How to Choose a Pillow for Back Pain

While mattress companies love to regale potential customers with how comfortable their product is, they tend to gloss over the fact that back pain sufferers will get more comfort from the proper pillow than a particular mattress. When you sleep, the position of your head and angle of your legs affect your spinal alignment.

Poor alignment results in a sore or stiff back when you wake up, especially for chronic back pain sufferers. A good pillow or two will keep your spine properly aligned throughout the night, allowing you to enjoy a good night’s rest and reduced pain throughout the day. Here’s how to choose the right pillow for back pain relief.

Pillow Sizes and Shapes

There is a wide variety of pillow options on the market today, from the small square euro pillow to full-length body pillows and everything in between. each size or shape has its own purpose. The following are some common shapes and their uses.

Standard Pillows

These are your typical, rectangular-shaped pillows you probably have on your bed right now.

Body Pillows

body-pillowThese body-length pillows are used to help keep your entire body aligned during sleep. Mostly associated with pregnancy, good body pillows can support both the head and legs when sleeping on your side. Most body pillows simply look like an extra long pillow up to 6 feet in length. Some are styled in a “U” or contoured shape to provide even better support.

See how to use a body pillow for more information.

Orthopedic Pillows

u-travel-pillowThere are various types of orthopedic pillow, each with its own unique function. The most common of these are travel pillows, which have a distinct “U” shape designed to support the neck and help keep your head from ending up in an awkward position while you sleep.

Donut and lumbar pillows are both designed to aid in sitting. Donuts provide relief from back pain caused by a tailbone injury and are also commonly used by hemorrhoids sufferers. Lumbar pillows, meanwhile, support the natural curve of your lower back when sitting. The top rated pillows are almost always orthopedic variations.

Throw Pillows

Known by various names, throw pillows are square pillows often used for decoration. In a sleep setting, these pillows are useful for adding neck support or placing between your knees when sleeping on your side to provide better spinal alignment. They are also good for lumbar support when sitting.

Types of Material

As there are no regulations concerning the materials used in pillows, you will find a wide variety of options. Some are more comfortable than others, and all may be categorized as either natural or synthetic.

Natural Materials

Some of the most comfortable pillows are made using natural fillers. While sometimes more expensive than synthetics, natural materials have some distinct advantages.

  • buckwheat-pillowBuckwheat – While it may sound uncomfortable, buckwheat hull pillows are considered one of the best options for people suffering from osteoarthritis and a number of spinal issues. This type is for those who prefer a more firm yet supporting pillow and one that stays cool throughout the night. Most people either say it’s the best pillow they’ve ever had or simply hate it.
  • Cotton – This material is typically medium-firm and able to remain cool longer than most other materials, making it a good choice for those who need a supportive pillow that holds its shape. It’s a good material for a pillow for neck pain sufferers.
  • Down – Available as either duck or goose down, these pillows are easy to reshape and don’t clump, making them a good option if you need a soft pillow that you can fold or mold for the proper height and thickness. They are also considered the softest material option, although you may have trouble finding where to buy them at a low cost, as they are also the most expensive option. The biggest disadvantage of down pillows is the fact that it may trigger allergies in some people. They are also one of the warmest pillows which may be good or bad.
  • Wool – Similar to cotton in feel, wool retains heat and absorbs moisture. It is a very durable material and wool pillows tend to have a fuller feeling than other materials.

Synthetic Materials

Generally cheaper and longer lasting, synthetic pillows provide their own advantages. The four most common types of synthetic material are as follows:

  • shredded-memory-foamMemory Foam – A popular option, foam retains its shape and has a firmer surface, A newer option, shredded memory foam, is even more comfortable and unlike solid memory foam, it stays cool during sleep. Shredded memory foam pillows provide excellent support and comfort for most types of back pain and we currently consider them the best pillow type out there.
  • Gel – Gel pillows provide the benefit of regulating your body temperature so those who get extra warm during sleep might want to give this type a shot. While these do provide good support, they may be a bit to firm for some.
  • Plastic – A synthetic alternative to buckwheat hulls, small plastic pellets are a good option for alleviating a variety of conditions involving back pain.
  • Polyester – Available on its own or in a wool blend, polyester is a common synthetic option designed to retain its shape and provide optimal neck support.


Whether you add a pillowcase or stick to the shell, the material you use will have an effect on the pillow’s softness and heat retention. Flannel, for example, retains heat and thus cancels out some benefits of using a cotton filler. Woven materials such as cotton, silk, or polyester are popular choices. Pillowcases should be washed frequently, regardless of the material used.

Choosing the Right Pillow for Your Sleeping Position

There are three major sleeping positions, and each provides its own effects on your spinal alignment. Depending upon the position you sleep in, certain types of pillow will provide more comfort than others.

On Your Back

Flatter pillows work best if you sleep on your back, and you will need support for both the neck and under the knees. Memory foam, buckwheat, gel, and down are all good options, and you should avoid thicker materials such as wool. A small rolled towel or down throw pillow under the lower back may also help. This position is generally considered the best for severe back pain sufferers.

On Your Side

Keeping the spinal alignment straight is the primary concern when on your side. A good pillow for side sleepers is a shredded memory foam pillow under your neck and head and another pillow between your bent knees works best. Alternatively, you may choose a single body pillow to do both jobs.

On Your Stomach

While the stomach is worst for back pain, some relief may be gained from a flat pillow under the pelvic region and head. Down is a good material for pillows used for stomach sleepers.

Note:  For more information on the best and worst sleep positions, see our article on how to sleep with lower back pain.

Additional Resources

  • The Bedding Site contains a section describing various pillow options in greater detail.
  • The Mayo Clinic provides a short slide show illustrating sleep and pillow positions.
  • Spine-Health offers a detailed guide on pillows for back pain sufferers.
The following two tabs change content below.


(Editor at Back Pained) – Adam is a former longtime back pain sufferer who is now pain-free. He has created this site to help others get back pain relief at home as an alternative to expensive specialist appointments or physical therapy that may or may not work. A research junkie, he's spent considerable time determining which of the countless back pain products actually work and which ones are a waste of money. He now enjoys spending time on the basketball court re-learning that jump shot from when he last played in high school.
Categories Sleep

Leave a Comment