How To Optimise Your Mattress & Pillows To Prevent Neck & Back Pain

Mattress & pillows to prevent shoulder, neck pain and back pain

People often come to see me for back pain or neck pain pain caused by ‘sleeping a bit funny’ or sleeping on a different mattress.  Others with pre-existing problems feel they can’t get comfortable in bed, or their pain is worse on waking in the morning. If this is you, or if you are generally prone to to episodes of neck, shoulder or back pain, it may be worth re-evaluating your sleep set-up.

A good night’s sleep is one of the most significant contributors to our sense of wellbeing, both physically and mentally. But when you are recovering from an injury, sleep is more important than ever, speeding up the body’s natural healing process.

There are three key things that can make the difference between a good night’s sleep and a disturbed, uncomfortable one: your mattress, your pillow set up and your sleeping position. Bare in mind whilst reading this though; there is no one-size-fits-all. We are all individual, so finding a comfortable set-up for you, that allows you a good night’s sleep is as good a guide as any.

1. Your Mattress

The mattress you choose is far more relevant in preventing pain, than the bed base. This is because your mattress will largely determine how your spine and joints are supported during sleep. Having said that, your bed base does need to be stable and provide adequate support for the mattress.

As a general rule, a mattress needs to be firm enough to stop you slumping into it, but with enough ‘give’ to allow your hip and shoulder to sink in slightly when side-lying. This gives your spine the best possible chance of resting in a horizontal position whilst supporting your body’s natural curves.

This means the heavier you are, the firmer your mattress needs to be. If you are light and small you will need a softer mattress. If you sleep with someone who is a different size and weight to you, you may need different levels of support on either side of the mattress. Some manufacturers factor this into their mattress designs, so its worth shopping around if you are looking for a new mattress.

The type of mattress is largely down to personal choice (pocket sprung, memory foam, latex etc). Each have there own features and benefits which are discussed here.

Oh, and don’t be swayed by the term ‘orthopaedic’. According to the Sleep Council, this doesn’t mean the bed has been professionally assessed or recommended. It just means the mattress is extra-firm, which is not necessarily the best choice for you.

You may want to consider buying a new mattress if:

  • Your mattress is more than 10 years old
  • Its uneven, floppy or lumpy or has protruding springs
  • It’s hammock-shaped with a dip in the middle
  • You consistently wake up with stiff sore back, neck or hips which eases off during the day

2. Pillows

Pillow(s) should provide enough height to keep your head and neck aligned with your spine. So if you were to flip your body upright, your sleeping posture would roughly be a supported version of  your standing posture. If you sleep side-lying, your pillow(s) will need to be a little higher than if you sleep on your back, to accommodate the space between your shoulder and head.

As a general rule, two pillows may be better than one if you sleep side-lying and one pillow better if you sleep on your back. If you use two pillows, it may help if the top pillow is softer and more flexible so it can mould to support your head and neck. If you sleep on your front (not recommended if you suffer from neck or back pain), you only need a very thin flat pillow to avoid straining your neck.

Whether you choose traditional feather and down pillows, synthetic or memory foam is really just a matter of preference as all can provide the necessary level of support.

Tips to prevent back, neck & shoulder pain when sleeping

3. Tips on Sleeping Positions

If You Have Neck Pain…


  • Try a softer pillow on top of a firm pillow so you can mould the top pillow to support and fill the gap between your head and shoulder.


  • Ensure your pillow(s) enable your head and neck to be aligned with the rest of your spine, not flexed forwards.


  • Try not to lie on your front as this will put strain through your neck and upper back.
  • If this position is really the only way you can sleep, try sleeping with one knee bent up and use just a small flat pillow under your head and neck.

If You Have Lower Back or Hip Pain…


  • Try placing a pillow between your knees or a small flat pillow under your waist to keep your spine more aligned, and reduce strain going through your hips and pelvis.


  • A pillow under your knees can help alleviate lower back pain, or a small flat pillow in the small of your back.


  • This can sometimes be the only comfortable position if you have a disc problem. However, sleeping on your front is not generally not the best position if you are suffering back pain.
  • If you are unable to sleep comfortably in any other position, try placing a small flat pillow under your tummy to minimise the strain on your lower back.

If You Have Shoulder Pain…


  • Lie on your good side and support your painful shoulder and arm with a pillow in front of you.
  • Or use a small pillow or towel over your waist and under the arm, resting your arm along your body.
  • Avoid sleeping with your arm above your head, as this is inhibits the healing process.


  • If you have shoulder pain, try placing a small flat pillow lengthways under the affected arm and shoulder to support it.
  • Avoid sleeping with your arm above your head, as this is inhibits the healing process.

Please note, these tips constitute general advice. If your back or joint pain persists, make sure you see a qualified therapist such as osteopath to work out the cause of your pain and how best to treat it.

Emma Lipson is Principal Osteopath at Feel Better Osteopathy in Warwick, Warwickshire.

Over to you…

Do you have any questions about your own sleep set-up? Have you found any good ways to get a more comfortable night’s sleep? If you found this article useful, please like, share or comment below.

If you liked this, you may also enjoy reading: