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Can sleeping with the right pillow ease neck pain?

Can sleeping with the right pillow ease neck pain?

A pain in the neck is surprisingly common. At any given point in time, nearly 13 per cent of us will be walking around with a sore neck and, over a lifetime, around 50 per cent of us will experience chronic neck pain. The problem often gets better by itself - a good thing, as doctors have little more than painkillers and muscle relaxants to offer neck-pain sufferers. But while symptoms persist, it can cause considerable suffering.

The causes of neck pain are varied, but generally fall into two types: mechanical and degenerative ( 'wear-and-tear'). Other, more serious causes include rheumatoid arthritis, bone disorders and serious injuries that damage the vertebrae or spinal cord in the neck.

'Mechanical' neck pain is very common and can be the result of minor injuries or sprains to muscles or ligaments in the neck and poor posture (for instance, in people who spend much of their working day bent over a desk). Often, the exact cause or origin of the pain is not known.

Pain from degeneration of the spinal bones (vertebrae) and of the cartilaginous 'discs' between the vertebrae is especially common in older people. This is sometimes called 'cervical [neck] spondylosis'.

Pain travels
You may even have neck problems without knowing it. While mechanical problems can strain the neck, the pain you feel is not always at the site of the problem.

Chiropractic suggests, for instance, that chronic headaches may be the result of a neck injury or strain (which may happen without the sufferer knowing it). When Australian researchers did a study of 105 sufferers of chronic sustained headaches, they found that 80 per cent of those treated with nine short sessions of chiropractic manipulation reported sustained benefits two years later (J Manip Physiol Ther, 1994; 17: 369-75).

Other findings suggest that elbow pain can effectively be treated by manipulating the neck (Pain, 1996; 68: 69-74).

Sleeping comfortably?
Trauma to the neck can literally occur while you are sleeping - and the problem may be your pillow. Although most of us move around from time to time in our sleep, many of us tend to lie in the same position for long periods of time. If your neck and shoulders are poorly supported by your pillow, this can place considerable strain on the surrounding muscles, ligaments and cervical spine.

There are several types of pillow on the market. The foam pillow is fairly dense, firm and resilient, with little 'give'. With this type of pillow, tight or tired neck muscles may find it difficult to relax and it can be hard to get comfortable quickly. Similarly, on waking, the neck may feel stiff from being held so firmly in one place during sleep.

Feather-filled pillows are the most expensive, and tend to be considerably softer and less supportive than foam ones. During sleep, the head tends to gradually sink down, increasing the stretch on the neck, which may lead to pain and stiffness on waking.

The hollowfibre- or polyester/wool-filled pillow is probably the most commonly available pillow. They are often used by allergy sufferers as the filling is made of 'hypoallergenic' materials. The fibres can become compressed and lose their resilience in just a few months.

Most of these offer only one height over the entire pillow, which may alter head and neck alignment, and cause discomfort when the user changes position. Also, we all differ in neck thickness and shoulder width. Ideally, we need a different height of pillow when lying on the back compared with lying on the side. Since this is not practical, manufacturers have come up with a compromise - the semi-customised orthopaedic pillow.

These pillows vary in shape. Many have a central depression to cradle the head but, for this to work, the head needs to stay in the 'hollow' - which is difficult as most people change position while sleeping. To address this, these pillows are made with a raised area that lies under the neck at the lower edge of the pillow. This will support the neck no matter where the head rests.

Do they work?
The term 'orthopaedic' is often used to imply a health benefit. However, the word is not a guarantee. Nevertheless, there has been an encouraging amount of research into these specially shaped pillows.

In a study using radiographs to compare the neck bones of those using regular and 'roll-shaped' pillows, the researchers concluded that the roll-shaped pillows restored the optimal curve of the neck while decreasing neck pain and discomfort while sleeping (Jackson R, The Cervical Syndrome, 4th edn, Charles C. Thomas, 1987).

Another study of 91 fibromyalgia patients and 60 newly diagnosed fibromyalgia patients, all with neck pain, found that after 18 months of using a special neck-support pillow, 63 and 84 per cent, respectively, achieved significant pain relief (J Rheumatol, 1994; 21: 8).

Finally, one small study compared three types of pillows in terms of pain intensity, pain relief, quality of sleep, disability and overall satisfaction in people with mild neck pain. It concluded that finding the right pillow can significantly reduce pain and improve sleep, but does not significantly improve disability (Arch Phys Med Rehab, 1997; 78: 193-8).

But can specially shaped pillows do harm? Few studies have looked at whether orthopaedic pillows can produce neck pain in people without the condition. In one, lasting a week, using specially shaped pillows had no negative effects (such as neck or back pain) in those with no such pain before the trial. In fact, 83 per cent of participants reported that they slept better with the support pillows (J Can Chiropr Assoc, 1998; 42: 156-62).

The products
We asked our panel of eight volunteers to try out some of the UK's best-selling orthopaedic pillows. All our testers had neck ache - some for reasons that were not clear and some due to mechanical problems (for instance, fused vertebrae). Each pillow was used for a week, with a break before moving on to the next one.

There were five main criteria for evaluating these pillows: improvement in neck ache was the first and most important; this was followed by the packaging (including first impressions and the quality of information that came with the product); third was comfort; then adverse symptoms; and, finally, value for money (such as whether the pillow seems durable, or comes with a guarantee).

