
ABSTRACT:
Neck pain being a neuromusculoskeletal condition has traumatic & non-traumatic causes. Pain and disability are the main features of neck pain. Common causes include ageing, trauma, physical strain, injury like whiplash, mental stress, growth and other health condition like cancer, meningitis, tuberculosis, cervical rib etc. Clinical examination and radiological investigations help in diagnosing and treating neck pain. The prevalence of neck pain in general population is about 0.4% to 86.8%. Treatment options include pharmacological and non- pharmacological methods. Among pharmacological methods we have analgesics to treat pain, and in non- pharmacological methods we have physiotherapy and orthotic bracing. Among these treatment options usage of pillow finds a special place under non-pharmacological treatment methods. It is very unfortunate that it is highly underestimated and under prescribed by both physicians and physiotherapists who treat neck pain. Hence in this overview we have analysed two big studies conducted in favour of benefits of pillow usage in treating neck pain in adjunct to present treatment options. Both the studies gave a positive response regarding the usage of pillow to treat neck pain and improve the quality of life of patients suffering with it. Hence pillow usage should be encouraged in adjunct to present treatment options to get better results.
Key words: Neck pain, pillow usage, analgesics, physiotherapy, orthotic bracing.
INTRODUCTION:
Neck pain is a neuromusculoskeletal problem which has both traumatic and non-traumatic causes. It is associated with pain, disability and contributes to health care burden worldwide (1). Common causes for neck pain include ageing, physical strain, injury like whiplash (a type of cervical spine injury), mental stress, growth and other health conditions like cancer, meningitis, tuberculosis, cervical rib etc. Diagnosis is based upon clinical examination and radiological investigations. Some studies conducted concluded that estimated 1 year incidence of neck pain was between 10.4% to 21.3% with a higher incidence noted in office and computer workers (2). The prevalence of neck pain in general population ranges from 0.4% to 86.8%. It was more prevalent among women and high- income countries when compared to medium and low-income countries. Also, it was high in urban areas when compared to rural areas (2).
Studies conducted from the year 1990 to 2020 say the prevalence of neck pain was stable with global age standardised prevalence rate of 2450 per 1,00,000 population. Globally females showed higher age- standardised prevalence rate of 2890 per 1,00,000 population than males which was 2000 per 1,00,000 population. The prevalence peaked between 45 years and 75 years age group in both males and females. By 2050 the number of neck pain cases are expected to be 269 million which indicates a rise of 32.5% from 2020 to 2050. It’s a matter of concern has to be addressed accordingly (1).
Causes for neck pain can be traumatic and non-traumatic. They can also be specific and non-specific. Specific type has a particular cause behind but non-specific type doesn’t have one particular cause behind. Osteoarthritis (OA) of zygapophyseal joints of the cervical spine and lumbar spine cause neck pain and back pain. Zygapophyseal joints are also known as z-joints. They have been observed as a source of chronic pain in neck and back region. Studies done concluded that with use of diagnostic tools, we can trace the source of neck pain from z-joints after trauma in about 36% to 60% of cases (3). Due to shift from offline mode to online mode of teaching the neck pain in college students has increased. In a systematic review and meta-analysis done included 33 studies which had a total of 18,395 participants. In that study the investigators found 33 potential risk factors out of which 11 were included into the metanalysis after thorough assessment. All results were statistically significant. The factors mainly identified were lack of proper use of pillow, lack of exercise, improper siting posture, history of neck and shoulder trauma, senior grade, staying up late, usage of electronic devices for long periods keeping the neck bowed, and emotional stress to cause neck pain (4).
In a systematic search conducted it was found that sedentary life style, usage of computers and mobiles for long time, increased the risk of development of neck pain in adults especially in university going students (5). According to Zheing et al., in their observational study which was a cross-sectional design it was concluded that prevalence of neck pain among students increased significantly during the covid-19 pandemic due to prolong use of mobiles and computers on tables and beds without maintaining good posture (6).
We have many treatment options to treat neck pain. They include pharmacological and non-pharmacological methods. Among pharmacological methods we use analgesics. Under non-pharmacological treatment we have exercise therapy, manual therapy, orthotic bracing and explaining care measures to be followed during activities of daily living. Even the European clinical practice guidelines suggested to go for non-pharmacological treatment methods for neck and back pain than going for medical management (7)
A systematic review and meta-analysis done by varangot et al., concluded that neural mobilisations are effective to improve overall pain intensity when given along with regular physiotherapy to treat neck pain with radiculopathy (8). In a randomised control trial done by Simon et al., concluded that giving diaphragm manual techniques along with standard cervical treatment gave good results when compared to standard cervical physiotherapy given alone to reduce neck pain (9). As per the study done Bogduck and Mecvikor et al., they analysed 11 population studies, 4 diagnostic studies and 3 case control studies. They concluded that no study showed a positive association between OA of z-joints and neck pain (3).
