Two of the most frequently asked questions from physiotherapy or chiropractic patients are “how do I choose a pillow,” and “how do I choose a mattress?” Mattress and pillow shopping is confusing because there are lots of choices, but once you understand what the pillow or mattress should be doing for you then it is less painful to choose one. It’s also important to note that a proper pillow and mattress combination can help improve neck pain or back pain and quality of sleep.
When do I need a new pillow or mattress?
  • Consistent waking in the night or morning with stiffness and pain in the shoulders or neck areas. Or waking with numbness and tingling in an arm, hand, leg or foot.  These problems can slowly build up over time and start out in a subtle way.
  • Difficulty getting comfortable in any position and restless poor quality sleeps.
  • And it’s been so long you can’t remember when you bought your pillow, or maybe it came with the cottage or you inherited it!
Both pillows and mattresses have two main purposes:
  1. To support and
  2. To cushion.
1. The pillow and mattress should provide optimal support
That means that it should support and maintain the natural alignment and curves of the spine (neck, mid back and lower back) and hips (in the case of a mattress) whether a person is on their front, side or back. It’s important to understand the normal posture and alignment of the spine when looking from the side as compared to looking from the front or back. The natural posture of the spine is as follows. When looking from the side, the neck (cervical spine) curves forward towards the throat. The midback (thoracic spine) curves backwards and the low back (lumbar spine) curves forward towards the stomach. See diagram below:
Diagram 1
    
With proper alignment and good posture the head sits directly on top of the shoulders, not poking forward as if to guide a person around corners.
When looking from the back the spine should be straight and perfectly vertical with no curves. See diagram above.
Side Sleeping
Now let’s look at how the mattress and pillow should support the natural spinal curves and alignment by looking at a person on their side lying on the floor. In picture 1 below, the spine is normally aligned as shown with the black line. The back and neck are lined up as if the person was standing. Note that the space between the ribs and the hip indicated by the arrow should be filled in with the support from a good mattress. And the space between the neck/head and floor is filled in with the pillow.
                                                                                                Picture 1
A proper pillow will keep the head and neck lined up in a natural and neutral position. This is where the head, neck and back all line up in a straight line.
Notice in picture 2 below that the black line outlines where a proper pillow support fills in the space between the head, face, neck and the mattress. The pillow follows the body shape in three dimensions to keep a straight line between the head, neck and hips. A proper mattress will allow the body to sink into it just enough to allow the natural position of the spine to be supported as shown in picture 2 below:
 
Picture 2
Back Sleeping
Pillows
For back sleepers the pillow needs to support the natural curve of the neck while cradling the head all in a neutral and natural alignment. See picture 4 below. A proper alignment means the ear opening/canal is lined up with the tip of the shoulder like the straight black line. The thickness, shape and firmness of the pillow with determine how the head and neck are positioned. A proper pillow will follow the shape and contour of the black line below filling in the space between the neck and the mattress (floor). It also allows the head the sink into the pillow to provide a depression for the head to be cradled in.
How to Buy a Mattress
Mattresses
When sleeping on the back, let’s look at how the mattress should support the natural spinal curves and alignment by looking at a person lying on the floor. In picture 4.1 below, the spine is normally aligned. Note that the space between the ribs and the hip indicated by the arrow should be filled in with the support from a good mattress.
                                                                                                 Picture 4
A proper mattress will allow the body to sink into it just enough to allow the natural position of the spine to be supported as shown in the below picture 4.2:
                                                                                                 Picture 4.2
Stomach Sleeping
DON’T EVER EVER DO IT!!
Firm vs cushioned pillows and mattresses are more of a preference as long as the above rules are followed.
Sleep is so important to our quality of life, so consider your sleeping arrangements if you are not happy with yours:)
Dr. Meghan