Frequently Asked Question

Hey guys, Dr. Lloyd here coming from Rincon chiropractic, chiropractic office in San Francisco, California. And today I’m going to address a question I get asked a lot by my own patients. My patients often asked me, Doc, what is the best pillow for me? And it’s a really tough question to answer oftentimes because it’s such an individual thing. So this morning, I spent my time going over doing a review of the literature, seeing what published reports on PubMed had to say about pillow selection, and what would be best for you and your neck pain. And the answer with that is it depends and it’s hard to choose. But first of all, in the literature, a pillow is not called a pillow. It’s called sleep support. So in the medical literature, the job of the pillow is not to be comfortable for you, it’s there to support your head and neck. So in terms of pain relief for the your neck, or the relief of your tension headaches and migraine headaches, we’re looking at a pillow as support. It’s gonna support you throughout the whole night. The interesting thing I found out about this this morning is tach. Humans have no active control over your posture and your neck position while you are asleep. So when you’re sleeping, and you don’t have very good pillow support, your neck is gonna go to the side, it might fall back into extension, like go into flexion and that is going to cause problems for your neck. And you don’t have this built in mechanism to reposition your neck, unless things get painful right away. So therefore, a supportive pillow is necessary. And this sort of support is particularly necessary if you have neck pain, or if you have a neck injury that you’re dealing with. Now a neck injury can be acute, something that just happened, or it could be chronic, some injury that you had years ago, can be an old car accident, could be an old sports injury, something where you whipped your neck around to damage some of the structures in there. So humans have no active control. Side bending in particular is very vulnerable to neck damage overnight. So you can have a lot of range of motion in your neck when it comes to flexion and extension. But when it comes to side bending, that’s when you lose a lot of that range of motion. If you have arthritis in your neck, you even have less Have that side bending range motion. side bend is important because if you if you bend your neck to one side, you’re going to shut down half the muscles that support your neck while the other half have to take up the posture control the discs in between the bones in your neck. They also become vulnerable to side bending. If you bend the one side on that long the discs because there there’s no gravity compressing them will balloon up with fluid overnight on one side and when you wake up in the morning you might have this compressive kink in your neck which can be very painful. If it’s not the disc material, it can be the rosette joints in the back of the neck. So in the front of the neck, you’ve got discs that support one third of your the weight of your head and neck on each side of the discs in the back of the neck. One third is on the left facet joint And when third is on the right facade joint, bending your neck all night long to one side can make one of your facade joints open up and becoming gorgeous fluid also. So when you wake up in the morning, you try to put gravity back on that, that swollen for set joint that can cause a lot of pain. And it will make your muscle spasm around your neck as the muscles try to guard what’s going on in there. So these abnormal mechanical forces on the neck happen with side bending. So that’s one of the reasons why sipping on your site is not as good as sleeping on your back. You need to use your pillow as support. It keeps your neck neutral. So we recommend that you find a pillow that supports your neck and your head throughout the night properly. And as you can see on this graphic, when you’re sleeping on your side with a good support under your head, neck, yourself Find remains in a flat inline position. It’s not bending to one side or the other. The wrong pillow will allow your neck to flat to hang to one side. Either too much support pushing your neck up or too little support allowing your neck to flop to one side and this will compress or pinch pain sensitive structures. So what’s the best pillow? The best pillow is known. Some of the studies today were pretty equivocal about what kind of pillow you should have. Down pillow, down alternative feather pillow, cotton pillow, polyester or manmade materials memory foam pillows or latex pillows like a purple pillow that has a matrix of latex that supports your neck. Most of the stays kind of lean towards the newer kinds of materials for better neck support. They don’t like the feather pillow supports and actually when they did some studies comparing the two kinds, or or two or three kinds, that people who had feather pillows tend to drop out of the studies because it’s so uncomfortable. So pretty interesting to me because I used to have it down till I really like had lots of support. But the literature says otherwise, still, by and large, the studies are equivocal and what they really recommend is try to find the pillow that is most comfortable for you. If you’re sleeping in your pillow, sipping on your pillow at night, and it feels good to you, then you found that good pillow for you. If you’re sleeping on your pillow at night, and it doesn’t feel good, you still waking up in the morning with a with pain in your neck, pain in the shoulders. one of two things could be happening. You might have the wrong pillow, but it might not help So matter what kind of pillow you have because you have other forces in your life, other factors in your life that is creating neck pain or headaches or or shoulder tension. So once you found the pillow that you’re comfortable with though, you need to also observe some good basis for good sleep. And here they are. We recommend that you either sleep on your back or on your side. Now the pervert position is being on your back, but with a pillow that is too thick. You can see on the graphic that the is is causing this person’s neck to go too far in the flexion. Again compressing sensitive structures or pinching or pulling sensitive structures. The graphic on the bottom shows that the spine is in neutral and the neck has some support. cradling the neck and cradling the skull to allow that support to last throughout the night. The second best position to sleep in is to be on your side. And again, you need to have the right amount of support for your neck when you’re on your side. If you’re a side sleeper, you have slightly a slightly thicker pillow compared to when you are a back sleeper. And the reason is because you have to overcome this distance between your shoulder and your neck. It’s gonna be a little bit thicker. You don’t need this much distance when you’re on your back. Again, the same principle applies when you are sleeping. You should strive to have a neutral spine the whole time. What’s not good for your neck is to sleep on your stomach. You know why? Because when you’re on your stomach, you have to turn your neck off Let long to breathe. It’s not comfortable to breathe into your pillow. So you turn your neck and it’s usually always to the same side. Sometimes when the patient comes to my office, I’m feeling their neck. I can feel a prominent C to bone on one side compared to the other and I can always kind of tell that there is a side sleeper or a bat or a stomach sleeper, because they have to have your neck turned all night long. And it’s always that one direction. So we don’t recommend sleeping on your stomach. Even though that’s a hard habit to break the summarize what the literature says about using a pillow. This study published in 2019 by bester, and others say current studies investigating the best properties of a pillow indicate that pillows must be supportive. So as to decrease the bounce rate. stress on the cervical spine, your neck during sleep. Pillows must be of intermediate height somewhere in between the extremes and must be made of a material that does not result in excessive pressure. So, I hope that answers your question about what kind of pillow to use. It depends. I’ve got my favorites. I’ll do another video on reviewing some of the pillows I’ve tried over the years and some of the pillows that my patients have tried over the years to. Again for me personally, I like the decor pillow it’s a pillow. It’s got a cotton feeling fill in it and it’s got this D shape cut out of it, which allows you to to drape your neck over the supportive part and cradles your head and neck all night long for good support. The downside to that one as always too. In the beginning it was too firm. And it put a lot of pressure on your skin. So whenever I turned my side to sleep on my side, there was a lot of pressure pushing into my face. And that can bring job problems and create headaches in its own way. So stay tuned for my next video. I’m going to review some of those other pillows to Dr. Lloyd from Rincon chiropractic in San Francisco.