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Pillows and mattresses for back and neck pain

Given that we spend between 5-9 hours in bed each night you would expect that getting the right pillows and mattresses for back and neck pain patients would be very important. I am often asked which are the best pillows and mattresses for back and neck pain patients, but the truth is there isn’t necessarily a best one. There are some that are more likely to be right for you than others.Whilst I cannot give individualised advice in a short article, we can use a recently published paper to shine a bit of light into the murky waters of treating back pain.


Mattresses come in many different forms, pocket sprung, memory foam, gel, water, air, latex, adjustable, the choice can be startling and rather confusing. Ultimately you want something that will allow you to remain supported in a neutral position throughout the night, either on your back or your side. Too hard and there will be pressure points around your coccyx and mid back, too soft and the curves of your spine won’t be properly supported.
The firmness level of the mattress you require depends on your weight and shape. If you are a side sleeper and your hips are wider than your shoulders, you will want a softer mattress. For those side sleepers whose shoulders are as wide, or wider than their hips then a firmer mattress is likely to be better. If you are a side sleeper it’s a good idea to alternate which side you sleep on so that you aren’t always putting pressure on one side of your body.


A good pillow can also make the difference between a good night’s sleep and a disturbed night of plumping up feathers every couple of hours. Feather pillows tend to be very supportive and comfortable when new but do tend to loose some of that support over time. Foam or other synthetic fibres can provide good support but they can sometimes be very firm and rigid or very soft and provide little support.

When sleeping on your back your make sure the pillow supports your head and fills the gap in the curve of your neck. You do not need the pillow to go down to your shoulder blades and generally one medium sized pillow should be enough to keep your head and neck in a neutral position. If you are a side sleeper you need a thicker pillow, especially if you have broad shoulders; as the distance between the tip of your shoulder on the mattress and the side of your head and neck needs to be supported to remain in a neutral position. This may require two small to medium sized pillows or one large one.

The price discrepancy in mattresses and pillows is enormous. Buying the most expensive won’t necessarily guarantee a good nights sleep but better quality products are more likely to give you more lasting support. The key is to buy a product that has approximately the right specifications for you and make sure you try them out. Most shops will offer a service that allows you to exchange your mattress or pillow if you aren’t happy with them and some will allow you to test their pillows out before buying.


Many people will say that their husband or wife likes or needs a different kind of mattress to their own preference or requirement. In this situation, if you can, it is worth considering a king sized bed frame which often allows 2 single mattresses to be put together. This then allows a double bed to be created with different levels of firmness and support on each side.

When looking at what the science tells us the first systematic review investigating the effect of mattresses on chronic low-back pain concluded that there is no high quality evidence to currently support use of a particular type of mattress for the treatment of chronic low-back pain. The authors went on to state that based upon the current body of evidence, we are still truly unable to advise patients on what is the best mattress for them to purchase or indeed if mattresses have any real effect in managing chronic low-back pain. Do not despair at this synopsis; it’s often hard to reach a firm conclusion about a problem as diverse as back pain. This just means that you don’t have to believe the marketing and advertising that says the most expensive new mattress is definitely the best. It doesn’t mean that a new pillow or mattress won’t be helpful to you. If your mattress is worn out it may make a big difference.

My final word of advice is; think like a scientist. If you are having a bad episode of back pain for which you are having regular treatment or rehabilitation or you are taking painkillers that you wouldn’t normally be taking, this may not be the time to change your mattress. There are too many variables in these situations to say which intervention is or isn’t helping you. Wait until your routine and daily life is as normal and if the mattress or pillow still isn’t right then it might be time for a change. If you are having treatment you can always ask your healthcare professional for some advice.

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