The RMT's Pillow Guide: What to Tell Clients Who Keep Asking

You know the moment. You've just spent an hour working on a client's upper traps and levator scapulae. The tissue is finally releasing. They're feeling better than they have in weeks.

Then, as they're getting off the table: "So what pillow should I buy?"

It's the most common question in manual therapy. And honestly, it's not easy to answer in 30 seconds while your next client is waiting. So here's everything we've learned from 38 years of helping people in Brantford find the right pillow, distilled into something you can actually use.

Why the Pillow Question Matters

You already know this, but it bears repeating: your clients spend 6-8 hours every night either supporting or undermining the work you do. A pillow that throws the cervical spine out of alignment can undo a week's worth of treatment in a single sleep cycle.

The frustrating part? Most clients think pillow selection is about comfort preference. Soft versus firm. Memory foam versus down. But you and I both know it's about biomechanics.

The Sleep Position Framework

Here's what we tell people when they ask, broken down by how they actually sleep.

Side Sleepers (The Most Common)

Side sleeping is mechanically the most demanding on pillow selection. The pillow needs to fill the entire space between the ear and the mattress surface, keeping the cervical spine parallel to the bed.

The quick assessment: Have your client lie on their side on your treatment table. Measure the distance from the outer edge of their shoulder to the side of their head. That's roughly the pillow loft they need.

For most adults, this is 4-6 inches. Broader shoulders need more loft. Narrower frames need less. A pillow that's too thin lets the head drop toward the table, shortening the upper traps and scalenes on one side. Too thick, and the head tilts upward, creating the same problem on the opposite side.

What to recommend: Medium-firm to firm pillows that won't compress too much under head weight. Latex holds its loft better than memory foam for side sleepers. If they're on a tight budget, a firmer polyester fill works reasonably well.

Back Sleepers

Back sleeping is more forgiving, but the common mistake is using a pillow that's too thick. This pushes the head forward, flattening the cervical curve and loading the posterior chain.

The quick assessment: When lying supine, the client's ears should be roughly level with their shoulders, not pushed forward. If you can see obvious forward head posture in supine, their pillow is too high.

What to recommend: A thinner pillow (2-4 inches) with a slight contour or built-up area under the neck. Cervical pillows with a roll design can work well here, though some clients find them uncomfortable at first. Water pillows are adjustable and surprisingly effective for back sleepers who need to fine-tune their support.

Stomach Sleepers

You already counsel against this position. The cervical rotation required creates exactly the dysfunction patterns you're treating. But some clients won't change.

What to recommend: The thinnest pillow they can tolerate, or a very soft, compressible option. Some stomach sleepers do better with no pillow at all under their head, with a thin pillow under the pelvis instead to reduce lumbar hyperextension.

The real recommendation is sleep position retraining, but that's a longer conversation.

Material Considerations

Clients often ask about specific materials. Here's the practical breakdown:

Memory foam: Conforms well but retains heat and can compress over time. The slow response can be problematic for combination sleepers who change positions at night.

Latex: More responsive than memory foam, naturally cooler, holds loft better over time. Good for side sleepers who need consistent support. Higher upfront cost but longer lifespan.

Buckwheat: Adjustable and breathable. Clients can add or remove hulls to customize loft. The rustling sound bothers some people. Good for hot sleepers and those who want precise customization.

Down and down alternative: Soft and compressible. Generally not ideal for side sleepers who need more support, but can work for back sleepers who prefer a traditional feel.

Water pillows: Adjustable support by changing water level. Can provide good cervical support for back sleepers. The weight is a consideration for some.

When to Recommend Specialty Pillows

Some situations call for specific solutions:

Cervical pillows with contours: Can help back sleepers with forward head posture, but require an adjustment period. Warn clients they may feel worse for 1-2 weeks before feeling better as tissues adapt.

CPAP-compatible pillows: Clients with sleep apnea on CPAP therapy need pillows designed with cutouts for their mask. Standard pillows can break the seal and reduce treatment effectiveness.

Orthopedic or therapeutic pillows: Often appropriate for clients with diagnosed conditions, post-surgical patients, or those with chronic pain patterns that standard pillows can't address.

The Mattress Variable

Pillow selection doesn't happen in isolation. A client's mattress affects what pillow they need.

Softer mattresses let the shoulder sink in more during side sleeping, which means less pillow loft is needed. Firmer mattresses keep the shoulder elevated, requiring more pillow height to fill the gap.

If a client recently changed mattresses and is suddenly experiencing neck issues, the pillow they've used for years might no longer be appropriate.

Setting Realistic Expectations

Here's what we tell clients, and you might find it useful:

There's an adjustment period. Any pillow change, even to a "better" pillow, takes 1-2 weeks of adaptation. The body has accommodated to the old pillow's positioning, and tissues need time to adjust. Clients should expect some initial discomfort.

One pillow doesn't last forever. Most pillows lose their supportive properties within 2-3 years, though quality latex can last longer. If a client says they've had their pillow for 7 years, that's part of the problem.

Testing matters. This is why we invite people to actually try pillows in our showroom. Lying on a pillow for 5-10 minutes in their typical sleep position tells you more than any product description.

What We See in Our Showroom

After nearly four decades of pillow consultations, some patterns emerge:

Most people are sleeping on pillows that are too old, too flat, or the wrong height for their sleep position. The client who comes in complaining of morning neck stiffness often has never thought about pillow loft in relation to their shoulder width.

Side sleepers almost universally need more pillow than they think. Back sleepers almost universally need less. Stomach sleepers need to hear, gently, that their sleep position is working against them.

The clients who do best are the ones who understand that pillow selection is about spinal alignment, not just comfort preference.

Frequently Asked Questions

Related Reading

• Best Organic Pillows Canada: Natura Latex Pillows Brantford
• Natural Latex Pillow Canada: Complete Buyer's Guide 2025
• Best Pillow for Side Sleepers: Natura Organic Options
• Hockey Parent Survival Guide: Sleep Recovery
• Why I Love Mattress Miracle Pillow Collection