Overall, many of our testers benefited from the use of orthopaedic pillows and, because our users switched back to their usual pillows between trying out each of the test pillows, they had ample chances to compare those with the shaped ones. One commented, ''''All these pillows made conventional pillows seem inadequate.'''' Another said, ''''Each time I reverted to my old pillow, the neck soreness returned.''''

Once all the evaluations were in, it was evident that not only could you not judge a pillow by its package, but that you also could not prejudge benefits by how comfortable it felt at first.

Tempur provided by far the most informative packaging. Our panel noted that the pillow was ''''well presented'''', ''''appeared very chic'''' and ''''just seemed to be of a higher quality than the others''''. Tempur 's package information included a 'heads up' about the odd smell of their space-age material - something that Putnam's, the second-best-presented pillow, did not include. There is no doubt that the Tempur pillow was the one our testers most wanted to try out.

But the proof is in the sleeping - sort of. The pillow that most of our panel rated as immediately comfortable was Sissel 's Optimum Support. Ironically, this pillow provoked the least enthusiastic response initially among our panel: ''''seemed too basic'''', ''''looked like a cheaper version of the other pillows'''' and ''''not enough information'''' were typical responses.

As the tryout progressed, however, it was Putnam's Royal - the smallest pillow in the test - that provided the best relief from neck pain. An amazing 87.5 per cent of our panel felt it helped not only their neck pain, but also other problems such as disturbed sleep, headache and back pain. Sissel came a close second, with 75 per cent claiming to be helped. In contrast, Tempur only managed to produce an improvement in 50 per cent of our users, while the other half complained of more headaches and greater neck stiffness on waking.

Many users found that Putnam's Royal moulded well to both the neck and shoulders (although a couple found it uncomfortable when sleeping on their side). The fact that the pillow included an ear recess for added comfort was well received.

Putnam's Kingsize gained points for looking more like a standard pillow in size, and fitting well into conventional pillow cases - but most of our testers found it too large. This may be because the majority of our panel (75 per cent) were women - although body build, not gender, was key. Those with broader shoulders found the larger pillow supportive while those of smaller build found it too big. One woman who didn 't get on with the pillow wrote: ''''I let my husband try the Kingsize pillow after me and he hasn 't experienced his usual mid-thoracic tightness since!''''

Clearly, fitting the pillow to the sleeper is important. So, if you're thinking of buying an orthopaedic pillow in a shop, spend 30 minutes or more testing it first, even if you feel embarrassed. These pillows can be a major investment - the average price of our test pillows was around lb49 - so treat it seriously. Look for a money-back guarantee - that way, you can try it out in your own home and judge whether it truly suits your needs. Make sure the pillow provides support for the way you sleep. For instance, if you lie on your back, it 's important not to choose a pillow that is too thick. If you tend to sleep on your side, the most important thing is to make sure that the pillow fills the gap behind your neck to provide total support.

Neck and back pain is often linked, and a terrific pillow on a terrible mattress may have little impact. Although it may have echoes of 'marketingspeak', it pays to think of your mattress and pillow as a 'sleep system' - they should work together to support the whole body. Poor mattress design can create inappropriate body support and this, in turn, may cause muscle discomfort and back pain.

Manufacturer: Putnam's Pillows
Price: lb38.19
Rating: ****
Our overall winner offers good support, with a semi-customised shape that seemed to provide pain relief for both men and women, although it was more effective for back-sleepers than those who sleep on their side. Nevertheless, it does have some drawbacks. First and foremost was the smell endemic to its space-age material. This fades with use, but some found it very unpleasant.

A second minus was the fact that it retained more heat than normal pillow materials. Several users commented that their heads felt more sweaty with this pillow.

As one reader stated: ''''If Putnam's upgraded their package information and did something about the smell (and maybe included a removable washable cover), this would be a superior pillow.''''

But even with these misgivings, the Royal provided genuine relief for the majority of our users.

Optimum Support
Manufacturer: Sissel
Price: lb39.95
Rating: ***
Poor packaging lets this pillow down. Our readers wanted to know more about the materials and what to expect. But on the plus side, this pillow comes with a useful removable cover that our entire panel liked. Although first impressions were not good, 75 per cent of the panel found this a comfortable pillow - the highest approval rating in our test; 75 per cent also felt the benefits of good support, leading to less neck ache on waking and throughout the day. The ventilated design of the pillow did not feel as hot during sleep as the Tempur or Putnam 's offerings.

Manufacturer: Putnam's Pillows
Price: lb39.96
Rating: ***
A larger version of the Royal, not all our panel liked this one. Again, there was a negative smell factor with this pillow and, perhaps because of its large size, only 62.5 per cent of our users found it beneficial. The testers who appreciated it the most seemed to be those with broader shoulders. As one panel member commented, ''''One size will not fit all!''''

Original Neck Pillow
Manufacturer: Tempur
Price: lb69.95
Rating: **
Clever marketing has made this the chic support pillow to own, but testing in the 'real world' does not support the idea of this as a superior pillow. Given its excellent first impression, for many of our panel, it failed to live up to its promise.

In terms of comfort, this medium-sized pillow was little different - at first. But while some, like Putnam 's Royal and Kingsize, became more comfortable with use, several found that this pillow became less comfortable over time. Half our panel claimed it made their neck and back aches worse. On the plus side, it comes with a removable washable cover.

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