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My tips on the best pillow to avoid muscle strain in the neck, upper back and shoulder.

When sleeping, it is necessary to maintain an equilibrium posture in the neck to avoid a sustained contraction, leading to compression of your joints. Equilibrium posture during sleeping is when there is an equal amount of tension of all neck muscles.

Pillows are intended to support the head and neck in a neutral position to minimize biomechanical stresses on cervical structures while sleeping. That is because they maintain the neck in a horizontal position to gravity.

One recent study investigated which pillow types produce different types and frequencies of waking symptoms in pain-free adults. Subjects were encouraged to test each trial pillow for a whole seven nights (completers), unless symptom production, or lack of sleep, necessitated cessation of its use.

The number of subjects having the lowest percentage of completers (67.3 percent) was the people who tested a feather pillow. The feather trial pillow performed least well, producing the highest frequency of waking symptoms. The latex pillow performed best, with 97 percent of the subjects who tested the latex pillow able to complete the seven-day trial. The foam contour pillow performed no better than the foam regular pillow.

The key to finding a pillow that will maintain an equilibrium posture in the neck is to test it in the store. Lie down with the pillow under your head and have someone take a photo horizontal to your spine to see if your head is level, angled above, or below horizontal.

Using a pillow that is too thick or too many pillows can cause strain on the neck, shoulder and upper back. Muscles Affected: trapezius, levator scapula and scalenes

The other thing that is important is for the pillow to maintain that thickness for as long as possible. When the pillow thins from use, your neck muscles will need to contract all night in an attempt to maintain your 9–12-pound head in the horizontal position.

Using a pillow that is too thin or no pillows can put the head, neck and upper spine out of a neutral alignment leading to cause strain on the neck. Muscles Affected: trapezius, levator scapula and scalenes
Sleeping with the arm under the pillow can cause strain on the shoulder and upper back and spine. This is a sign that your pillow may be too thin

It is common to find many who develop the chronic habit of adopting an abnormal posture of keeping the arm above the head under the pillow. Poor posture while sitting or standing happens when you lean your body outside perpendicular to the pull of gravity.

Poor posture while sleeping happens when you lean your body or head outside of the perfectly horizontal posture to the pull of gravity. Poor sleeping posture can be a cause of thoracic outlet syndrome (1). Oftentimes, we have developed this habit to give a lift to the thinned-out pillow, so it maintains our head level, to avoid strain on the neck muscles.

For those of you who cannot break the habit of putting your arm under the pillow, you might want to try pinning the sleeve of your pajama arm to the pajama leg. You should sleep on the opposite side and avoid lying on your stomach. Pillows might be placed under each arm when lying on your back (2).

The head, neck and upper body must be in alignment while sleeping. That means your pillow cannot be too thick or too thin. Muscles Affected: Opposite side trapezius, levator scapula and scalenes

One thing that has helped me in those situations is to stuff the base of the pillow with a folded towel between the pillow and the pillowcase to thicken the pillow, so it is thick enough to maintain the horizontal position of the neck and the head.

This is an excerpt from a chapter in Dr Stoxen’s #1 best seller The Human Spring Approach to Thoracic Outlet Syndrome. The book is available on Amazon.com in these 13 counties US UK DE FR ES IT NL JP BR CA MX AU IN on Kindle. The book is available on Amazon.com in these 7 counties US UK DE FR ES IT JP in paperback.

The Human Spring Approach to Thoracic Outlet Syndrome by Chicago Chiropractor, Dr James Stoxen DC FSSEMM (hon)
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