With approximately one third of our lives spent sleeping, it is essential to have good quality sleep in order for the body to maintain normal physiological function and biological processes [1,2]. However for many of us, a good night’s rest is interrupted by uncomfortable neck pains that most likely will wake us during the night and persist throughout the day. Studies have shown that problems sleeping and in sufficient time of rest can also be indirectly linked with increased risk of diseases, hormonal changes, sleeping disorders and associated stress [3]. So you may ask, what can be done to ensure you get a more comfortable nights’ rest and reduced neck pain?

Studies have concluded that the proper selection of pillow can significantly reduce neck muscular tension and pain, improving an individual’s overall quality of sleep [1]. Poor neck support increases the work of neck and upper back muscles during sleep, causing increased biomechanical stress and morning pain [2]. Therefore the posture we adopt during a night’s rest can be related to musculoskeletal injuries of the neck and upper back, with muscular tension found to be a contributing factor to constant headaches [2].


What can be done?

Muscular tension and neck pain can therefore benefit from an appropriate pillow type as an adjunct management strategy to neck exercise training [1,4]. There are many various pillows on the market designed to help create the most relaxed position for the neck joints and surrounding muscles. How do you know what pillow to choose?

Here are some tips:

  • A pillow that has firm support to cervical lordosis (neck contour) which holds the head and neck region sufficiently in a neutral alignment to the upper back, reducing the biomechanical load to these regions [2] 
  • A neck pillow with the appropriate shape and consistency [5] 
  • A pillow of the correct height that will correctly support the cervical lordosis [5]
  • A one size fits all approach does not exist.


What has studies shown?

Studies have found that after 18 months of use of a supportive pillow, 84% of users achieved clinically important relief from neck pain [1] Compared to conventional pillows cervical pillows were shown to be effective in reducing neck pain and discomfort [1]

Another study found that muscle activity was higher in those with shoulder and neck pain, with a change of pillow height to a more suitable height significantly lowering the amount of muscle activity [2]. This study also showed that a pillow height of 10 cm not only had the lowest muscle activity but also resulted in similar muscle activity on both side when in side lying positions. They concluded that the best perception of comfort was associated with better head and shoulder alignment which produced the lowest amount of muscular activation [2]. A study that compared the comfort of certain material types of pillows found that memory foam pillows performed best with reduced waking pain and improved sleep quality, whilst the feather pillow performed the worst [6].

However, changing a pillow may be beneficial in improving a night rest and reduce pain, but for those who experience acute and chronic neck pain clinical treatment is most advantageous in conjunction with a suitable pillow.


How can Physiotherapy help?

  • Provide suitable tailored maintenance strategies to decrease muscular tension, pain and headache symptoms
  • Create a personalised exercise and stretching program to increase neck and upper back muscle strength
  • Undertake a postural and movement assessment of neck and upper back and provide recommendations on adjustment of seating posture
  • Help assist you with selecting the correct pillow for you through analysing posture and upper back and neck biomechanics
  • Provide education to encourage self-management strategies.


If you have any questions regarding neck pain and sleeping posture please give us a call at (02) 8411 2050. Here at Thornleigh Performance Physiotherapy, we can give you an accurate diagnosis and treatment, to help you get back in action as soon as possible. We are conveniently located near Beecroft, Cherrybrook, Hornsby, Normanhurst, Pennant Hills, Waitara, Wahroonga, Westleigh, West Pennant Hills, and West Pymble.



  1. Erfania P, Tenzif S, Guerriero RC. Assessing effects of a semi-customized experimental cervical pillow on symptomatic adults with chronic neck pain with and without headache. Journal of the Canadian Chiropractic Association. 2004;48(1):20-28.
  2. Sacco ICN, Pereira ILR, Dinato RC, Silva VC, Friso B, Viterbo SF. The effect of pillow height on muscle activity of the neck and mid-upper back and patient perception of comfort. Journal Of Manipulative And Physiological Therapeutics. 2015;38(6):375-381.
  3. Lavin RA, Pappagallo M, Kuhlemeier KV. Cervical pain: A comparison of three pillows. Archives of Physical Medicine and Rehabilitation. 1997;78(2):193-198.
  4. Helewa A, Goldsmith CH, Smythe HA, Lee P, Obright K, Stitt L. Effect of therapeutic exercise and sleeping neck support on patients with chronic neck pain: a randomized clinical trial. The Journal of Rheumatology. 2007;34(1):151-158.
  5. Persson L, Moritz U. Neck support pillows: a comparative study. Journal Of Manipulative And Physiological Therapeutics. 1998;21(4):237-240.
  6. Gordon SJ, Grimmer-Somers K, Trott P. Pillow use: The behaviour of cervical pain, sleep quality and pillow comfort in side sleepers. Manual Therapy. 2009;14(6):671-678.