Does a Pillow Add to Chiropractic Care for Neck Pain?

Last updated: October 2026

A pillow may add to chiropractic care for chronic neck pain: in a randomized study of 30 adults, both groups improved with six adjustments, and the group that also received a new pillow reported a larger drop in pain (Soal et al., 2019). The adjustment happens in the office, and the neck spends every night in between resting at whatever height the pillow sets. This article covers what that trial found, then what pillow height measurably changes and how a Pillowise fitting chooses it.

Key takeaways

In a randomized study of 30 adults with chronic neck pain, both chiropractic groups improved, and the group given a pillow improved more on pain (73% vs 43%) (Soal et al., 2019).
A meta-analysis of nine studies covering 555 participants found pillow use improved waking pain and neck disability (Pang et al., 2021).
Pillowise is chosen using shoulder width, neck height and neck circumference, plus sleeping position and mattress firmness.

Why does the night matter between adjustments?

Sleep is the longest static posture of the day, and the neck holds whatever angle the pillow sets for all of it. The patient goes home after an adjustment and spends the next several nights on that pillow.

Sleep and neck complaints also travel together over time. In the HUNT study, 13,429 Norwegian adults were followed for 11 years, and those with insomnia at the start were more likely to report chronic neck complaints later (RR 1.34) (Uhlig et al., 2018). The study was observational, so it shows an association rather than a cause.

What did the chiropractic and pillow trial test?

Researchers at a chiropractic teaching clinic in Johannesburg randomly assigned 30 adults with neck pain lasting more than three months to two groups of 15 (Soal et al., 2019). Both groups received six chiropractic adjustments over three weeks, spaced three to four days apart.

One group also received a new pillow after the first visit, with instructions to sleep on the back or side. Pain was scored on a 0 to 10 scale and day-to-day impact on the Vernon-Mior Neck Disability Index, at the first, fourth and seventh visits.

What did the trial find?

Both groups improved significantly on pain and on disability from the first visit to the last (Soal et al., 2019). Chiropractic care on its own moved average pain from 5.27 to 2.87 out of 10.

The group that also had the pillow moved from 5.93 to 1.60, a 73% average improvement against 43%, and the difference between the groups at the final visit was significant for pain (p = 0.015). Disability scores improved by 71% with the pillow and 59% without, and that gap was not significant (p = 0.195).

The authors concluded that a pillow could be included as an adjunct management tool alongside chiropractic treatment of chronic neck pain (Soal et al., 2019).

What do larger reviews show?

A systematic review and meta-analysis covering nine studies and 555 participants found pillow use improved waking pain and neck disability, with satisfaction increasing (Pang et al., 2021).

In a randomized controlled trial of adults with chronic nonspecific neck pain, 64 of 70 completed, and a designed pillow produced a greater reduction in neck pain than ergonomic education alone (Vanti et al., 2019). Advice on its own did less than advice plus a pillow.

What does pillow height measurably change?

The Johannesburg trial gave every participant the same pillow at a single height of 12 cm. Height is the variable the mechanism studies keep returning to.

On the back, height changes the curve of the neck. In 16 adults tested at 0, 10 and 20 cm, T1 slope and the C2 to C7 Cobb angle increased as the pillow rose while neck tilt decreased, and 10 cm suited normal lordosis best in that group (Kim et al., 2015). A finite element study of 10 participants lying on their backs showed pressure under the head and neck shifting with each change in height from 110 to 170 mm (Ren et al., 2016).

On the side, height changes muscle activity. In a pilot study of 15 adults, a height equal to shoulder width produced lower sternocleidomastoid and trapezius activity, and higher comfort, than heights at half or one and a half times shoulder width (Jiao et al., 2025).

Why do generic pillows miss?

A standard contoured pillow, not fitted to the individual, performed no better than ordinary shapes in a randomized study of 106 side sleepers (Gordon et al., 2009). No single optimal pillow height can be specified, because it depends on four variables that differ from person to person: cervical alignment, body dimension, contact pressure, and muscle activity (Lei et al., 2021).

What we measure

Pillowise is a fitted cervical pillow that licensed healthcare providers measure and dispense.

A licensed healthcare provider or Pillowise partner takes three measurements: shoulder width, neck height, and neck circumference. Combined with sleeping position and mattress firmness, an algorithm identifies the best-fitting pillow.

Shoulder width is the measurement the EMG study found mattered most. A height matched to it produced the lowest neck and shoulder muscle activity during side sleeping (Jiao et al., 2025), and body dimension is what drives the individual optimum (Tian et al., 2025).

The size is chosen from those three measurements plus sleeping position and mattress firmness, rather than from a single stock height. Pillowise pillows are made from premium Dutch memory foam, OEKO-TEX Standard 100 certified, with a uniform cervical height.

Scope of the evidence

The Johannesburg trial was small and short: 30 adults aged 22 to 38, three weeks, no blinding, one stock pillow for everyone, and pillows donated by their manufacturer, so the authors note that chance cannot be excluded (Soal et al., 2019). The most recent systematic review screened 29,091 records, included five studies covering 239 patients, and found no clear advantage for any pillow type in chronic neck pain (Ghosh et al., 2025). No study has tested a Pillowise pillow, and we make no claim that a pillow treats neck pain.

