway on their side or with their arms under their body. This can be a little trickier to choose a pillow for this sleeping position, but having a few options within reach can solve this conundrum.

The key, as with every type of sleeping position, is to ensure a neutral spine. To achieve this in the side stomach sleep position, stick with a low-height pillow – especially if your shoulders are primarily facing downward. A medium support pillow that has compressible fill such as feathers or down alternatives is ideal for this type of sleeper as it can be fluffed up to support the head when the body shifts more to the side, but squishes nicely when needed.

An even trickier situation arises for those whose sleep takes them through all the sleeping positions during the night. Maybe you start on your side, roll to your back for a while, shift to the other side, and eventually wind up belly down.

Specialty pillows designed for combo sleepers can be a solution, and there are numerous options on the market, though the price can be prohibitive. The key, again, is to determine how to best support your spine and keep your head, neck and back in neutral position as much as possible.

Once you’ve dialed in your sleeping posture you can start exploring all the other fun options in the world of pillows such as shape and size, type of fill, case material, and more.

If you’re struggling with sleep and even swapping pillows doesn’t seem to help, a physical therapist can work with you to determine if there is a musculoskeletal factor at play. 

Don’t just ignore the pain you’re waking up with or the pain that’s keeping you from falling asleep in the first place. Let us help! Find a Therapeutic Associates Physical Therapy clinic near you and schedule an assessment today.

woman stretches upper body while outdoors

Start your physical therapy journey today.

As physical therapists, we know the importance of movement for overall health and well-being. From injury recovery to achieving optimal performance, our passion is to help every patient reach their goals and live an active, pain-free life. Get started with PT today!

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