How To Buy The Right Pillow: A Chiropractor’s Guide
I get asked about pillows constantly in clinic. Patients bring them in, show me in photos online, describe them in detail, and want me to tell them whether it is the right one. The honest answer, more often than not, is: it depends.
That is not a cop-out. It is actually the most useful thing I can tell you, because there is no one side fits all pillow. Most marketing is built around the idea that there is a perfect pillow out there waiting for you, and you just have not found it yet. In reality, the research does not support that framing. A 2025 systematic review concluded that no particular pillow type shows clear superiority for reducing neck pain, disability, or improving sleep quality. What matters is whether the pillow works for your body, in your bed, in the position you actually sleep in.
Here is how to think through that properly.
Start with your sleep position
Everything else follows from this. Your sleep position determines what the pillow needs to do, so it is the first question to answer.
Side sleepers
You need a pillow that fills the gap between your head and the mattress. The goal is to keep your ears roughly over your shoulders, the same neutral alignment you are aiming for when you are standing. A pillow that is too thin lets your head drop toward the mattress. One that is too thick pushes your head up and loads the opposite side of your neck. Neither is ideal.
One thing most pillow guides do not mention is the shoulder. If you are sleeping on your side, the shoulder you are lying on should be positioned slightly forward and down, not forward and up. Forward and up holds the shoulder joint in a position that can irritate the bursa and the structures on top of the shoulder, similar to the way a rounded shoulder posture (when your shoulder rolls forward and rises) causes problems during the day. Letting the arm rest naturally, or gently hugging another regular, soft pillow, tends to assist the shoulder in resting in a better position.
Back sleepers
You need less height than a side sleeper, because the gap from the mattress to your head is smaller when you are on your back. The goal is to support the natural curve of your neck without pushing your head forward. A pillow that is too thick tilts the chin toward the chest and holds the neck in sustained flexion throughout the night. By morning this sustained stretch can irriate the muscles of the neck and sometimes the discs.
For those of us with thick necks or are prone to sleep apnoea this can further narrow the airway and contribute to sleep breathing issues.
Stomach sleepers
Stomach sleeping forces your neck into rotation for hours at a time, which places sustained load on the cervical joints, muscles, and potentially the discs. Ideally, I encourage people to move away from this position over time.
That said, I know that is easier said than done. Some people have slept on their stomachs their entire lives and the comfort of it is real. So let me give you the practical options.
If you are a committed stomach sleeper and not ready to change, you could try sleeping without a pillow. No pillow keeps you as flat as possible and reduces the additional strain on the neck, even though the rotation is still there.
If you want to start shifting position: try placing a thin, inexpensive pillow under your chest and stomach. This gives you some of the sensation of sleeping on your front while gently encouraging your body to rotate toward its side. It is not a quick fix, but it works for some people as a transitional step.
The pillow and mattress work as a system
This is the point almost every pillow guide misses, and it matters a lot in practice.
The height you need from a pillow is directly affected by the mattress underneath you. A firmer mattress does not compress under your shoulder when you sleep on your side, which means the gap between the mattress and your head is larger, and you need a thicker pillow to fill it. A softer mattress absorbs more of your weight, reducing that gap, and you may need less height to stay in a neutral position.
If you change your mattress, your pillow may no longer be right for you, even if it felt perfect before. The two are a paired system. This is part of why fitting a pillow in a shop, without the mattress you actually sleep on, only tells you so much.
What I usually recommend as a starting point
Given everything above, if someone comes to me without much prior experience and asks where to begin, I point them toward a height-adjustable pillow. My usual recommendation is the Complete Sleeprrr, specifically the classic density version.
“The reason I recommend it is not because it is the best pillow in the world. It is because it is adjustable, which means it can be modified to suit different people and different bed environments.”
You can remove inserts from the middle to reduce the height, which gives you some flexibility as you figure out what actually works for you. It is established, widely available through chiropractors and physios around Australia.
I usually suggest the classic density rather than the firmer option to start, because it is a safer middle ground for most people. It is not too stiff, it still allows some adjustment, and it does not commit you to a particular feel before you know what you need. If you already have a lot of experience with pillows and know you prefer something firmer or softer, that prior knowledge is worth using.
One practical note: check the returns policy before you buy any pillow. This applies regardless of brand. If you cannot try it and return it, you are taking a financial risk on something that may not suit your bed, your body, or your sleeping style. Most pillows aren’t returnable once opened but it is always worth checking ahead of time.
On the other end of the spectrum, I am generally cautious about highly specific pillows marketed for a particular type of sleeper, a particular condition, or a particular body part. Some of them look excellent. Some are expensive and difficult to assess their effectiveness. Without a clear trial and return option, it is hard to know which category you are dealing with. In my opinion, it is simpler and safer to choose a regular shaped, contoured pillow that is adjustable if you’re starting fresh.
The pillow's job is neutral posture, not pain treatment
I want to be clear about what a pillow can and cannot do. A pillow's job is to support your head and neck in a neutral position throughout the night, as close as possible to how you would stand with good posture. If it does that, it is doing its job.
There is no specific pillow for neck pain that is categorically different from a pillow that simply fits you well. The goal is the same: spinal alignment during sleep. If the pillow achieves that for your body, in your bed, in the position you sleep in, it is probably the right pillow. If you have an existing injury or condition affecting your neck or upper back and are unsure what you need, that is worth discussing with your chiropractor rather than relying on product marketing.
Children and Pillow thickness
Children are often given soft adult-sized pillows that are far too thick for their smaller frames. The goal of the pillow and mattress combination is the same as for adults: support the head and neck in a position that approximates good standing posture. Because children's bodies are proportionally different and their spinal curves are still developing, they need considerably less lift than an adult.
My clinical suspicion, and I want to be clear this is not yet supported by research I have reviewed, is that consistently sleeping on a pillow that is too thick during childhood may contribute to forward head posture over time. I cannot confirm that with a reference. But the logic holds: if a developing child sleeps night after night with their head pushed forward, that sustained position may influence how posture develops. An age-appropriate, thinner pillow makes sense for children on structural grounds alone.
How long before you need a new pillow?
For most memory foam pillows, including the Complete Sleeprrr, the foam starts to permanently deform over time from daily use. The manufacturer recommends replacement every 2 to 3 years, which is probably reasonable advice for most people. Body weight, frequency of use, and sleeping position all affect how quickly a pillow may deform.
As a general rule is whether the pillow springs back quickly when you press it. If it holds a compressed shape for longer than it used to, it is no longer providing the support it was designed for. If you are waking with neck stiffness that was not there when you first got the pillow, that is also worth paying attention to.
Stacking two pillows, by the way, is not a substitute for replacing a worn-out one. Beyond the mechanical problem of pushing your head too far forward, stacking pillows can also affect airway patency during sleep. The more the head is pushed into flexion or rotated, the more potential there is to compromise airflow. If you are regularly folding or doubling up your pillow to get comfortable, the pillow needs replacing or changing.
The bottom line
There is no single best pillow. The right pillow for you depends on your sleep position, your body size, the firmness of your mattress, and what you have already tried. Start with something adjustable and reasonably priced. The Complete Sleeprrr classic is a sensible place to begin for most people.
If you are waking with persistent neck stiffness, headaches, or upper back tension that does not seem to shift, it is worth getting your spine assessed rather than just replacing your pillow. Sometimes the pillow is the problem. Often it is not.
“Not sure whether your pillow is contributing to your neck or upper back pain? Book an appointment at our Bicton clinic and we can assess your posture, sleep position, and what is likely driving your symptoms.”
