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

  • Author Footnotes
    1 Present address: 2 Chui Ling Lane, Tseung Kwan O, N.T., Hong Kong SAR.
    Johnson C.Y. Pang
    Corresponding author.
    1 Present address: 2 Chui Ling Lane, Tseung Kwan O, N.T., Hong Kong SAR.
    School of Health Sciences, Caritas Institute of Higher Education, Hong Kong SAR
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  • Author Footnotes
    2 Present address: ST 535, The Hong Kong Polytechnic University, Hung Hom, KLN., Hong Kong SAR.
    Sharon M.H. Tsang
    2 Present address: ST 535, The Hong Kong Polytechnic University, Hung Hom, KLN., Hong Kong SAR.
    The Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR
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  • Author Footnotes
    3 Present address: Level 7, Susan Wakil Health Building D18, The University of Sydney, Sydney, NSW 2006, Australia.
    Allan C.L. Fu
    3 Present address: Level 7, Susan Wakil Health Building D18, The University of Sydney, Sydney, NSW 2006, Australia.
    Discipline of Physiotherapy, Sydney School of Health Sciences, The University of Sydney, Australia

    Musculoskeletal Research Hub, Charles Perkins Centre, The University of Sydney, Australia
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  • Author Footnotes
    1 Present address: 2 Chui Ling Lane, Tseung Kwan O, N.T., Hong Kong SAR.
    2 Present address: ST 535, The Hong Kong Polytechnic University, Hung Hom, KLN., Hong Kong SAR.
    3 Present address: Level 7, Susan Wakil Health Building D18, The University of Sydney, Sydney, NSW 2006, Australia.


      • Neck pain can adversely affect quality of life, productivity, and sleep quality.
      • Inadequate pillow support can contribute to neck pain and waking symptoms.
      • Rubber pillows and spring pillows may have better performance than feather pillows.
      • The effect of pillows on sleep quality for patients with neck pain is inconclusive.



      Neck pain is a prevalent condition that can adversely affect quality of life, productivity at work, and sleep quality. The aim of this systematic review and meta-analysis was to identify clinical trials assessing the effect of different types of pillows on neck pain, waking symptoms, neck disability, sleep quality, and spinal alignment.


      We systematically searched CINAHL Complete, Cochrane Library, EMBASE, Medline, Pubmed and Psychinfo databases from inception to September 2020. Two reviewers independently assessed the articles and evaluated the methodological quality using PEDro.


      Thirty-five articles fulfilled the inclusion criteria of the study. There were nine high-quality studies involving 555 participants. The meta-analysis revealed significant differences favouring the use of rubber pillows to reduce neck pain [standardized mean difference (SMD): -0.263; P < 0.001). Moreover, waking pain (SMD: -0.228; P < 0.001) and neck disability (SMD: -0.506; P = 0.020) were reduced while the satisfaction rate was enhanced (SMD: 1.144; P < 0.001) with pillow use. Pillow designs did not influence sleep quality (SMD = 0.047; P = 0.703) in patients with chronic neck pain.


      The use of spring and rubber pillows are effective in reducing neck pain, waking symptoms, and disability and enhancing pillow satisfaction in patients with chronic neck pain. Moreover, there may be no change in the alignment of the cervical spine in the side-lying position, regardless of the use of rubber or feather pillows. Rather, the cervical alignment may be significantly impacted by the shape and height of the pillow.


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