Sidiq et al., in their randomised sham-controlled study concluded that giving dynamic taping in addition to standard neck physiotherapy helped in improving pain, functional disability and wellbeing among patients with chronic non-specific neck pain when compared to sham group (10). Macais et al., in their randomised controlled study concluded that giving scapular mobilisation helped on reducing the mechano-sensitivity of median nerve and relieving the radicular pain in subjects with neck pain radiating to upper limb (upper limb nerve tension test+) (11).
Li et al., in their randomised controlled study concluded that using extracorporeal shock wave therapy helped in relieving patients neck pain, improve the neck rotation and enhanced the quality of life (12). Kaya et al., in their randomised control study said that proprioceptive neuromuscular facilitation (PNF) helped in reducing the neck pain, disability level and improve neck range of motion, cervical muscle endurance, posture of individuals with forward head posture (text neck syndrome) (13).
Ozlu et al., their randomised control trial concluded that along with ergonomics training interactive telerehabilitation program was effective to reduce the neck pain, neck disability and improve neck range of motion in office workers when compared to home exercise program alone (14). The subjects under study had chronic nonspecific neck pain. Boston and kaya et al., in their randomised controlled study said that instrument assisted soft tissue mobilisation (IASTM) combined with electrotherapy helped in relieving neck pain, improved the endurance of the neck muscles, when compared to exercise group alone (15).
Having many options to treat neck pain, using a pillow while sleeping has been poorly advised by clinicians and physiotherapists. Extensive research is been conducted worldwide to prove the importance of pillow usage in treating the neck pain. Pang et al., in their systematic review and meta-analysis concluded and highlighted that:
- Neck pain effected the quality of life, productivity and sleep quality.
- Inadequate pillow support can cause neck pain.
- Rubber and spring pillows showed better results than feather pillows.
- The overall effect of pillow size on sleep quality in patients with neck pain is inconclusive.

They concluded that to reduce the neck pain use of spring and rubber pillow were found better than normal feather pillows. There was no change in spine alignment in supine and side lying position when spring and rubber pillows were used. The cervical spine only showed deviations when the shape and height of the pillow was changed (16).
Yamada et al., in their observational study concluded that pillow designed using the set up spinal sleep method (SSS method) helped in reducing the neck pain and somatic symptoms (17).
Hence the present study is an overview of studies done till date to support the use of pillow in activities of daily living to help in relieving neck pain which can be acute, chronic, specific and non-specific.
REVIEW OF LITERATURE:
- (Bogduck et al., 2024) In their study discussed about the role of osteoarthritis of zygapophyseal joints of cervical and lumbar spine in causing back and neck pain (3).
- (Zheng et al., 2024) In their study checked for the prevalence of neck pain in online learning students (6).
- (Sidiq et al., 2024) In their study checked for dynamic taping to treat chronic non-specific neck pain when compared to standard physiotherapy alone (9).
- (Macias et al., 2024) In their study checked the effect of scapular mobilisation on reducing the neck pain with radiculopathy (10).
- (Li et al., 2024) In their study checked for the efficacy of extracorporeal shock wave therapy in reducing neck pain due to cervical spondylosis (11).
- (Kaya et al., 2024) In their study checked for the effect of proprioceptive neuromuscular facilitation techniques on text neck syndrome (12).
- (Ozlu et al., 2024) In their study checked for the effects of interactive telerehabilitation practices in office workers with chronic nonspecific neck pain (13).
- (Bostan et al., 2024) In their study checked for the effect of instrument-assisted soft tissue mobilization combined with exercise therapy on pain and muscle endurance in patients with chronic neck pain (14).
- (Gao et al., 2023) In their study checked for the factors responsible for neck pain in college going students (4).
- (Mazaheri et al., 2023) In their study checked for the relationship between sedentary behaviour and neck pain in adults (5).
- (Yamada et al., 2023) In their study checked for how pillow adjustments helped in bringing changes in neck pain and somatic symptoms (16).
