Exercise for Neck Pain: What the Research and PT Guideline Show

Last updated: October 2026

Exercise is one of the best-supported tools physical therapists use for neck pain, and National Physical Therapy Month arrives in October. A Cochrane review of 27 trials found that strengthening exercise for the neck, shoulders, and upper back reduced chronic neck pain (Gross et al., 2015). An umbrella review of 25 systematic reviews found that motor control, Pilates, resistance training, traditional Chinese exercise, and yoga each reduced short-term pain compared with no exercise (Rasmussen-Barr et al., 2023). Below is what the research shows, what the clinical guideline recommends, and where pillow height comes in for the hours between sessions.

Key takeaways

For chronic neck pain, neck, shoulder, and upper back strengthening reduced pain right after treatment, with moderate-quality evidence (Gross et al., 2015).
Five exercise types reduced short-term pain compared with no exercise, and no single type stood out as best (Rasmussen-Barr et al., 2023).
A Pillowise fitting takes three measurements (shoulder width, neck circumference and neck length) and adds sleeping position and bed type to choose from seven sizes.

What does exercise do for chronic neck pain?

A Cochrane systematic review analyzed 27 trials with 2,485 participants with mechanical neck disorders (Gross et al., 2015).

For chronic neck pain, strength training for the neck, shoulder blades, and upper limbs reduced pain immediately after treatment (SMD -0.71). Combined neck, shoulder, and shoulder blade strengthening and stretching improved both pain (SMD -0.33) and function (SMD -0.45). Both findings were rated moderate quality.

For chronic neck pain with headache, strengthening and endurance exercise also helped, with moderate-quality evidence.

Which types of exercise help?

An umbrella review pooled 25 systematic reviews of adults aged 18 to 70 with neck pain lasting 12 weeks or more (Rasmussen-Barr et al., 2023).

Compared with no exercise, motor control exercise, Pilates, resistance training, traditional Chinese exercise, and yoga all reduced short-term pain. All of these except resistance training also improved short-term disability.

No single exercise type was clearly best, which leaves room to match the program to the patient.

What does the clinical guideline recommend?

The 2017 neck pain clinical practice guideline from the APTA Orthopaedic Section gives graded recommendations for exercise in chronic neck pain (Blanpied et al., 2017).

For mobility deficits, it recommends mixed neck and shoulder blade exercise, including neuromuscular, stretching, strengthening, endurance, and aerobic exercise. For neck pain with headaches, it recommends shoulder-girdle and neck stretching, strengthening, and endurance exercise. For radiating pain, it recommends stretching and strengthening combined with other interventions.

Most of these are Grade B recommendations, often as part of a multimodal plan delivered by a physical therapist.

Why does the plan matter?

The research supports specific exercise types, chosen for the patient's presentation and delivered as part of a broader plan. That is the work physical therapists do every day, and National Physical Therapy Month in October is a good time to recognize it.

What does pillow height change overnight?

In a radiographic study of 16 adults, raising the pillow from 0 to 10 to 20 cm increased T1 slope and C2-7 Cobb angle while neck tilt decreased (Kim et al., 2015). A crossover study of 10 healthy participants paired with finite element modeling measured how heights from 110 to 170 mm shift pressure across the head and neck (Ren et al., 2016).

In a pilot EMG study of 15 adults lying on their side, the height matched to shoulder width produced the lowest neck and shoulder muscle activity (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, made in seven sizes.

Our sleep specialists take three measurements: shoulder width, neck circumference, and neck length. Combined with sleeping position and bed type, an algorithm identifies the best-fitting pillow from seven sizes.

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).

A systematic review of 11 studies covering 309 participants identified a 7 to 11 cm unloaded central height among the parameters supporting spinal alignment and sleep comfort (Radwan et al., 2021). The size is chosen from those three measurements plus sleeping position and bed type, rather than from a single stock height.

Pillowise pillows are made from premium Dutch memory foam and certified to OEKO-TEX Standard 100, meaning every component has been tested against the standard's limits for harmful substances.

Scope

The exercise studies tested exercise programs, not pillows. No study has tested whether a fitted pillow adds to the benefits of exercise for neck pain, and we make no such claim. The most recent systematic review found no clear advantage for any pillow type in chronic neck pain (Ghosh et al., 2025).

For providers

The exercise evidence supports what physical therapists already do: choosing specific exercise types for each patient and building them into a broader plan.

Asking which sleeping position patients hold longest and what they sleep on adds context to the home program.

A fitted pillow extends the work of the visit into the hours between visits, alongside the exercise, manual therapy, and other care the provider is already delivering.

Common questions

Does exercise help chronic neck pain?

Yes. Strengthening exercise for the neck, shoulders, and upper back reduced chronic neck pain with moderate-quality evidence (Gross et al., 2015).

What is the best exercise for neck pain?

No single type was clearly best. Motor control, Pilates, resistance training, traditional Chinese exercise, and yoga each reduced short-term pain compared with no exercise (Rasmussen-Barr et al., 2023).

Can a pillow replace neck exercises?

No, and we make no such claim. A pillow fitting addresses head and neck height during sleep. Exercise is part of the care a provider plans and delivers.

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

Blanpied, P. R., Gross, A. R., Elliott, J. M., Devaney, L. L., Clewley, D., Walton, D. M., Sparks, C., & Robertson, E. K. (2017). Neck pain: Revision 2017. Journal of Orthopaedic & Sports Physical Therapy, 47(7), A1-A83. https://doi.org/10.2519/jospt.2017.0302

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

Gross, A., Kay, T. M., Paquin, J. P., Blanchette, S., Lalonde, P., Christie, T., Dupont, G., Graham, N., Burnie, S. J., Gelley, G., Goldsmith, C. H., Forget, M., Hoving, J. L., Brønfort, G., Santaguida, P. L., & Cervical Overview Group. (2015). Exercises for mechanical neck disorders. Cochrane Database of Systematic Reviews, 2015(1), CD004250. https://doi.org/10.1002/14651858.CD004250.pub5

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

Radwan, A., Ashton, N., Gates, T., Kilmer, A., & VanFleet, M. (2021). Effect of different pillow designs on promoting sleep comfort, quality, & spinal alignment: A systematic review. European Journal of Integrative Medicine, 42, 101269. https://doi.org/10.1016/j.eujim.2020.101269

Rasmussen-Barr, E., Halvorsen, M., Bohman, T., Boström, C., Dedering, Å., Kuster, R. P., Olsson, C. B., Rovner, G., Tseli, E., Nilsson-Wikmar, L., & Grooten, W. J. A. (2023). Summarizing the effects of different exercise types in chronic neck pain: A systematic review and meta-analysis of systematic reviews. BMC Musculoskeletal Disorders, 24(1), 806. https://doi.org/10.1186/s12891-023-06930-9

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

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