Twenty Years of Pillow Research: a Brief Summary


Over 100 scientific research papers have been written about the potential benefits of a pillow for optimal spinal positioning, spanning over 20 years of research from universities and clinics from around the world. In consideration of these observations, the MUTU pillow was designed to address the key findings found within this growing research space.

Exploring the definition of neck pain, its global prevalence and causation, we discuss how pillows have been found to be a simple, but inexpensive means of therapy. 


The Need for the Perfect Pillow

Amongst it’s variety of causes, neck pain has been aggravated by poor sleeping posture  due to its long-term overnight strain of the surrounding cervical ligaments and muscular matrix of the neck.

If not a cause on its own, physical therapists and physiotherapist can often suggest for patients to update their pillows as a means to encourage healing through correct alignment of the spine during sleep and minimize chronic non-specific neck pain [8].

Success of the treatment however is highly dependent on finding a pillow that can provide suitable height and support for each patient. Pillows that fail to provide proper cervical alignment for such patients can lead to further strain on the ligaments supporting it, and ultimately cause amplified muscle stiffness, tension headaches, and chronic neck pain upon waking [7-8]. 

Luckily for patients suffering from non-specific chronic pain, there is no shortage of possible pillow choices. With so many choices however, comes an expensive exercise of trial and error; spending hundreds of dollars before finding the right pillow. 

It was through this premise, that the MUTU was born.

  • A pillow that could be tailored to each persons unique support and anthropometric needs, and remove the need to trial multiple different types of pillows before finding the perfect one. 

  • A pillow that could be used by side sleepers and back sleepers alike, to ensure that their cervical spine may be supported in every position. 

  • but ultimately, the comfortable, clean and cool pillow in the market. 


The Global Epidemic of Neck Pain

Neck pain is defined by the World Health Organisation as pain in the neck with or without pain referred into one or both upper limbs that lasts for at least 1 day. Due to the variety of causes of musculoskeletal neck pain, the rates of recurrence and chronicity of neck pain are typically high due to improper care and treatment [1] .

Neck pain is one of the most common conditions treated by physiotherapists across the world, with prevalence likely to increase over the coming decades with increasing ageing populations seen throughout the world, especially in low- income and middle-income countries [2]. It's known that approximately half of all individuals will experience an episode of clinically significant neck pain over the course of their lifetime. [16]

Within Australia alone, 10-15% of the population experience neck pain and require conservative therapy for relief of symptoms [3].


The Burden of Neck Pain



Under the chronic, debilitating symptoms of neck pain, patients have been known to experience significant professional and social implications as a consequence from the disorder.

Simple, but integral movements of the rotation and extension of the head are essential for vision and spatial awareness and as a consequence, its limitation has shown to hinder daily tasks such as driving and working on a computer. In addition to personal disability, neck pain has demonstrated significant consequences towards work productivity and work absence with neck pain is known to be the second largest cause of time-off work under lower back pain.

Under these observations that the the World Health Organisation conducted a six-year Global Burden of Disease Study in 2010, concluding that neck pain lied 4th highest disabling disorder, against 291 other conditions [2]. 


The Search for the Right Pillow

Due to the growing prevalence of non-specific, chronic neck pain, the need for a supportive and height adjustable sleeping pillow is growing more and more significant as a method of conservative treatment.

Lying as a critical factor influencing spinal alignment during sleep, it is highly recommended that chronic sufferers find a pillow that is capable of supporting a neutral alignment for their particular body shape, size and sleeping position.  However, this is almost impossible due to the variety of models that are currently commercially available. In order to simply the purchasing process, the 'perfect pillow'  has been defined based on its satisfaction of three criteria; filler type (support) , pillow height and sleeping style (alignment).

A pillow expected to relieve waking neck pain however must satisfy all three key criteria, as the fulfillment of one alone will not be able to provide significant effects, as found below. 




Although the correlation between head support and waking neck pain and comfort is significant [4,6-11], multiple studies have attempted to compare the efficacy of different types of pillow structures and fillers (feather, foam, rubber etc.), against outcomes of waking pain and sleep quality. The results of these studies however have been contradicting and highly varied [12], with pillows who have performed superior in one study, performing poorly in another, under a different sample population. This is unsurprising as each study tested different pillow models, each with a different levels of support, albeit containing the same filler. It is therefore unwise to choose a pillow based on filler type alone. 



Regardless of filler type, what is clear amongst these studies however is the observation between pillow height and sleeping quality, being identified as one of the critical factors influencing spinal alignment [12-15]. Despite this, almost all pillows marketed towards cervical pain management are manufactured in one height for one sleeping position. In reality, each individual contains unique structural measurements and proportions that requires tailored support for effective waking pain management and therapy. In saying this, there are online guidelines available which can provide you with an ideal pillow height based on your gender and body height which you can use in your purchasing decision. This however relies on pillow manufacturers delivering a pillow that matches exactly to the height that you require. 