- (Varangot et al., 2022) In their study checked for the effect of neural mobilization techniques in the management of musculoskeletal neck disorders with nerve-related symptoms (7).
- (Collaborators et al., 2021) In their study checked for the global, regional, and national burden of neck pain from 1990–2020, and its projections towards 2050 (1).
- (Simoni et al., 2021) In their study checked for the effectiveness of standard cervical physiotherapy plus diaphragm manual therapy on pain in patients with chronic neck pain (8).
- (Pang et al., 2021) In their study checked for the effects of pillow designs on neck pain, waking symptoms, neck disability, sleep quality and spinal alignment in adults(15).
- (Corp et al., 2021) In their study gave evidence-based treatment recommendations for neck and low back pain across Europe.
- (Hoy et al., 2010) In their study discussed about the epidemiology of neck pain (2).
METHODOLOGY:
It is a summary of the numerous investigations that have been conducted on the research issue thus far. A difficult problem that has plagued the general public for decades is neck pain. There are numerous pharmacological and non-pharmacological approaches to treating neck discomfort. Two papers by Yamada et al. and Pang et al. were examined. In their study, Pang et al. found that using spring and rubber pillows helps individuals with chronic neck pain feel better while also reducing waking symptoms, neck pain, and impairment. Whether rubber or feather pillows were used, the cervical spine’s posture remained unchanged when lying sideways. Instead, the height and form of the pillow had a major effect on the cervical position. Thirty-five papers that met the inclusion criteria were included. There were 555 individuals in nine excellent research.(16)
Another study by Yamada et al. found that the Set-up for the Spinal Sleep method of modifying pillow height greatly reduced somatic symptoms associated with psychological and social issues as well as physical neck pain. The SSS-8 was used to assess and enroll research participants who presented to the hospital between April 1, 2016, and July 31, 2016, with stiff shoulders and neck pain as their primary complaint. The following were the requirements for eligibility:
- patients with a score of 8 or higher on the SSS-8 who came to the hospital with complaints of stiff shoulders or neck pain, with or without radiating upper extremity pain;
- patients who gave written consent; and
- patients who knew how to adjust the pillow and could use it as directed. Before the patients began using the cushion, they were interviewed in order to determine the third inclusion criterion.
It was determined that the patient understood how to use and adjust the pillow if they often woke up with their head resting on it. The following were the exclusion criteria:
- patients who requested medication, physical therapy, or rehabilitation at the time of study participation;
- patients who clearly showed signs of cervical myelopathy and were in need of surgery; and
- patients who the responsible physician determined were not suitable for study participation.
Participants who satisfied the aforementioned qualifying requirements were prescribed pillows made using the SSS method. Questionnaires were used to gather data on neck pain, including the numerical rating scale (NRS) and SSS-8, at baseline and two weeks and three months after using pillows. Kurashiki Medical Center’s institutional review board granted ethical permission (approval number 219), and prior to study participation, each patient provided written informed consent. The three-step SSS approach was created at the 16 Gou Orthopaedic Clinic. First, the pillow height is changed such that, in the lateral position, the participant’s head and trunk are parallel to the bed’s surface. Second, when in the supine posture, the cervical spine is maintained at an anterior tilt angle of roughly 15° from the bed surface. Third, by varying the pillow height in 5-mm increments and decrements, the participant’s ability to turn over at various pillow heights is assessed. The ideal cushion height was determined by how easily the individual could turn over. Two things influence how smoothly rolling over occurs. The patient’s subjective assessment was the first consideration. The patient is to flex both knees to roughly 60 degrees, rotate thrice to the left and right without recoil, and cross both arms in front of the chest.
After that, the patient made a subjective assessment of their ability to rotate effortlessly. The evaluator’s objective assessment is the second factor. The assessor used visual cues to determine whether the patient’s pelvis and left or right shoulder were moving in synchrony or not. All handmade pillows were produced from the same material, and the SSS method was used to measure and calculate the adjusted pillow heights. These materials included Japanese entrance mats (CAINZ Co., Saitama, Japan) that were 90 cm long, 60 cm wide, and 1 cm high, made of 100% polyester on the front, polyester and cotton on the back, and non-slip vinyl chloride resin, as well as a 100% cotton towelket (sold by the Japan Towel Wholesalers Association, size: 140 cm ×190 cm). The base of a pillow that was 30 cm long, 60 cm wide, and 3 cm high was made from Japanese entrance mats that had been folded in thirds. The surface was leveled when the towelket was folded in and placed on the mat bellows. One by one, the surface layers were raised and lowered to change the height. The cushion was then manually compressed to provide a stiffness that would keep it from sinking more than 5 mm under the weight, as the typical head weighs 4 kg. An automatic food scale was used to quantify compression, and a ruler was used to measure sinkage in pillow height in 1 mm increments. The Japanese version of the SSS-8, a self-administered questionnaire, was used to measure somatization. A condensed 8-item version of the Patient Health Questionnaire-15, the SSS-8 was created to evaluate the existence and intensity of common somatic complaints.
