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The Perfect, Pain-free Sleep? Pillow and Sleep Position Posture Recommendations For Back and Neck Pain.


Some of the most frequent questions I hear from chiropractic patients is "what type of pillow should I use?" and "do I need a new mattress?".


It makes sense, you wake up feeling stiff and sore, so it must have been your pillow/mattress/sleep position, right? So finding "the right" pillow or mattress will fix that stiff neck or sore back, right?



An important note to begin is that research has shown that in most cases, for those suffering with neck and back pain, their pillow and mattress are not the cause, but in some instances can worsen their problems. In my career, I have many patients spend lots of money replacing pillows and mattresses to find that it has made no difference and sometimes even worsens the situation. Addressing the underlying cause is step number one. An appropriate pillow, mattress and sleep posture enhances a properly functioning muscles and joints. Secondly, there is no one perfect pillow for every person. Much like a shoe, there are several key criteria that makes for the proper pillow for most people, then each person needs to "find the right fit".


Mattresses are similar, but generally with less variation. We need the support of a medium-firm to firm mattress, then for comfort, a mattress topper can be added without sacrificing the underlying support.


Below is some more specific information regarding sleep positions and pillows.


A woman demonstrating good and bad back sleeping posture
Back Sleeping Posture Information

A woman demonstrating good and bad side sleeping posture
Side Sleeping Posture Information

In the image above of the side sleeping position, note that the hips, the knees and the shoulders are stacked over top of each other. With the bottom upper arm pointing the elbow straight out in front of the individual, the shoulder is in a stable position. The bottom hand can then be resting as shown, positioned under the face or tucked under the pillow, etc. The neck is fully supported by the pillow, without any gaps and the head is kept in neutral.


When back sleeping, the head and neck again need to be supported in neutral, while having a roll or cushion under the back of the knees helps to reduce the strain on the low back.


Stomach sleeping is a far more challenging position in which to minimize the stressors on various regions of the body, especially the neck, shoulder(s) and hip(s). This will be discussed further in a later post.


Pillow material and shape is less important than how the pillow supports the individual person. Generally, adaptive materials (memory foam, water pillows, etc) are a step in the right direction, but some people do best with down or polyester filled pillows.


Like selecting a shoe, "try before you buy" is the best advice. Take an hour or so, go into a bed shop and lie in your sleep position on a variety of pillows for around 5 minutes to "get a feel" for the pillow and determine if it meets the basic criteria (full neck support & proper neck alignment for the position you tend to spend most of the night in). This technique is not an absolute guarantee, but usually provides the best success for selecting the "right" pillow for you.


Alternatively, with the increasing number of online retailers of pillows and mattresses, many offer return windows of up to 100 nights, making it much easier to trial a pillow for several nights then exchanging for a different style or size if the fit isn't right.


A pillow several patients have found to be very good is linked on this page:


Water-filled pillows have the advantage of being highly configurable to an individual and supportive. They can suit any body shape as well as side and back sleepers. The disadvantages are that it is very heavy when filled, tends to be warm, and initially "fiddly" to get it just right (lots of adjusting the volume of water).


"Memory foam" pillows are very popular, but not inherently superior to other types of pillow material as the types and quality of foam used can vary greatly, as can the shape and size.


Remember, no matter how great your pillow and mattress are, there are a variety of other factors that affect sleep quality and therefore how your body is feeling when you wake up. These will be addressed in a later post.


For those individuals wanting further information on pillow and sleep position posture recommendations for neck and back pain or if you follow these recommendations and still experience pain and stiffness in the mornings, an in-clinic assessment can be performed to identify the underlying issues that are causing your problems. Appointments can be booked online for my chiropractic clinic in Lower Lonsdale, North Vancouver.

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