Choosing the Right Pillow and Mattress to Prevent Neck and Back Pain
Shopping for the right mattress and pillow can be extremely overwhelming. It certainly was for me when I went shopping six months ago. My wife and I were in the market for a new sleep system and as soon as we walked into the big box stores in our area, we quickly became lost in the number of brands available, the option for foam vs. spring vs. hybrid, deciphering how a traditional top differs from euro and pillow top, considering if these tops even mattered.
For pillows, we had to choose between polyester vs. down/feathered vs. latex, consider whether we wanted memory foam and/or contoured shapes, and finally for both mattress and pillows, we had to choose our preferred firmness: extra soft, soft, medium soft, medium, medium firm, firm, extra firm.
Shopping for a better sleep system nearly short-circuited my brain and considering the average human being spends one-third of their lives sleeping (or 7-8 hour per day), and poor sleep negatively affects a person’s quality of life, it felt rather important that I get this right.1
If you’re reading this blog, you’re probably in the market for a new mattress or pillow. I hope this blog guides you through the process efficiently and successfully.
Selecting the Right Mattress to Prevent Neck and Back Pain
It’s pertinent that you select your mattress before your pillow because your body position on the bed will dictate the height or type of pillow that’ll work for you. If your mattress is softer, your body will likely sink more into the bed, leading to spinal column misalignment, and if it’s too firm, your body will sink less, resulting in inadequate support for your neck and shoulders.2 The purpose of a pillow is to optimize neck alignment, and since your neck bones are connected to your back bones, which is connected to your hip etc., picking the surface that’ll support the majority of your body first is highly recommended.
When selecting your mattress, you really only need to consider the following:
Fortunately, picking a mattress doesn’t have to be that hard. Based on the scientific literature, most people with back pain prefer a medium-firm mattress, thus making it a good starting point.
When purchasing a mattress, many stores will offer a trial period where if you aren’t completely satisfied after a certain number of days, you can reselect a new mattress based on your experience of the one that you trialed. If you found your medium-firm mattress too soft, choose the next firm option. If you found the medium-firm mattress too firm, choose the next soft option.
Using the above method to purchase your mattress is like trying on new shoes and buying based on feel. There’s nothing fancy in the decision-making process. But it doesn’t mean there aren’t technological options out there to inform your choice. Just as some retailers offer pressure mapping technology to guide shoe selection, so too do some retailers offer pressure mapping technology to guide mattress selection. Should a retailer offer this service, give it a shot. Make sure you take off any extra layers (like winter jackets) when lying down, so that the system can accurately detect areas of higher pressure. With your pressure map obtained, a sales associate might be able to make better recommendations.3-7
A 0.4-degree Celsius change in skin temperature can result in deeper sleep and the reduced likelihood of waking up in the middle of the night.8 Depending on whether you run hot or cold, you might want to consider whether a specific mattress protector is necessary. If you run hot, a cooling mattress cover can be considered. With that said, the best way to regulate your temperature at night is to manipulate your home’s thermostat settings or the thickness of your blanket. Temperature preferences are highly variable. My recommendation: set your thermostat to somewhere between 21-23 degrees Celsius and adjust your thermostat or blanket cover thickness based on feel.
Aside from these two factors, I couldn’t find any recent literature to support foam over spring over hybrid mattress. It seems the choice between euro and pillow tops boils down to your personal preference. Prioritize firmness and temperature regulation and you’ll be dreaming in no time.
Selecting the Right Pillow to Prevent Neck and Back Pain
There are two ways you can go about this, and it really depends on your preferences. Many mattress retailers also have a selection of pillows too, and if you have the budget for it, and don’t have the time to shop around, running through their selection to see what feels most comfortable might be the most efficient solution. However, don’t let the price tag fool you. Just because it’s expensive doesn’t mean it’s better.
When choosing your pillow, I recommend you consider the following: latex or polyester. For those who have neck pain, latex and polyester pillows have been shown to reduce waking neck pain, and improve sleep quality and pillow comfort scores, whereas feather and foam with or without a contour, had no significant effect on these metrics.9-10
Another factor to consider is pillow height and this largely depends on the mattress you sleep on and sleep position (stomach vs. back vs. side sleeping).11 Ideally, you want to maintain a neutral spine position and have a firmness that provides adequate support. Selecting the right pillow (from my experience) is more of a trial-and-error process that depends on your overall available range of motion (neck, back, hips etc.), age, sleep position preferences, mattress type, etc.
Firmness is another consideration but this boils mostly down to preference. Most of the time, I’ll ask my clients to try a polyester medium-firm pillow to start, then make adjustments according to this experience.
If you aren’t able to solve your waking neck pain after trying this, I’d recommend booking a Physiotherapy or Chiropractic assessment to determine whether a different recommendation needs to be made.
- DeVocht et al., App Ergon (2006)
- Jacobson et al., J Chiropr Med (2006)
- McCall et al., Appl Ergon (2012)
- Jacobson et al., App Ergon (2008)
- Kovacs et al., Lancet 362 (2003)
- Bergholdt et al., Spine (2008)
- Raymann et al., Brain (2008)
- Gordon et al., Man Ther. (2009)
- Gordon et al., J. Pain Res. (2010)
- Lei et al., Healthcare. (2021)
Wesley Lai, Physiotherapist
Wesley Lai is a registered physiotherapist practicing at Rebalance Sports Medicine in downtown Toronto.