In addition to an inadaptability to height, there is no single model within the market that adequately adapts to the various sleep movements of users.   Users are not limited to sleeping in one position during sleep, but rather oscillates between different positions, most commonly shifting between lateral and supine positions. This can often aggravate waking pain due to the improper support provided in unconscious sleeping position. It is common within the current pillow market to find pillows designed for users with preference to a singular sleep position, despite sleep movement being almost impossible to unconsciously control. 


Final Thoughts


Although, non-specific cervical pain is known to be caused by a variety of different factors, it is common for physiotherapists and physical therapists to simply advise patients to change their pillow as a treatment for waking cervical pain. 

Success of the treatment however is highly dependent on finding the 'perfect' pillow for each patient, suitable to provide ideal height and support for each condition; if not, symptoms could be amplified.

Luckily for patients suffering from non-specific chronic pain, there is no shortage of possible pillow choices. However with so many choices, comes an expensive exercise of trial and error; spending hundreds of dollars before finding the right pillow. It is thus imperative for patients to find a pillow that is capable of being adjusted to not just height, but also to sleeping position in order to save time, money and sleep for patients suffering from debilitating cervical pain. 

Say hello to the MUTU


Key Reading

[1] Childs, J.D., Cleland, J.A., Elliott, J.M., Teyhen, D.S., Wainner, R.S., Whitman, J.M., Sopky, B.J., Godges, J.J., Flynn, T.W., Delitto, A. and Dyriw, G.M., 2008. Neck pain: clinical practice guidelines linked to the International Classification of Functioning, Disability, and Health from the Orthopaedic Section of the American Physical Therapy AssociationJournal of Orthopaedic & Sports Physical Therapy38(9), pp.A1-A34.

[2] Hoy D, March L, Woolf A, et al. The global burden of neck pain: estimates from the Global Burden of Disease 2010 study. Annals of the Rheumatic Diseases 2014;73:1309-1315.

[3] Hush, J.M., Michaleff, Z., Maher, C.G. and Refshauge, K., 2009. Individual, physical and psychological risk factors for neck pain in Australian office workers: a 1-year longitudinal study. European spine journal18(10), pp.1532-1540.

[4] Erfanian, P., Tenzif, S. and Guerriero, R.C., 2004. Assessing effects of a semi-customized experimental cervical pillow on symptomatic adults with chronic neck pain with and without headache. The Journal of the Canadian Chiropractic Association48(1), p.20.

[5] Leilnahari, K., Fatouraee, N., Khodalotfi, M., Sadeghein, M.A. and Kashani, Y.A., 2011. Spine alignment in men during lateral sleep position: experimental study and modeling. Biomedical engineering online10(1), p.103.

[6] Liu, S.F., Lee, Y.L. and Liang, J.C., 2011. Shape design of an optimal comfortable pillow based on the analytic hierarchy process method. Journal of chiropractic medicine10(4), pp.229-239.

[7] Gordon, S.J., Grimmer-Somers, K.A. and Trott, P.H., 2011. A randomized, comparative trial: does pillow type alter cervico-thoracic spinal posture when side lying?. Journal of multidisciplinary healthcare4, p.321.

[8] Persson, L., 2006. Neck pain and pillows–A blinded study of the effect of pillows on non-specific neck pain, headache and sleep. Advances in Physiotherapy8(3), pp.122-127.

[9]Hagino, C., Boscariol, J., Dover, L., Letendre, R. and Wicks, M., 1998. Before/after study to determine the effectiveness of the align-right cylindrical cervical pillow in reducing chronic neck pain severity. Journal of manipulative and physiological therapeutics21(2), pp.89-93.

[10]Gordon, S.J., Grimmer-Somers, K. and Trott, P., 2009. Pillow use: the behaviour of cervical pain, sleep quality and pillow comfort in side sleepers. Manual therapy14(6), pp.671-678.

[11] Lavin, R.A., Pappagallo, M. and Kuhlemeier, K.V., 1997. Cervical pain: a comparison of three pillows. Archives of physical medicine and rehabilitation78(2), pp.193-198.

[12] Shields, N., Capper, J., Polak, T. and Taylor, N., 2006. Are cervical pillows effective in reducing neck pain?. New Zealand Journal of Physiotherapy34(1).

[13] Verhaert, V., Haex, B., Wilde, T.D., Berckmans, D., Verbraecken, J., Valck, E.D. and Sloten, J.V., 2011. Ergonomics in bed design: the effect of spinal alignment on sleep parameters. Ergonomics54(2), pp.169-178.

[14] Her, J.G., Ko, D.H., Woo, J.H. and Choi, Y.E., 2014. Development and comparative evaluation of new shapes of pillows. Journal of physical therapy science26(3), pp.377-380.

[15] Ren, S., Wong, D.W.C., Yang, H., Zhou, Y., Lin, J. and Zhang, M., 2016. Effect of pillow height on the biomechanics of the head-neck complex: investigation of the cranio-cervical pressure and cervical spine alignment. PeerJ4, p.e2397.

[16] Fejer R, Kyvik KO, Hartvigsen J. The prevalence of neck pain in the world population: a systematic critical review of the literature. European spine journal. 2006 Jun 1;15(6):834-48.