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Title: The effect of various pillow types on cervico-thoracic and forward head posture in young adults
Authors: Karim, Yumna
Issue Date: 13-Jun-2014
Abstract: Correct neck support is required during sleep to align the spine and maintain neutral posture,
and to immobilise the joints in the neck which would allow the cervical paraspinal muscles to
relax (De Laittre, 1974; Ambrogio et al., 1998; Erfanian et al., 1998). Poor spinal posture
during sleep however, has been hypothesized to result in lateral bending and uneven loading
on the intervertebral discs and cervical facet joints, and compression of pain-sensitive
structures in the neck (Leilnahari et al., 2011). The pillow is a significant contributing factor to
sleep quality and the development of symptoms on waking (Gordon et al., 2011). This should
theoretically reduce pressure on the pain-sensitive structures and allow the intervertebral
discs to be unloaded and rehydrated (Leilnahari et al., 2011).
To determine and compare the effect of the Simmons’ Beautyrest pillow, a polyester foam
pillow, a latex pillow, and no pillow, on cervico-thoracic and forward head posture in the
supine and recumbent supine positions in asymptomatic individuals.
Forty asymptomatic subjects between the ages of 20 and 30 years were recruited using
convenience sampling. The study was a double-blinded comparative investigation where all
participants underwent a case history, physical examination and an orthopaedic examination
of the cervical spine. Thereafter, digital photographic images of the participants lying without
a pillow and on three different pillows (Simmons Beautyrest® pillow, a polyester foam pillow
and a latex pillow) in the supine and recumbent positions were captured. These images were
then uploaded onto a computer, and using the linear co-ordinates of each anatomical
landmark (which was determined by the researcher using CorelDraw Graphics Suite 12), the
cervico-thoracic and craniocervical postures were determined. The cervico-thoracic posture
was determined by calculating the gradients of the intersegmental slopes, relative to the
horizontal plane, using the formula (y2 − y1)/(x2 − x1). The craniocervical posture was
determined by calculating the craniocervical angle. This angle was determined by
constructing lines between the anatomical landmarks and measuring the angle produced at
C7. At the end of the objective data collection, participants were asked verbally which pillow
they found most comfortable. All data was collected by the researcher. Statistical analysis
was done using IBM SPSS version 21.0. Repeated measures ANOVA test was used to
compare the mean slope measurements in the four conditions. Inferential techniques
included Wilcoxon Signed-Rank test and t-tests. A p-value of < 0.05 indicated statistical
The mean (± SD) age of the participants was 24.3 (± 2.57) years. In terms of pillow
preference, 15 participants preferred the latex pillow, 8 preferred the polyester pillow and 17
preferred the Simmons Beautyrest® pillow. In the recumbent position for the C2-EOP slope
the latex and Simmons Beautyrest® pillows supported the neck in a similar manner (p=
0.480) and closer to neutral than no pillow and the latex pillow. For the C4-C2 and the C7-C4
slopes, the latex pillow produced the least extreme slope. For the T3-C7 slope, the polyester
pillow produced the slope closest to neutral. Overall, for the entire cervical spine, the latex
pillow produced the least extreme slopes, but at the cervico-thoracic junction, the polyester
pillow produced the most neutral slope. In all segments, the condition without a pillow
produced the most extreme slopes. When comparing the slopes themselves, it can be seen
that the most extreme deviations from neutral occurred at the C2-EOP segment. The midcervical
spine deviated least from neutral. In the supine position, there were no significant
differences (p> 0.05) in the sagittal angular displacement between the pillows.
The results of this study support the view that there is no one particular pillow that is better
than the others for providing optimal support to the head and neck. Furthermore,
practitioners should be aware that it is the craniocervical and cervico-thoracic slopes, which
are determined with the patient in the recumbent position, that provide significant information regarding support provided by the pillow rather than the sagittal angular displacement
assessed in the supine position.
Description: Submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, 2014.
Appears in Collections:Theses and dissertations (Health Sciences)

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