Quick Answers
When should I replace my pillow? Synthetic every 1-2 years, down every 2-3 years. Quick test: fold it in half. If it doesn't spring back on its own, it's done.
In This Article:
What height for side sleeping? You need a thicker pillow (4-6 inches) to fill the gap between your shoulder and head. Your spine should stay straight, not angle up or down.
Memory foam or down? Memory foam is consistent and hypoallergenic. Down is softer and lasts longer but needs fluffing. Depends on whether you like firm or squishy.
The RMT's Pillow Guide: What to Tell Clients Who Keep Asking
Quick Answer: The "best pillow" depends entirely on sleep position and body mechanics. For side sleepers, recommend a pillow thick enough to fill the gap between ear and mattress (usually 4-6 inches). For back sleepers, a thinner pillow that supports the cervical curve without pushing the head forward. For stomach sleepers, the thinnest possible option, or consider retraining sleep position. The goal is neutral spine alignment, not a specific brand or material.
š 16 min read
A practical guide from 38 years of sleep consultations in Brantford
Reading Time: 8 minutes
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 Mechanics That Matter
A properly fitted pillow maintains the natural cervical lordosis (the slight inward curve of the neck) regardless of sleep position. When this curve is lost or exaggerated, the posterior neck muscles work overtime to stabilize the head. After 7 hours of this compensation, your client wakes up with the same tension patterns you just released.
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.
The 30-Second Version for Your Clients
- Side sleepers: Thick enough to keep your ear level with your shoulder. Usually 4-6 inches.
- Back sleepers: Thin enough that your head doesn't push forward. Usually 2-4 inches.
- Stomach sleepers: As thin as possible, or none at all. Consider changing positions.
- Combination sleepers: This is tricky. A medium-loft adjustable pillow, or separate pillows for different positions.
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.
A Note on Local Climate
Brantford summers can get humid, and our winters mean dry furnace heat. Clients who sleep hot should consider breathable materials like latex, buckwheat, or pillows with cooling gel layers. Memory foam tends to trap heat, which can increase tossing and turning.
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
What pillow do massage therapists recommend for neck pain?
Most RMTs recommend a pillow that maintains neutral cervical spine alignment for your specific sleep position. For side sleepers, this typically means a medium-firm pillow 4-6 inches thick. For back sleepers, a thinner pillow (2-4 inches) that supports the cervical curve without pushing the head forward. The goal is keeping the spine aligned, not a specific brand or material.
How do I know if my pillow is causing my neck pain?
If you consistently wake with neck stiffness that improves throughout the day, your pillow may be the issue. Check your sleep position against pillow height: side sleepers need enough loft to keep ears level with shoulders, back sleepers need minimal loft to avoid forward head position. Pillows older than 3 years have often lost their supportive properties.
Should RMTs sell pillows to clients?
This varies by practitioner preference and regulatory guidelines. Many RMTs choose to recommend rather than sell, directing clients to stores where they can test options. Some keep a few quality pillows available for clients who want immediate solutions. Either approach works as long as recommendations are based on the client's specific needs rather than profit margin.
What's the best pillow material for neck support?
Latex generally provides the most consistent support over time, maintaining loft without the heat retention of memory foam. However, "best" depends on sleep position, body temperature preferences, and budget. Memory foam conforms well but sleeps hot. Buckwheat is adjustable and breathable. Water pillows allow precise customization. The best material is the one that maintains proper alignment for that individual.
How long does a pillow last before it needs replacing?
Most pillows lose their supportive properties within 2-3 years of regular use. Quality latex pillows can last 4-5 years. Memory foam typically compresses and loses responsiveness within 2-3 years. Down and synthetic fills often flatten within 1-2 years. If you can fold a pillow in half and it doesn't spring back, it's past its useful life.
Pillow Buying Guide: Match Your Pillow to How You Sleep
Your pillow affects neck alignment as much as your mattress affects spinal alignment. The wrong pillow creates neck strain that leads to morning stiffness, headaches, and poor sleep quality. The right pillow keeps your neck neutral, and what's right depends entirely on how you sleep.
The Goal: Neutral Neck Position
Whether you're on your back, side, or stomach, the goal is the same: keep your neck as neutral as possible. Your head shouldn't be pushed up too high or allowed to fall too low. The pillow fills the gap between your head and the mattress, and that gap varies by sleep position.
Research shows that pillow height directly impacts neck pain. For the average adult, mid-range pillow height (about 10 cm) produces the lowest neck muscle strain and highest comfort ratings. Very low or very high pillows lead to significantly greater muscle activation and strain.
Pillow Needs by Sleep Position
Side Sleepers
Side sleepers have the largest gap to fill between their head and the mattress because their shoulder creates space. You need a thicker, firmer pillow, typically 5-7 inches of loft depending on your shoulder width. The pillow should fill the gap so your spine stays straight from tailbone to skull.
A pillow that's too thin lets your head drop toward the mattress, straining the upper neck. Too thick pushes your head up, straining the opposite direction. Neither is good.
Back Sleepers
Back sleepers need moderate height with neck support. About 4-5 inches of loft works for most people. Memory foam pillows with a contoured shape can work well, supporting the natural curve of your neck.
Too thick a pillow pushes your chin toward your chest, straining the back of your neck. Too thin and your head falls back, straining the front.
Stomach Sleepers
Stomach sleeping is hardest on your neck regardless of pillow. Your head must turn to one side, creating inherent strain. If you stomach sleep, use the thinnest pillow possible or no pillow at all. Consider transitioning to side or back sleeping for better long-term neck health.
Pillow Materials
Memory Foam
Contours to your head and neck shape. Good for consistent support but can trap heat. Solid memory foam pillows maintain their shape longer than shredded versions.
Shredded Memory Foam
Adjustable loft because you can add or remove fill. More breathable than solid foam. Good for people who need customizable height.
Latex
Responsive, bouncy, and naturally cooler than memory foam. More durable than other materials. Higher price point but longer lifespan.
Down and Feather
Soft and moldable but compress over time and need frequent fluffing. May not provide consistent support for neck issues. Good for stomach sleepers who need very low loft.
Down Alternative
Mimics down feel at lower cost and without allergy concerns. Compresses faster than down but more affordable to replace.
Signs Your Pillow Is Wrong
- Wake up with neck pain or stiffness that wasn't there when you went to bed
- Morning headaches
- Constantly adjusting your pillow throughout the night
- Numbness or tingling in arms or hands
- Pillow doesn't spring back when folded in half
Additional Support Tips
Body Pillows
Help maintain side sleeping position and prevent rolling onto your stomach. Can improve full-body alignment.
Pillow Between Knees
For side sleepers, prevents the upper leg from pulling the spine out of alignment. Reduces hip and lower back strain.
Pillow Under Knees
For back sleepers, relieves lumbar pressure by reducing the curve in the lower back.
Pillow Lifespan
Pillows don't last forever. Over time they compress, lose shape, and become less supportive. They also accumulate allergens. Replace pillows every 1-2 years for synthetic fills, 3-5 years for quality memory foam or latex. The fold test: if your pillow doesn't spring back when folded in half, it's time to replace it.
Try Before Buying
Like mattresses, pillows are personal. What works for one person's neck doesn't work for another's. At our Brantford store, you can test different pillow types and heights. Bring your sleeping position preferences and any neck issues you're experiencing. We'll help you find something that actually keeps your neck happy.
Mattress Miracle: complete sleep solutions since 1987.