Physiotherapy Archives - West Lakes Physio - Sports & Rehab Physiotherapy

Waking up with a stiff neck, sore back or aching joints is a common complaint. We often think about what we do during the day — our posture, exercise, work and activities — but what happens during the seven or eight hours we spend asleep may also play a role.

Research is increasingly suggesting that both sleep position and sleep quality can influence musculoskeletal pain and recovery.

Does sleep position matter?

While there isn’t one perfect sleeping position for everyone, spending long periods in positions that place sustained strain on the neck or back may contribute to morning pain or stiffness.

Even side sleeping can vary. A well-supported position where the pelvis and spine remain relatively aligned may be comfortable. Often however, the top leg will fall well forward and can cause prolonged rotation through the pelvis and spine. A pillow between the knees or for the upper leg to rest on infront of you can help alignment.

Pillow support matters too. If your pillow doesn’t adequately support your head and neck, you may spend several hours in a position that places extra strain on sensitive tissues.

This doesn’t mean your sleeping position is necessarily causing your pain, but it may be one factor worth considering — particularly if your symptoms are consistently worse when you first wake.

It’s not just how you sleep — it’s how well you sleep

Perhaps even more important is sleep quality.

Pain can certainly make it harder to sleep, but research is showing that the relationship can also work in the other direction. Regularly getting poor or disrupted sleep may increase our sensitivity to pain and affect the body’s ability to recover.

Poor sleep has also been associated with increased inflammation, reduced pain inhibition, slower recovery and changes in mood, concentration and general wellbeing.

This means sleep shouldn’t necessarily be viewed simply as something that becomes poor because you are in pain. For some people, improving sleep may be an important part of managing persistent pain and supporting recovery.

What can help?

Small changes may make a difference. These can include reviewing your pillow and sleeping position, keeping regular sleep and wake times, reducing screen use late at night and developing a consistent wind-down routine.

The article also highlights strategies such as morning light exposure, regular exercise, limiting stimulating activities late in the evening, relaxation or breathing exercises, and gradually changing unhelpful sleep habits.

Key takeaways

Pay attention to your morning symptoms. Regularly waking with pain or stiffness may be a clue that sleep posture or sleep quality is worth exploring.
There is no single “perfect” sleeping position. The aim is a comfortable, well-supported position that avoids prolonged twisting or strain.
Check your pillow support. Your pillow should comfortably support your head and neck rather than leaving them tilted or rotated for hours.
Sleep quality matters as much as sleep posture. Interrupted or insufficient sleep may increase pain sensitivity and make recovery more difficult.
Keep a consistent sleep routine. Regular bed and wake times, morning daylight and reducing late-night screen exposure can all support better sleep.
Think beyond the painful area. Exercise, physiotherapy treatment and good sleep can work together rather than treating each separately.
Tell your physio about your sleep. If pain is regularly worse on waking, information about your sleeping position, pillow and sleep quality may provide another useful piece of the puzzle.

If you regularly wake with neck, back or joint pain, let your West Lakes Physio physiotherapist know. Looking at what happens overnight — as well as what you do during the day — may help us develop a more complete approach to your treatment and recovery.
Learn more about Sleep and Sport Performance here
Waking with neck pain? Read our Pillow Guide here.

Based on “The Nocturnal Spine” by Dr Doug Cary, Specialist Musculoskeletal Physiotherapist and sleep researcher, published in InTouch, Issue 3, 2026.

“What sort of pillow should I be sleeping on?” is still one of the most common questions I’m asked when treating people with neck pain.

The answer is rarely a particular brand or type of pillow. The best pillow is generally one that feels comfortable, supports your usual sleeping position and allows your neck to rest in a comfortable position overnight.

If you sleep well, your neck feels comfortable in bed and you wake without increased pain or stiffness, your pillow is probably doing its job.

But if you find yourself regularly waking with a stiff or sore neck — or rotating through every pillow in the house trying to find something that works — it may be worth looking more closely at your pillow and sleeping position.

Start with the position you sleep in

The aim is to support your head and neck comfortably rather than leaving your neck tilted or twisted for long periods.

Side sleepers

Side sleepers generally need enough pillow height to fill the space between the shoulder and the head. A pillow that is too low may allow your head to drop towards the mattress, while one that is too high can push it in the opposite direction. Your shoulder width, mattress firmness and body shape will all affect how much support feels right for you.

Back sleepers

Back sleepers will usually be more comfortable with a lower pillow. If the pillow is too high, it can push the head forward and bring the chin towards the chest. Some people find a pillow with gentle support or contouring beneath the neck more comfortable.

Tummy sleepers

Sleeping on your stomach requires your neck to remain rotated for long periods, which can be uncomfortable for some people with neck pain. If this is your preferred position, a thinner pillow is generally more comfortable than a high one.

What if you sleep in several positions?

Most of us don’t stay perfectly still all night. If you regularly move between your side and your back, a pillow that can be moulded or adjusted may be more comfortable than something very rigid. This is where pillow filling and construction become important.

What type of pillow should you choose?

There are plenty of options, and each has advantages and disadvantages.

Synthetic pillows tend to be inexpensive, lightweight and easy to scrunch or reshape. They can work well if you change positions frequently, although they may lose their shape sooner than some other options.

Feather or down pillows are soft and very mouldable, so you can adjust the height and shape. However, very soft versions may not provide enough support for some side sleepers.

Memory foam and contour pillows provide a more structured shape and may suit people who prefer firmer or more consistent support. Some people love this feel; others find it too firm or warm.

Latex pillows also tend to provide firmer, longer-lasting support but may not suit people who prefer a softer pillow.

There are also water, gel and other speciality pillows designed for particular comfort or support needs.

The important point is that a more expensive or more complicated pillow isn’t automatically a better pillow for your neck.

A simple trick to try

If your neck is uncomfortable at night, try placing a small rolled towel along the lower edge of your pillow inside the pillowcase. This can provide a little extra support beneath the neck without changing your whole pillow. If you find this noticeably more comfortable, you may prefer a pillow with some gentle contouring or additional neck support.

How do you know when your pillow needs replacing?

There isn’t a single replacement date that suits every pillow. What matters more is whether it is still doing its job. If your pillow has become flat, lumpy, uneven or no longer returns to its usual shape, it may not be providing the same support it once did.

And if you regularly wake feeling as though you need to fold, stack or constantly rearrange it to get comfortable, that may also be a clue that it’s time for a change.

So, what is the “best” pillow?

At the end of the day, there isn’t one perfect pillow for everyone.

Think about:

your usual sleeping position
the height and firmness you find comfortable
whether you tend to move between positions
whether your neck feels comfortable during the night
how you feel when you wake in the morning.

If you have persistent neck pain or regularly wake with stiffness, your pillow may be only one part of the picture. Sleep position, sleep quality and your neck itself can all contribute.

At West Lakes Physio, we can assess your neck, talk through your sleeping position and help you work out whether changing your pillow or night-time support may be useful.

If you’re unsure, bring the details of your current pillow to your next appointment and have a chat with your physio.

You can read more about the links to poor sleep and pain here.

By Sandy Woolman, Physiotherapist – West Lakes Physio Sports & Rehab

Tag: Physiotherapy