Proper pillow placement ensures the spine maintains a neutral alignment while the body is at rest. This means the natural curves of the neck and back, particularly the cervical and lumbar regions, are supported and not forced into an unnatural position. A pillow’s primary function is to fill the space between the head and the mattress, keeping the head level with the rest of the spine. Achieving this balance reduces strain on muscles, ligaments, and discs, promoting restorative sleep and preventing morning aches. Optimal placement depends entirely on the position in which a person sleeps.
Pillow Placement for Back Sleepers
For back sleepers, the correct head pillow should support the neck’s forward curve without elevating the head excessively. The pillow should be medium-firm and low-loft, keeping the head and neck aligned with the chest and upper back. The goal is to fill the space created by the neck’s natural curve to prevent the neck from flattening or tilting backward.
The main pillow should be tucked just above the shoulders, ensuring the shoulders do not rest on the pillow, which would push the head forward. This positioning helps maintain neutral cervical alignment.
A small pillow or bolster should be placed directly under the knees. This slight elevation causes the pelvis to rotate backward, gently flattening the lower back against the mattress. This action helps maintain the natural inward curve of the lower back and can reduce pressure on the intervertebral discs.
Pillow Placement for Side Sleepers
Side sleeping requires a pillow that is thicker than what is used by a back sleeper to fill the gap between the ear and the shoulder. This head pillow must be firm enough to keep the neck perfectly straight, ensuring the cervical spine remains in a neutral position. The thickness, or loft, should match the distance from the side of the head to the outside edge of the shoulder, often requiring four to six inches.
The placement of a second pillow between the legs is important for maintaining lower body alignment. Without support, the upper leg tends to fall forward, rotating the pelvis and twisting the lower back out of alignment. Placing a firm pillow between the knees and thighs keeps the hips stacked vertically, preventing this rotation and reducing strain on the hips and lumbar spine.
Side sleepers can further optimize their posture by hugging a body pillow, which prevents the upper arm and shoulder from collapsing inward. This full-length support maintains alignment from the neck down to the hips. The combination of the thick head pillow and the knee/body pillow ensures the spine remains straight along its entire length.
Strategic Support for Spinal Neutrality
Stomach Sleeping Support
Stomach sleeping is generally discouraged due to the extreme rotation required of the neck. Head support should be minimal, using a very thin pillow or no pillow at all. The primary pillow placement is a thin cushion positioned under the abdomen and pelvis. This prevents the midsection from sinking too deeply, which would cause the lower back to arch excessively and strain the lumbar spine.
Therapeutic Elevation
Pillows are also used strategically to manage specific health concerns by providing elevation. For conditions like Gastroesophageal Reflux Disease (GERD), a wedge pillow is placed at the head of the bed to elevate the entire upper torso. This elevation, ideally between 30 and 45 degrees, uses gravity to prevent stomach acid from flowing into the esophagus.
Cervical Rolls
Specialized supports like cervical rolls maintain the cervical curve for back sleepers who require extra neck cradling. These rolls are placed along the bottom edge of the main pillow, fitting directly into the small space beneath the neck. This ensures that while the head rests on the flatter portion of the pillow, the natural curve of the neck is actively supported, contributing to proper spinal alignment.