The SSS-8 evaluates the degree to which the following physical symptoms have disturbed the respondent over the previous seven days:
- gastrointestinal or bowel issues;
- back pain;
- joint, arm, or leg pain;
- headaches;
- chest pain or dyspnea;
- light headedness;
- fatigue or low energy; and
- difficulty falling asleep.
Scores range from 0 (not at all) to 4 (very much) for each item. The, SSS-8’s English version was translated into Japanese by one of the authors21. The SSS-8’s Japanese translation has undergone psychometric and linguistic validation22. As in Gierk et al., the total SSS-8 score (0–32) was divided into five groups: low (4–7), medium (8–11), high (12– 15), extremely high (16–32), and no to minimal (0–3). The achievement of the least clinically meaningful difference (MCID) in neck pain NRS and patient satisfaction at the conclusion of the three-month therapy period was the study’s clinical result. According to earlier sources, the MCID for neck discomfort NRS was defined as three points or more. Patients were asked to rate their level of satisfaction at the end of treatment on a 4-point scale, with 1 denoting contentment and 4 denoting dissatisfaction. The group of patients who selected 1 as satisfied was considered satisfied. To extract factors associated with MCID achievement, baseline characteristics were compared by the investigators. To examine whether the achievement of MCID could be predicted at baseline, only baseline data were used in this analysis. Comparisons between the two groups were analysed using the t-test for continuous data and the χ2 test for categorical data. In addition, a logistic regression analysis was performed with MCID achievement as the dependent variable. Additionally, the dependent variable in a logistic regression analysis was MCID achievement.(17)

RESULTS:
Significant differences favoring the usage of rubber pillows to alleviate neck discomfort were found in the meta- analysis conducted by Pang et al. [standardized mean difference (SMD): -0.263; P < 0.001). Additionally, using pillows increased the satisfaction rate (SMD: 1.144; P < 0.001) while decreasing waking pain (SMD: -0.228; P < 0.001) and neck impairment (SMD: -0.506; P = 0.020). In individuals with persistent neck pain, pillow designs had no effect on sleep quality (SMD = 0.047; P = 0.703). From the beginning until September 2020, they conducted a thorough analysis of the CINAHL Complete, Cochrane Library, EMBASE, Medline, Pubmed, and Psychinfo databases.(16)
Yamada et al.’s study included an analysis of the baseline characteristics of the 84 patients who took part. The corresponding SSS-8 scores were 13.2, 9.9, and 8.2 (Jonckheere–Terpstra test; p<0.001 for both), while the mean values of neck pain NRS at baseline, two weeks, and three months were 6.8, 5.1, and 4.1, respectively. With a drop of three points or more, 42 patients (50%) were able to attain the MCID for neck discomfort NRS. The group that acquired MCID had considerably higher baseline neck pain NRS values. With an odds ratio of
2.02 and a 95% CI of 1.42–2.88, age- and gender-adjusted logistic regression analysis revealed a strong positive correlation between baseline neck pain NRS and MCID performance. The group that was satisfied experienced a significantly higher 3-month decrease in neck pain NRS and SSS 8. Improvement in the neck pain NRS score and improvement in the SSS-8 at three months were significantly positively correlated in the age- and gender- adjusted logistic multivariate regression analysis with patient satisfaction as the dependent variable. With a 95% CI of 1.09–1.73. (17)
DISCUSSION:
In individuals with persistent neck discomfort, the usage of spring and rubber pillows improves pillow satisfaction while also reducing waking symptoms, neck pain, and impairment. Furthermore, whether rubber or feather pillows are used, the cervical spine’s alignment may remain unchanged when laying on one’s side. Instead, the height and form of the pillow may have a big influence on the cervical position.(16)
