One of the most common questions I receive from patients with neck pain is: “What’s the best pillow to prevent neck pain?”  The answer is simple: The one that keeps your spine aligned in the proper position!

What is the Proper Spine Position to Prevent Pain?

Your spine should be in proper alignment regardless if you are sitting, standing, sleeping, or lifting.  The proper spine alignment is a lordotic curve (small curve inward) in your low back, shoulders back, and ears aligned over your shoulders with your eyes on the horizontal.  See my article here for proper sitting posture and exercises to correct your posture.

What’s the Best Pillow for a Side Sleeper?

If you are a side sleeper – then read on.  The best pillow for a side sleeper needs to fill the gap between your bed and your head while keeping your head in straight alignment with your spine.  It is easiest to check if your pillow properly aligns your spine by having someone look at your alignment.  (You can also set up a mirror and check for yourself.)  Your pillow should not be so fluffy that it puts your neck and spine in lateral flexion (or tilted) like picture #2 below.  Your pillow should also not be so flat that your neck and spine is lateral flexed to the other side like picture #3 below.

You should also use a pillow between your knees to keep your knees hip-width apart.  This is important to decrease strain and rotation on your lower spine and sacroiliac joints. See picture below.

What’s the Best Pillow for a Back Sleeper?

If you are a back sleeper, your pillow will most likely need to be flatter than the side sleeper.  But, the same principle is true: the pillow needs to fill the gap between your bed and your head keeping your neck in straight alignment.  If your pillow is too fluffy it will put your neck in extension(looking up).

If you are able, you should place a pillow under your thighs to rotate your pelvis into a slight posterior tilt to decrease the strain on your lumbar spine.

What’s the Best Pillow for a Stomach Sleeper?

STOP!  Sleeping on your stomach is horrible for all your joints!  It places prolonged strain and stress when you put your body in this poor position. (I only use lying on your stomach for those with herniated discs as as treatment exercise in my practice.)  Prone lying (on your stomach) places your neck in significant extension and mandates rotation so that you don’t smother yourself in your pillow.  While prone, you must either put your shoulders in full flexion (over your head) or internally rotate them to keep them by your sides.  And lastly, your lower spine is in an excessive anterior tilt while prone.  Placing your body in any of these positions for too long of a time period will cause significant strain and irritation to your joints. If you are unable to fall asleep any other way and must sleep on your stomach, then place a pillow under your hips (refer to the image below) to put your lower back in a better position and relieve strain.

What’s the Best Pillow If I Roll All Over the Bed?

We can not control our bodies while we are sleeping.  So, we may end up in a different position from the position we were in when we fell asleep. You will probably wake up and find that you have kicked the pillow out from between your knees and/or have changed bodily position.  That is perfectly okay :-).  The best thing to do is fall asleep in a good position with the right pillow for your preferred sleep position.  The more time your spine is in the proper position the less strain and irritation is placed on your joints.

What if I Still Have Pain After Picking a Better Pillow?

If you still have pain following all of these sleeping pillow guidelines, and you have tried the best pillow to prevent neck pain suggested here based on your sleep type, try using a rolled hand towel under the arch in your neck.  (You can also purchase a cervical roll if you don’t feel like making one.)  Sometimes, especially after a neck injury, your spine requires more support when sleeping.  Adding this towel roll will give specific support to the cervical spine. Keep in mind the same principle stands that you need to keep your neck in straight alignment.  So when lying on your side you will need a larger roll to accomplish this as compared to lying on your back.

What’s the Best Pillow to Prevent Neck Pain? – Final Thoughts

In conclusion, there is no magic or best pillow to prevent neck pain when sleeping.  We are all made differently and will require different heights of pillows for proper alignment while sleeping.  Answering the question: “what’s the best pillow to prevent neck pain” will depend on the individual.  When purchasing a pillow to prevent neck pain, you should choose a material you like and then trial it in your bed in your preferred sleeping position.   It helps to have someone look at your head and neck position and check your spine alignment.  You may find it beneficial to add a towel roll under your spine to give some extra support while sleeping.  When it comes to sleeping positions, back sleeping is the best followed by side sleeping.  Make sure you avoid stomach sleeping to help provide back and neck pain!