Choosing The Proper Pillow To Help With Low Back Pain

Choosing the best pillow to help with lower back pain is equally as important as finding the right mattress. Using the wrong pillow can flare up an existing low back or neck problem. Conversely, finding the right ergonomic pillow will likely lead to a more comfortable night’s sleep and less long-term pain.

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Why does the choice of pillow matter?

Less pain and higher quality of life

A key reason why choosing the proper pillow matters is that researchers confirm a strong positive relationship between back pain, ability to function, and quality of sleep¹. The people in this study who slept well enjoyed a better overall quality of life and lower levels of back pain. In 2019, UC Berkeley scientists reported that a sleepless night leads to feeling 126% more pain² than after a good night’s rest. This finding highlights the importance of sleep (not only for coping with lower back pain) but also as a pillar in any pain management strategy.

So, if you find that your current pillow doesn’t lend to a good night’s sleep, it will be harder to attain the benefits that quality rest³ provides, such as lower intensity of back pain or recovering quicker.

Spinal alignment

Taking care of proper posture doesn’t stop when your day ends, as your head hits the pillow. Your pillow plays a crucial part in keeping your back and hips well-aligned. According to specialists at the University of Rochester Medical Center, you should choose a pillow that will keep the neck aligned with the chest and lower back⁴.

Once you find the right pillow to place under your head, experts recommend sleeping on your side and placing a pillow between your knees. This helps alleviate some of the pressure on your hips and lower back.  If you’re a stomach or back-sleeper, you may want to support your spine by placing a pillow under your hips. However,  finding the right sleep position varies person-to-person. So, it may be worthwhile experimenting with several positions to identify one that suits you.

Which pillows relieve lower back pain?


There are both synthetic and natural latex pillows on the market. You might find these listed as rubber rather than latex. These pillows often contain shredded bits of latex fill, which lets you remove or add filling in order to personalize the fit. Its customizable capacity makes them a compelling option for many back pain sufferers.

Down pillows

Down pillows (or synthetic down fill) are probably the plushest and softest type. So, if you’ve never liked sleeping on a hard pillow, this could be your winner.  Down is likely to be your most comfortable pillow option if you are a stomach sleeper, as this position usually calls for a thinner, softer pillow. Down also retains body heat quite well, so if you require additional warmth, this could be your pillow of choice.

Memory foam

Memory foam pillows are made from the synthetic material polyurethane. It goes through a special manufacturing process that gives it that characteristically spongy and bounce-back quality.  Since a memory foam pillow conforms to your unique shape, it can help keep your back aligned. These pillows will also return to their original shape, and resist getting compressed over time (as traditional pillows tend to do). As a result, these pillows can make very effective “knee pillows” — which can be positioned between the knees when sleeping on your side.

Cooling pillows

If overheating tends to get you tossing and turning in your sleep, consider investing in a cooling pillow. Many different designs are available, but they tend to have multiple layers, such as memory foam for support and a special cooling/breathable material in the center.

How to choose the best pillow for your lower back pain

The best indicator that you have the right pillow for your back is, of course, going to be your comfort and restful sleep. However, there are a few key questions to ask yourself when evaluating a new pillow:

  1. Does the pillow fit comfortably between your neck and shoulder? If you feel like the pillow is bending your neck too far in one direction? If so, then it could cause stiffness, pain, and spinal misalignment from your head down to your low back.

  2. Is the pillow too firm or soft? The density, or in other words, the firmness or softness of your pillow is crucial for supporting your head in a rested position.  Soft pillows tend to sink lower and conform to your head shape. Whilst harder pillows maintain their original shape and height.

  3. Is your pillow too tall or short? You’ll need to explore what feels best in terms of how thin or thick your pillow is, which again contributes to providing just the right support for your unique body shape and spine. Your preferred sleeping position plays a role in determining the best heat for you. Those who sleep on their backs may prefer a lower pillow while side-sleepers may consider taller pillows. Keeping a symmetrical position while sleeping can help prevent imbalances that lead to lower back pain.

  4. Do you run hot or cold when you sleep? Check how your pillow rates for breathability before you buy. If you know that you tend to “run hot,” then it’s worth finding a pillow that’s got excellent airflow, or even a pillow with special cooling gel.

  5. What’s your preferred sleep position? How thick a pillow you’ll need will usually be determined by the position you sleep in the most. For example, if you’re a side sleeper, you’re probably going to require a thicker pillow with moderate density to get the proper support. On the other hand, if you sleep on your stomach, a thinner pillow may be the best way to achieve alignment. Or, if you’re a back sleeper, a moderately thick pillow will probably provide the best fit.

  6. Does your retailer have an online tool you can use? Many e-commerce stores now offer an online assessment tool or quiz to help you identify the proper pillow.  Usually, they analyze the amount of support you require and which position you typically like to sleep in. There may also be additional customization options available, depending on the store. However, the best option would be to try your pillow in-store.

Sleeping positions to try

Once you’ve decided on which pillow to use beneath your head, there are a few sleeping positions and additional pillow options⁵ that researchers suggest to help alleviate stress on your lower back.  These include:

  • Side with knees bent slightly (drawn in), and add a firm pillow between them.

  • Back with a pillow below the knees, possibly with a rolled towel beneath your low back.

  • The stomach is the least recommended sleep posture for back pain, but if it’s the only way you can fall asleep, try propping a pillow under your belly (pelvis).

Whichever position you find most comfortable, be mindful that you’re keeping your head, shoulders, and hips symmetrical. For example, an exceptionally tall pillow may aggravate your low back pain if you’ve been used to a low profile pillow all your life. 

The lowdown

When it comes to lower back pain and choosing the best pillow, it’s important to remember that your body shape plays an essential part in determining which pillow is the best fit. The goal is to find a pillow that allows you to sleep and keep your head, neck, and pelvis in a neutral position without any misalignment. Of course, how this is achieved will depend significantly on your body shape and size. With the variety of pillows available to choose from, there are many options out there to help alleviate your back pain and improve your night’s sleep.

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