Can we find that ‘just right’ position of our head and neck whilst lying on a pillow?

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Waking in the middle of the night with neck pain or waking in the morning with stiffness is mainly caused by a poor neck position overnight.

In our first Blog of this series “Good Morning, Bad Neck Pain” we found that the best position for the head and neck to be in overnight was as close a position to how we stand or sit (properly) upright during the day.

Specifically the neck should be in an inwardly curving position (Lordosis) and the middle back between your shoulder blades should be in a slightly outwardly curving position (Kyphosis). As we are lying down these positions would be mildly leveled out due to the decreased influence of body weight.


Whether we lie on our back or side these positions should be maintained. In addition, with side sleeping, the head should be centered on the neck i.e. no head tilting forward or backwards and the neck alignment should be straight with the rest of the spine i.e. no head tilting sideways.


The main reason why we often cannot achieve these positions is the improper use of a pillow or simply having the wrong pillow.

As everybody’s neck has a different curve and length there is no “one size fits all” rule with pillows.

In fact a pillow that is able to adapt to the weight and shape of your head and neck is probably the very best fit.

Finding “The Goldilocks Zone” of perfect positioning of your neck and head to a pillow is not an exact science. In fact most articles regarding sleep ergonomics are usually non-specific regarding how to individually customize your head and neck to your pillow.

What we know is that if the pillow is too high or too low or if the pillow is too hard or too soft it can either overstrain the soft tissue of the neck and middle back or over compress joints and discs pinching nerves which supply the arms and hands.

Compounding this is the fact that many pillows will change shape overnight due to the weight of our head which changes our neck position whilst we sleep. Throw in the fact that on average most people will roll 4-12  times per night which makes any idea of setting up the perfect position and staying there all night a little difficult!

So can we get to the “Goldilocks Zone” of perfect, pain free and risk free sleep? Can we get it just right?

The answer is: Yes, we must be able to. If it was not possible there would be a queue around the corner of the practice each and every morning with people waiting to see me with neck pain which occurred the night before!


Our bodies are very durable and can absorb some positional changes for small periods of time. Probably the fact that we do turn in our sleep moves the neck and middle back to prevent joints being compressed and muscles overstraining. So what we need is a good pillow with as close to the Goldilocks Zone “position” so that we reduce the risk of injury.

In determining the Goldilocks Zone the main considerations are;

– Body position and Pillow height

-Pillow and mattress firmness

– Pillow and mattress material


In this blog we will consider the first and most important considerations which are


  • Body Position and Pillow Height.

Back Sleepers.

This is the most easily controlled position to mimic the curves of your neck and middle spine.

Unfortunately sleeping on your back allows the lower back (Lumbar Spine) to sag, losing its naturally inward curve or lordosis. Having a pillow or roll ( Such as a McKenzie Night Roll ) could be used but another way is to put a pillow or two under your knees which allows the lumbar inward curve to stay in position overnight avoiding sagging and strain.

Measuring your position.

One easy way to see what position you are in is to lie down on your usual pillow and take a pillow selfie with your camera , tablet , phone etc..That way you will see how your head and neck fits with your pillow.

Just right – if you were looking at yourself side on whilst lying on your back your neck should be in the inwardly curved( Lordosis) position with your head straight.



Too Low –     head and neck tilted towards the mattress.


Too High –     head and neck tilted away from the mattress.




If you have a Contoured, Cervical or Orthopedic Pillow there can be additional problems.

Contour of the pillow too high,

– If you can feel pressure at the top of the neck.

– If your Adam’s apple feels like it is being pushed through your throat.


Contour of the pillow too low,

If you can feel pressure at the bottom of the neck

.-If the neck is straight but the head is tilted forwards.


Side Sleepers.

Is considered the next best position but will require a more contoured support in the pillow between the mattress and your ear.

The signs of a side sleeper requiring a contoured pillow include:

-Constantly bunching up your pillow under your neck.

-Placing your arm under your neck and head. (Not recommended.)

-Waking up with pain, stiffness and dysfunction in your neck.

Lying on your side can be problematic if you overstretch your upper leg too far forwards or if you curl your body into the fetal or bent up position. In these positions the spine curls which can lead to muscle, ligament or disc strain. Place a pillow between your knees or have the top knee bent on a pillow or hug a body pillow to keep your spine relatively straight.

Measuring your position.

Again you can take a pillow selfie.

Just Right.

– Neck straight (in neutral alignment) with the space between the mattress and ear filled in with pillow and contour.



Too high.

  • Neck and head tilted away from the mattress.

Too low.

  • Neck and head tilted towards mattress.


Contour of pillow too low.

  • Neck straight and head tilted away from mattress.

Contour of pillow too high.

  • Neck contoured, head tilted towards the mattress.


Stomach Sleepers.

Is by far the worst position because obviously you will need to turn your head to the side to breathe. Keeping your head turned for a period of 6-8 hours of sleep can cause strain leading to morning neck pain and stiffness.

Some young people with great flexibility can sustain this position but it is simply not recommended.


In the last blog of this series we will continue our Goldilocks adventure into discovering pillows and mattresses which are too hard or too soft, too hot or too cold and which materials do I look for in my perfect pillow or mattress.

If in the meantime if you would like any further information, please don’t hesitate to call Elizabeth Street Sports and Spinal Physiotherapy, on 96703996.