Every patient in Yamada et al.’s observational study used pillows manufactured using the SSS process. Somatic complaints and neck pain were assessed throughout time. Using a pillow greatly reduced somatic symptoms and neck ache. In 1949, Ruth Jackson was the first to use the term “cervical pillow.” The effects of pillows with different materials, forms, heights, and hardness on the cervical spine have been discussed. For a while, there had been no convincing proof of these impacts, but in 2021, fresh data was presented. The following five typical concerns were used by Chun-Yiu et al. in their systematic review and meta-analysis to examine the association between pillow design and selection: 1) neck discomfort and awakening symptoms, 2) neck disability, 3) pillow satisfaction, 4) sleep quality, and 5) spinal alignment15. The two issues that were most pertinent to this study were pillow pleasure and neck pain. Achieving MCID in neck pain NRS was significantly positively correlated with baseline neck pain NRS in the current study. This finding implies that patients with severe neck discomfort at baseline may benefit greatly with pillow treatment. Chun-Yiu et al. conducted a meta-analysis of nine high-quality studies, three of which examined the connection between different pillows and neck discomfort. For example, Helewa et al. reported a standardized mean difference (SMD) of -0.121 (95% CI [-0.608,0.366], p<0.625)23 for a foam pillow, -0.744 (95% CI [0.121,1.367], p=0.019)24 for a latex pillow, and -0.577 (95% CI [-0.964, -0.189], p<0.004)25 for a spring pillow. SMD is used to integrate the findings of studies that measure the same continuous variable on various scales across investigations, such pain. It is calculated by dividing the difference between two estimated means by the estimated standard deviation. According to Cohen’s interpretation, a modest effect is denoted by an SMD of 0.2, a moderate effect by an SMD of 0.5, and a big effect by an SMD of 0.8. Therefore, it is possible to interpret the findings of Fazli et al. and Vanti et al. as statistically significant reductions in neck discomfort, with big and modest effects, respectively.
The pillows utilized in these experiments, however, have certain inherent issues, according to the scientists. According to Fazli et al., the ergonomic latex cushion they employed in their study supported the neck and corrected cervical kyphosis. It also provided ergonomic support for both side-lying and supine positions. However, when individuals with varying body types utilized the one-size cushion, the report did not explicitly explain how the lateral and supine positions were maintained. According to the anthropometric criteria of average shoulder width, the cushion utilized by Vanti et al. was judged suitable for the vast majority of people. A typical size that fits most people does not, however, necessarily fit each person’s body type perfectly.
We measured and customized the cushion height for each participant in our study since we anticipated that each person would require a different height. Improvements in the neck pain NRS score and the SSS-8 at three months were significantly positively correlated, and there were no significant changes in baseline characteristics concerning factors associated with patients’ treatment satisfaction. The findings demonstrated a relationship between the patients’ subjective pleasure and both the improvement in somatic symptoms and the decrease in neck discomfort. Rubber and spring pillows are useful in improving pillow satisfaction in patients with persistent neck pain, according to Chun-Yiu et al.’s meta-analysis. In this metaanalysis, three studies examined satisfaction with pillow use: Gordon et al. reported an SMD of 2.804 (95% CI [1.876,3.732], p<0.001) for latex pillows and 2.600 (95% CI [1.886, 3.314], p<0.001) for polyester pillows27; Lee et al. reported an SMD of 1.024 (95% CI [0.469,1.579], p=0.000) for polyester pillows28; and Vanti et al. reported an SMD of −1.012 (95% CI [0.565, 1.458], p<0.001) for latex pillows.

As a result, every study showed a statistically significant increase in satisfaction. The polyester pillow that Lee et al. utilized was called a functional cervical pillow, and it was divided into two cores, a cervical support structure, two side flaps, and a head base support structure. Both the supine and prone positions are supported by this design concept for the cervical curve. Furthermore, it was asserted that the purpose of bilateral side flaps was to support the neck’s curvature in order to avoid an improper neck alignment in the prone position and to shield the shoulders from pressure when resting in the supine position. Humans are thought to rotate between sleeping in the lateral and supine positions in addition to sleeping in both of them. Because compartmentalized pillows, like the functional cervical pillow, have not been shown to facilitate smooth turning, researchers think that a flat construction is best suited for enabling patients to roll over with ease. The spring pillow utilized by Vanti et al. included 60 independent springs interior and a viscoelastic polyurethane outside construction.
