Back shoulder pain sleeping pillow

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

Click here: Second Opinion Arthritis Treatment Kit



Patients with back pain, neck pain, and shoulder pain may all benefit from the use of a comfortable pillow.

Use of a pillow while sleeping has two main functions:

• Support: From a physical perspective, pillows prop up the head, neck and shoulders - keeping them in alignment, relieving pressure and counterbalancing the points in the body.
• Comfort: From a more subjective perspective, pillows create a feeling of comfort, which aids in getting a good night’s sleep and feeling well rested.


The traditional pillow is the mattress top pillow - used to provide support for the head, neck, and upper spine while the body is lying in bed in a resting position.

The human neck curves slightly forward (to sustain the weight of the head when upright), and it’s important to maintain this curve when in a resting position. If the height of the pillow is too high when sleeping sideways or on the back, the neck is bent abnormally forward or to the side, causing muscle strain on the back of the neck and shoulders. This type of position may also cause narrowing of the air pipe, resulting in obstructed breathing, and sometimes snoring, which can hinder sleep. Conversely, if the height of the pillow is too low, the neck muscles can also be strained.

Based on the body’s measurements and personal preference, the pillow should maintain a height of 4 to 6 inches, properly supporting the head and neck (and shoulders when lying on back).

A large part of what makes a good pillow is personal preference. If the pillow feels comfortable, it’s likely to help one relax, get a good night’s sleep, and feel well rested in the morning. The pillow's surface can also be a source of comfort - some people prefer a pillowcase with a cool, smooth feeling (such as cotton), some prefer warmth (such as flannel), etc.

To help the pillow conform to various sleep positions, it is best if the pillow can be adjusted to fit the unique shape and curves and sleeping position of the user. A pillow should mold to one’s individual shape and alleviate any pressure points.

One’s sleep position will dictate how a traditional mattress top pillow can be used to provide the appropriate support.

• Using a pillow while sleeping on the back. When lying on the back, a pillow should support the natural curvature of the cervical spine, with adequate support under the head, neck, and shoulders. When sleeping on the back, the height of the pillow should be lower than in the sideways position. Placing a pillow or two beneath the knees further alleviates any back strain, and is the gentlest position on the back.
• Using a pillow while sleeping on the side. When lying on one’s side, a pillow should support the head and neck such that the spine maintains a straight and natural horizontal line. Weight should be evenly distributed so as not to create unnatural bending or pressure. Some people may prefer placing a small pillow or rolled up towel under their waist while lying on the side for additional support.
• Using a pillow while sleeping on the stomach. If sleeping or resting on the stomach is preferred, the pillow should be relatively flat, or the head should rest directly on the mattress, so that the head and neck aren’t turned unnaturally to either side. In this position, it is often best to place another relatively flat pillow under the stomach to help the spine keep its natural alignment.


Over time, most pillows will begin to lose their firmness and no longer support the neck adequately. When the pillow has reached this stage, it should be replaced.

Some specialty pillows are designed to cradle the head and provide a gentle traction on the neck. This type of pillow is often useful for people with neck arthritis, particularly if they have severe pain radiating into the shoulder area.

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