If tomorrow morning, you were to wake up with neck pain, would your first thought be, “Man, I need a new pillow?”
If you’re like most people, you may go on a hunt for the “perfect pillow” that you hope will keep your neck in “neutral”.
However, may I remind you that for thousands of years, humans have been sleeping on the ground with no pillows. Children naturally sleep without pillows as do our primate cousins.
“Current thinking is to keep the spine straight by use of a pillow. Has anyone ever seen a gorilla shinnying up a tree with a pillow?” —Tetley, 2000
However, since the invention of pillows, we have become fully dependent on them, which may be a factor that has reduced the resiliency of our necks. Is it possible that nature did not intend humans to sleep on soft comfortable mattresses with fluffy ergonomically correct pillows under our heads in the first place?
Could it be that the more we ‘baby’ ourselves during sleep, the more vulnerable our spines become to injury? Could it also be that comfortable pillows do more harm than good to our necks by decreasing the amount and frequency that we fidget during sleep?
The most recent 2025 systematic review has shown no superiority of any type of pillow over another (foam, polyester, or a contour pillow).
“…for chronic neck pain, with no particular type (of pillow) demonstrating clear superiority.” – Ghosh et al 2025
Another 2021 systematic review concluded that, “Pillow designs did not influence sleep quality in patients with chronic neck pain.” – Pang Chun-Yiu et al 2021
On the other hand, the same paper also concluded that, “The use of spring and rubber pillows are effective in reducing neck pain, waking symptoms, and disability…” – Pang Chun-Yiu et al 2021
Unfortunately, there have been no clinical trials to date on the potential effectiveness of using no pillows.
Here is a quote from a paper published in the British Medical Journal written by a physiotherapist who had several expeditions to various African countries studying tribal people who slept on the floor with no pillows.
Largely anecdotal evidence…for over 50 years from non-Western societies that low back pain and joint stiffness is markedly reduced by adopting natural sleeping and resting postures. —Tetley, 2000
Many health care providers and pillow sellers claim that sleeping without a “proper pillow” places the neck at risk since the neck would be “out of alignment”.
But where is the evidence? To date, there is no evidence that being “out of alignment” is associated with neck pain. Also, there is surprisingly little evidence that a pillow is even necessary to protect the neck.
Having said that, in an extreme case, if you are a stomach sleeper and experience neck pain or headaches upon waking, then perhaps do not use a pillow as it adds more extension and rotation to a neck.
To change habitual stomach sleeping, patients may consider a body pillow; it’s worth a try.
Although pillows are certainly more comfortable, they may be reducing the resiliency of our neck to tolerate awkward postures and movements while we are awake.
Perhaps this loss of resiliency may increase the risk of developing future neck pain.
If you currently have no neck pain and have normal neck mobility, you may consider sleeping without a pillow… starting tonight!
If you find the transition too difficult, you may certainly gradually reduce the thickness of your pillow or use a folded towel until you find that you no longer need anything.
Once you gradually start sleeping this way, you will not even think about going back to using pillows anymore.
Let’s just say, I’ve not used a pillow for almost 25 years and can’t recall experiencing a single incident of neck discomfort.
*MEDICAL DISCLAIMER: You may temporarily develop some neck discomfort when you first stop using a pillow. You may experience arm numbness when you try to use your forearm instead of a pillow. Everyone is unique, and we all have a different tolerance to change.
Generally, the younger you are, the faster you will adapt to the change. For some older adults, it may be too late to throw away your pillow, SO PLEASE IGNORE THIS ADVICE.
If a person is experiencing neck pain in the mornings, you may suggest that they simply try modifying their pillow by putting a rolled-up towel inside their pillowcase. They may make the towel roll as thick or thin as they wish. It may make sleeping on the sides and on the back more comfortable.
In summary, there are sooo many factors that can contribute to persistent neck pain. Your pillow? It’s probably the least of your worries.