Should I Stop Using a Pillow If I Have Neck Pain?

In our clinic's view, for most people the short answer is no.

Studies in people with chronic neck pain have compared different pillow designs. Some designs, such as rubber and spring pillows, may modestly reduce neck pain and waking symptoms^[1], but the evidence is limited and not entirely consistent: a 2025 review found no single type (latex, foam or standard) that was clearly better than the others^[2]. These studies compared different pillows rather than going without one, so rather than giving up your pillow, we suggest focusing on finding one that fits you.

The essential things to consider are:

1. Thickness of the pillow
2. Firmness of the pillow
3. Positioning of the pillow

1. Thickness of the Pillow

In our clinic, we choose pillow thickness mainly based on whether you sleep on your back or your side. The goal of a pillow is to keep your neck in a comfortable, roughly neutral position: not bent too far forward and not tilted to one side. Research suggests that the height and shape of a pillow may affect how your neck lines up, at least when you lie on your side^[1].

If you are a back sleeper, we usually suggest a slightly thinner pillow, just enough to fill the gap between your neck and the mattress.

If you are a side sleeper, we usually suggest a thicker pillow that fills the gap between the tip of your shoulder and the side of your neck, so if you have broader shoulders, you may need a thicker pillow.

What if I start sleeping on my back and then change position to sleep at night?

Consider your primary sleeping position as the one in which you spend maximum time at night. Some contoured "cervical" pillows have a lower side and a higher side, so you can switch as you change position during the night. That can be convenient, but in a study of 106 people who mainly slept on their side and each tried several pillows, a foam contour pillow did not show any advantage over regular-shaped pillows^[3]. That study didn't look at people who switch positions, but it suggests you don't necessarily need a special cervical pillow.

We generally don't recommend sleeping on your stomach, because your head has to stay turned to one side while you lie face down. Research on sleep position and neck pain is limited: the few studies available suggest that side lying is generally linked with fewer waking neck and back symptoms, but stomach sleeping itself has not been clearly shown to cause neck pain^[4], so think of this as a comfort tip rather than a strict rule. If you want to change the habit, a tip we often give is to do it gradually: place cushions beside you so it's harder to roll onto your stomach.

2. Firmness of the Pillow

Pillow material may matter too. In that same study of 106 side sleepers who each tried several pillows, the researchers concluded that feather pillows should not be recommended, while a rubber pillow did better than people's own pillows in most comparisons^[3]. A 2021 review of pillow studies also favoured rubber pillows^[1], but a 2025 review found that no single material (latex, foam or standard) was clearly best^[2], so the evidence is mixed. In our clinic, we suggest avoiding both very soft, squashy pillows and rock-hard ones. A simple at-home check I often suggest: fold a bed sheet and try lying on it. In my experience, that firmness is a good guide when choosing a pillow.

3. Positioning of the Pillow

When you lie on your back: we suggest the pillow support your head and neck and end at the top of your shoulders, rather than extending down under your shoulder blades.

When you lie on your side: tuck the pillow snugly down to the top of your shoulder so it fills the gap between your neck and the mattress.

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To meet a certified McKenzie therapist in East Brunswick, call 551-208-3234 at Spineck Physical Therapy.

References

1. Pang JCY, Tsang SMH, Fu ACL. The effects of pillow designs on neck pain, waking symptoms, neck disability, sleep quality and spinal alignment in adults: a systematic review and meta-analysis. Clin Biomech (Bristol). 2021;85:105353. doi:10.1016/j.clinbiomech.2021.105353 · PubMed
2. Ghosh S, Goyal M, Goyal K. Effect of pillow on pain, disability and sleep quality in patients with chronic neck pain: a systematic review. Rehabilitacion (Madr). 2025;59(3):100922. doi:10.1016/j.rh.2025.100922 · PubMed
3. Gordon SJ, Grimmer-Somers K, Trott P. Pillow use: the behaviour of cervical pain, sleep quality and pillow comfort in side sleepers. Man Ther. 2009;14(6):671-678. doi:10.1016/j.math.2009.02.006 · PubMed
4. Cary D, Briffa K, McKenna L. Identifying relationships between sleep posture and non-specific spinal symptoms in adults: a scoping review. BMJ Open. 2019;9(6):e027633. doi:10.1136/bmjopen-2018-027633 · PubMed

This article is for general education and is not a substitute for an individual evaluation by a licensed clinician.