The well-known characteristics of viscoelastic materials are employed by spring pillows, which can be effectively tailored to a person’s shape. The spring pillow used in their study measured 410 mm in width, 700 mm in length, and 120 mm in thickness. Individual pillow heights in the current investigation, as determined by the SSS approach, varied from 55 to 85 mm. For the participants, a pillow height of 120 mm is considered abnormally high, assuming that their body shape was average. Furthermore, we believe that the height change may potentially destabilize the cervical spine if the external structure’s viscoelastic polyurethane collapsed and depressed the entire pillow. Poor cervical spine alignment is one of the primary causes of neck pain, according to Ruth Jackson and other orthopedic doctors. In their systematic review, Chun-Yiu et al. also discussed spinal alignment and neck pain.
Since our SSS approach incorporates the idea of cervical spine alignment modification, it is also covered below even though cervical spine alignment was not specifically examined in this study. The previously mentioned meta- analysis also demonstrated that while the shape and height of the cushion may considerably alter cervical alignment, the usage of rubber or feather pillows may not alter cervical alignment while lying sideways. Finally, they came to the conclusion that “the stability of the cervical segment in the side-lying position appears to be satisfactory, although the effects of different shapes and heights of pillows on the outcomes and alignment of the cervical spine remain unclear.”
It is still uncertain which pillow design offers the optimal cervical angle when supine. Jia-Xing Lei et al. examined the shortcomings of the existing pillow height assessment studies, provided an overview of the field’s research, and suggested a number of objective and quantitative markers for evaluating pillow height, such as muscle activity, body size, contact pressure, and cervical spine alignment. In terms of emphasizing the value of adjusting pillow height, this study was significant. Dynamic adaptation to the pillow height, according to the study’s authors, is a phased fine-tuning of the pillow height that can gradually correct the cervical spine by making minor adjustments rather than making significant ones. Nonetheless, we think that each person’s body can be adapted to the ideal pillow height, which can be employed to preserve a particular cervical position. As a result, cervical spine alignment can be fixed straight away without requiring gradual adaption through minor changes.
Prior to doing this study, we had empirically investigated the design of pillows for outpatients to alleviate neck pain since 1971. The cervical tilt angle in the supine position was determined to be roughly 15° after assessing supine X-ray pictures obtained with a pillow in patients whose symptoms had resolved. Based on this information, we created a pillow height adjustment method (the SSS method) in our earlier study18. A cervical tilt angle of 15° in the supine position served as an index in this investigation, which employed the SSS method to verify cervical alignment. The study’s findings demonstrated the value of the SSS approach since we discovered a strong positive correlation between pillow satisfaction and a reduction in clinical symptoms. The outcomes also subtly demonstrated the value of our 15° index for modifying the cervical tilt angle when in the supine posture. Commercially available pillows or semi-customized pillows with theoretically perfect notions are the kind of pillows that most researchers choose for their studies; nevertheless, these pillows are restricted to a specific form, height, and material. To put it another way, a single pillow has several parameters. As a result, it might be challenging to identify whether a participant’s discomfort with a cushion is due to material, shape, or height. The SSS approach solves the adjustment difficulty mentioned above by giving height adjustment the highest priority parameter and using a material with a shape that permits height adjustment in millimeters and a firmness that maintains the established height (limited sinkage to within 5 mm). This study has the following two drawbacks.
The study design was the first and most significant drawback. Because there was no control or comparison group, the results of this one-arm, before-and-after comparison trial were difficult to interpret. Therefore, we did not compare pillows with varied shapes but the same height, or pillows with varying cervical tilt angles or heights. Additionally, the SSS method was supported by our own evidence, which served as the basis for the single strategy. To get more reliable results, more research contrasting this strategy with other criteria or approaches is also needed. Second, because posture during sleep is solely subjectively perceived by the patient, it has not been objectively studied. We intend to carry out an objective assessment in the future with a view to tracking pillow use (video, sensors, etc.) since it has been proposed that the ease of turning and posture during sleep is connected to pain relief and contentment.
In conclusion, the SSS method of pillow height modification greatly reduced somatic symptoms associated with psychological and social problems in addition to physical neck pain. Furthermore, it could be best to have a cervical tilt angle of about 15° when supine. We think that this easy, non-invasive, long-lasting, and inexpensive way of adjusting pillow height might help with cervical spine pain, but more research with a more reliable study design is needed to confirm these results.(17)
CONCLUSION:
Hence after analysing the studies done, it is clear that usage of pillow as an adjunct to present treatment options was found beneficial and helpful. Hence it is suggested that clinicians and physiotherapists should advise proper pillow usage to their patients with neck pain so that they can get benefitted.
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