From 1996 to 2016, US healthcare spending increased from $1.4 trillion in 1996 to $3.1 trillion, according to a 2020 study in the journal JAMA. Low back and neck pain accounted for the highest amount of health care spending, $134.5 billion. These expenses were paid by private ($77 billion) and public ($45 billion) insurance as well as out-of-pocket ($12 billion).

While lifestyles, age, and genetics play big roles in our low back and neck pain, so can pillows. We recently sat down with Dr. Hanna Gierman, DPT for some pillow talk.


What are the most common types of neck pain or conditions? 

  1. Hypomobile means that a person lacks mobility at the joints or vertebrae. This usually happens as we age and with the onset of osteoarthritis, which occurs when ligaments stiffen or our discs lose height. Surgical procedures like spinal fusions can cause reduced mobility too, as the joints are being fused to limit motion.
  1. Hypermobile means that a person has too much mobility at the joints or vertebrae. Too much mobility is the result of laxity of the ligaments, which stabilize and connect the bones. This may be how an individual was born (think of whether you or someone you know has “double joints”) or it may be the result of physical trauma, such as a car accident, fall, sports injury, etc. Oftentimes with this category, an individual suffers from chronic neck tension and muscle spasm, as the muscles try to help the ligaments stabilize the vertebrae.
  1. Radiculopathy refers to burning / tingling / numbness that radiates down the arms and into the hands. There are various causes of this condition. Individuals with this presentation typically fall into one of the other four categorizations of neck pain as well. Frequently, hypermobility can be at the root of the problem. Other causes include disc herniation and nerve entrapment. 
  1. Postural neck pain is on the rise in today’s society, as we see increased time spent in a forward head position. Constant use of smart phones and working in front of computers all day contribute to the development of spasm and overuse of our neck musculature. The more activated the front of our body is, the shorter and more tense the muscles become over time. This also contributes to the imbalance in the muscles at the back of our body, as they can become lengthened and weaker. Spasm in the muscles of the neck can also lead to the development of headaches, referred to as cervicogenic headaches.

Again, you may fall into one category or find that you are a mix. A physical therapist is well-trained to help determine what your presentation is, as well as establish a plan of care to help reduce your pain and restore proper function.


What’s the best sleeping position for neck pain?

Let me start by saying that I never want to tell someone that they can’t sleep in a certain position. I myself am a side-sleeper. However, there are optimal ways to position your body if you are going to sleep on your side, which I’ll save for the future.  

For those who sleep on their stomach, we really want to be mindful of how that position affects our neck. Stomach sleeping puts increased pressure on the discs and muscles in the neck because stomach sleeping requires that the neck be turned. When we are asleep, we are not moving in and out of positions as frequently as we are when awake. This causes the muscles on the turned side to remain in a shortened position and the disc to be compressed unevenly. Additionally, if we are asleep in an uncomfortable position and do not realize it, our brain may miss or experience a delay in the signal to move.

Quality of sleep is crucial for all types of healing. Sleep allows for our parasympathetic nervous system to engage (“rest and digest”). Regardless of our pain status, we all want to ensure that we are benefitting from a good night’s sleep for optimal health and wellness. When we do bring acute and chronic neck pain into the picture, a good night’s sleep becomes even more important to relieve our sympathetic nervous system (“fight or flight”). Individuals that are experiencing pain also experience increased activation of the sympathetic nervous system, which is triggered by our brain when we receive threat signals. Pain is the threat signal in this scenario. When our sympathetic nervous system doesn’t take a break, our quality of sleep suffers. 

Alignment is also a key component to improving the quality of our sleep and assisting the parasympathetic nervous system to activate. This is where choosing a pillow based on which pain category you fall into can be helpful. 


What’s the best type of pillow for most neck pain?

Pillows are tricky, because there are a number of factors that come into play when introducing something new or different to a person’s daily routine. When making a lifestyle recommendation, I consider the person sitting in front of me: 

  • Do they currently use a soft mattress or a firm mattress?
  • Does the description of “very firm” or “very soft” deter them when it comes to a pillow?
  • How open to new experiences are they? 
  • What is their financial situation?
  • Will they be comfortable making this kind of purchase?

Based on my experience with my own patients, I have found that those who suffer from hypermobility (typically due to whiplash, physical trauma, lax ligaments at birth) really like firm, supportive pillows. The idea is that this population needs support to keep them in alignment, which Hullwinkle pillows provide. By contrast, this population tends to struggle with softer pillows. Softer pillows have enough give to them that may allow the patient’s neck to move a few inches into extra extension (sleeping on back) or lateral flexion (sleeping on side). While asleep, minor movements throughout the night in an unsupported position can initiate or amplify an existing muscle spasm, further increasing discomfort.

I have also seen the opposite be true for those with hypomobility (typically our aging population with arthritis and fusions). Those with less mobility in their neck seem to feel “stuck” when sleeping on a firm pillow. I have received feedback indicating that those with less mobility in their neck prefer softer pillows that have more “give” to them. 


At Hullwinkle, we’re on a mission to help sleep enthusiasts live and play better. How hard is your pillow working for you?