Choosing the Right Pillow for a Healthy Neck: An Osteopath’s Perspective

One of the most common questions I get asked in clinic — often as patients are lying down for treatment — is, “What’s the best pillow for my neck?” It’s an excellent question, but one without a simple answer.

The truth is, there’s no one-size-fits-all pillow. The best pillow for your neck is the one that supports your individual anatomy and sleeping position, and that’s where things get interesting. From memory foam marketing claims to pillow stackers struggling to get comfortable, the world of neck support is a minefield.

Let’s break it down.

The Golden Rule: Fill the Gap

The key function of a pillow is to fill the gap between your head and the mattress, so that your neck remains supported and aligned — whether you’re lying on your back or side.

This gap varies significantly from person to person. A broad-shouldered adult will need a deeper pillow in side-lying compared to someone with a narrower frame. And when sleeping on your back (supine), the height needed is usually lower, but still essential — especially for the base of the neck.

Far too many people are sleeping with either too much height (stacking two or three pillows, forcing the head forward) or not enough support (allowing the neck to drop and strain). Neither option is ideal.

What Affects Pillow Choice?

When helping patients choose a suitable pillow, here are a few factors I always consider:

• Body shape and shoulder width
  The wider the shoulders, the deeper the gap when lying on your side — meaning a thicker pillow is usually needed.

• Sleeping position
  Back sleepers need less height than side sleepers. Stomach sleeping isn’t recommended for neck health, but if unavoidable, a very flat pillow (or none at all) is advised.

• Spinal health and age
  A young, flexible spine may tolerate more variety. But an older or osteoarthritic cervical spine has reduced passive mobility and may be more sensitive to poor pillow support — often becoming stiffer and more painful by morning.

• Mattress firmness
  A firm mattress doesn’t allow your shoulder to sink as much, increasing the gap between your head and mattress. A softer mattress may require less pillow height.

Neck pain exacerbated by poor pillow set up is a common complaint.

Side to Back… in One Night?

Here’s the catch: most people change position several times during the night. So how do we support the neck in both side and back sleeping?

A good quality contour pillow or adjustable pillow system may help here. But often, simply using two thin pillows — which together equal the right depth — can provide better adaptability than a single, rigid option.

Memory foam and orthopaedic pillows can be helpful, but they’re not a guaranteed solution. A pillow that’s too firm or shaped incorrectly for your body can make things worse.

How Often Should I Change My Pillow?

This one surprises people: experts recommend changing your pillow every 1–2 years — not just for structural support but for hygiene.

Pillows accumulate sweat, dust mites, bacteria and dead skin over time, which can trigger allergies and affect your sleep quality. If your pillow looks limp, smells musty, or no longer bounces back, it’s time for an upgrade.

How to Dispose of Old Pillows Responsibly

If you’re replacing your pillows (as recommended every 1–2 years), don’t just throw them in the bin. There are more sustainable options:

• Donate to animal shelters
  Many rescue centres and kennels accept old pillows, cushions, and duvets for pet bedding. Be sure they’re clean and in decent condition first.

• Repurpose at home
  Use them as stuffing for DIY projects like floor cushions, pet beds, draught excluders, or padding for storage and transport.

• Recycle textiles
  Some local councils and recycling centres offer textile recycling schemes where pillows are accepted. Check your area’s guidelines.

• Compost the filling
  If your pillow is made with natural materials like feathers, down, or wool, you can compost the filling. Just remove any synthetic fabric first.

• Upcycle creatively
  Turn old pillows into kneeling pads for gardening, extra padding in the car, or insulation for outdoor structures like sheds.

Recycling or repurposing your old pillows helps reduce textile waste and gives your items a second life.

Final Tips for Choosing a Pillow

• Focus on support, not brand hype.

• Lie on your side — can you draw a straight line from your head to your spine?

• Use thin pillows doubled up to test different heights before investing in a new one.

• If you wake with neck pain or stiffness, your pillow may be part of the problem.

• And remember — comfort isn’t the same as support.

When in Doubt — Ask Your Practitioner

At The Waterside Practice, we regularly advise patients on sleep posture and pillow choices based on their clinical presentation. If you're unsure whether your current set-up is helping or hindering your recovery, bring it up at your next appointment.

Because the right pillow isn’t just about comfort — it’s about giving your neck the support it needs to rest, repair, and stay pain-free.