For providers

The trial mirrors how many practices already work: care in the office, and a recommendation for the hours at home. Both groups received the same adjustments, and both improved.

A fitted pillow extends the work of the visit into the hours between visits, alongside the exercise, manual therapy, and other care you are already delivering. Sleeping position is one of the fitting inputs, so it is worth asking about at intake.

Staff training runs 15 to 30 minutes by Teams or Zoom, any trained staff member can take the measurements, and returns and exchanges are handled by Pillowise directly. More than 5,000 healthcare professionals worldwide trust and recommend Pillowise.

Common questions

Does a new pillow help chiropractic care work better?

In one randomized study of 30 adults, both groups improved with six adjustments, and the group that also received a pillow reported a larger improvement in pain, 73% against 43% (Soal et al., 2019). The study was small and short, and the disability gap between groups was not significant.

Should a pillow replace chiropractic adjustments?

No. Both groups in the trial received the same six adjustments and both improved, and the pillow was tested as an addition to that care (Soal et al., 2019). Your provider decides how the pieces fit together for you.

Does the height of the pillow matter?

Height measurably changes neck alignment, pressure and muscle activity (Kim et al., 2015; Ren et al., 2016; Jiao et al., 2025). Body dimension drives the right height for each person, which is why a fitting measures it (Tian et al., 2025).

Is a contoured pillow from a store enough?

Not reliably. A standard contoured pillow, not fitted to the individual, performed no better than ordinary shapes in a randomized study of 106 side sleepers (Gordon et al., 2009), and no single optimal height can be specified because it depends on four variables that differ from person to person (Lei et al., 2021). A contour helps only if its height matches the person using it. That is what the fitting settles, in a provider's office.

Find a Pillowise provider or become one

Pillowise pillows are clinically measured and dispensed exclusively through licensed healthcare providers as part of broader sleep, posture, and recovery education.

To locate a Pillowise provider near you, visit: Find a Reseller

Licensed healthcare providers interested in offering Pillowise may register here: Become a Reseller

References

Ghosh, S. K., Goyal, M., & Goyal, K. S. (2025). Effect of pillow on pain, disability and sleep quality in patients with chronic neck pain: A systematic review. Rehabilitación, 59(3), 100922. https://doi.org/10.1016/j.rh.2025.100922

Gordon, S. J., Grimmer-Somers, K., & Trott, P. (2009). Pillow use: The behaviour of cervical pain, sleep quality and pillow comfort in side sleepers. Manual Therapy, 14(6), 671-678. https://doi.org/10.1016/j.math.2009.02.006

Jiao, R., Xiao, W., Wang, M., Yu, S., & Li, H. (2025). The impact of pillow height on neck muscle activity: A pilot study. Sleep and Breathing, 29(1), 40. https://doi.org/10.1007/s11325-024-03219-6

Kim, H. C., Jun, H. S., Kim, J. H., Ahn, J. H., Chang, I. B., Song, J. H., & Oh, J. K. (2015). The effect of different pillow heights on the parameters of cervicothoracic spine segments. Korean Journal of Spine, 12(3), 135-138. https://doi.org/10.14245/kjs.2015.12.3.135

Lei, J.-X., Yang, P.-F., Yang, A.-L., Gong, Y.-F., Shang, P., & Yuan, X.-C. (2021). Ergonomic consideration in pillow height determinants and evaluation. Healthcare, 9(10), 1333. https://doi.org/10.3390/healthcare9101333

Pang, J. C.-Y., Tsang, S. M.-H., & Fu, A. C.-L. (2021). The effects of pillow designs on neck pain, waking symptoms, neck disability, sleep quality and spinal alignment in adults: A systematic review and meta-analysis. Clinical Biomechanics, 85, 105353. https://doi.org/10.1016/j.clinbiomech.2021.105353

Ren, S., Wong, D. W.-C., Yang, H., Zhou, Y., Lin, J., & Zhang, M. (2016). Effect of pillow height on the biomechanics of the head-neck complex: Investigation of the cranio-cervical pressure and cervical spine alignment. PeerJ, 4, e2397. https://doi.org/10.7717/peerj.2397

Soal, L. J., Bester, C. M., Shaw, B. S., & Yelverton, C. (2019). Changes in chronic neck pain following the introduction of a pillow and/or chiropractic treatment. Health SA Health, 24 , a1099. https://doi.org/10.4102/hsag.v24i0.1099

Tian, S., Yao, C., Wang, Y., Cao, X., Sun, Y., Wang, L., & Fan, Y. (2025). The individualized optimal pillow height and neck support design for side sleepers. Medical and Biological Engineering and Computing, 63 (2), 535-544. https://doi.org/10.1007/s11517-024-03204-x

Uhlig, B. L., Sand, T., Nilsen, T. I., Mork, P. J., & Hagen, K. (2018). Insomnia and risk of chronic musculoskeletal complaints: Longitudinal data from the HUNT study, Norway. BMC Musculoskeletal Disorders, 19 (1), 128. https://doi.org/10.1186/s12891-018-2035-5

Vanti, C., Banchelli, F., Marino, C., Puccetti, A., Guccione, A.A., & Pillastrini, P. (2019). Effectiveness of a "spring pillow" versus education in chronic nonspecific neck pain: A randomized controlled trial. Physical Therapy, 99 (9), 1177-1188. https://doi.org/10.1093/ptj/pzz056