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  Forms and Articles
for Michigan Doctors of Chiropractic

As described in the recent "Michigan Chiropractic Journal" articles' "Product Sales in Your Practice - Documentation System for Sales Tax Exemption, Medical-Legal Protection, and Staff Involvement in the Sales Process."

Easy to Use.


Product Sales in Your Practice
Part 4 - Cervical Pillows: One Size Does Not Fit All

By Stuart A. Firsten, DC

Editor’s note: Previous articles in this series introduced protocols for effective health product sales in chiropractic practice. Topics covered have included ethical and medical legal issues, and MI Sales Tax exemption. A “Product Recommendation Form” for better documentation and to facilitate staff involvement in the sales process was also presented. Part 4 of this series presents information to help you evaluate cervical pillow features and requirements for your patients. Parts 1- 3 of “Products Sales in Your Practice” are available online at .

Neck pain related to sleeping, shoulder pain, arm numbness, headaches, or awakening with discomfort and fatigue are complaints commonly seen in chiropractic practice. Such symptoms may be aggravated when tissues are strained from a pillow providing inadequate support. It is no wonder that cervical pillows are frequently recommended by chiropractors - to improve sleeping posture and as an adjunct to care. Cervical pillows should also be considered in cases when the patient has been subjected to trauma such as in an auto accident or in any case where maintaining the cervical lordosis in a neutral position can facilitate the healing process. The right pillow can provide relief, prevent future injury, and help patients obtain a better nights sleep. However, before deciding on which pillow to recommend chiropractors should consider several factors to help insure that patients will benefit the most.

There are countless types of cervical pillows on the market making it difficult to know which ones to inventory or recommend. Additionally, patients present with a variety of conditions and body sizes that necessitate individualized levels of firmness or support. Even the bed they sleep on may influence which type of pillow will work best for them. Such factors need to be evaluated before recommending a pillow to best suit your patients personal needs.

Inquiring about the type of pillow and bed the patient currently uses and favored sleeping positions can be useful in determining which pillow to choose. Many fall asleep on their sides but then awake on their back with pillows which are too thick or too firm. Others use two pillows, promoting flexion of the neck and reversing the natural cervical curve. Sleeping supine without a pillow can also cause the neck to flatten especially when the mattress is very firm. In most instances off the shelf pillows composed of feather, fiber filled, or solid foam have no mechanism to provide lordotic support inherent in their design. Some patients will naturally learn to roll their pillow or bunch it up when practicable to accommodate and support their spine. Usually this is motivated by trying to find the most comfortable position to fall asleep in. Unfortunately as they move about at night the area of support created will collapse thus they will lose the support that they need.

Pillows are not unlike shoes as they have to fit right to be comfortable. They also need to provide adequate support to limit excessive shearing forces when we are recumbent. The requirement for support also changes depending on the sleeping position. Since people tend to change positions throughout the night a cervical pillow needs to support the cervical spine in their various sleep positions to be effective. When supine the pillow support should maintain the natural lordosis. When on your side more support under the neck then beneath the head is typically preferred for comfort and to keep the spine from lateral flexing and in better alignment. A thicker pillow limits compressing the shoulder for side sleepers with broad shoulders. Stomach sleepers tend to fully rotate there necks and therefore this sleep position is often discouraged. However, many stomach sleepers do perfectly fine and a thinner pillow usually works best for them. A good pillow will conform to the shape of the users head and neck during various sleep positions and distribute pressure evenly while maintaining the spine in a neutral alignment.

Cervical pillow manufacturers often claim that their products provide relief in their advertisements. However in the real world doctors often find inconsistent results when recommending only one type of pillow to every patient. A pillow that is appreciated by one person may be thrown off the bed ending up on the floor by another. Research in this area has shown evidence that cervical pillows can be beneficial however it is impossible to know which brand or pillow style will work best in each specific case. The trick is to find a pillow that fits best for each individual patient, that provides adequate cervical support that they can tolerate in their most predominant sleeping position.

The most common types of cervical pillows recommended by chiropractors include preformed solid polyurethane foam pillows, visco-elastic foam pillows, water bladder pillows, synthetic fiber stuffed pillows, buckwheat pillows, and cylindrical roll pillows. Following are descriptions of each and reviews of their main features and benefits. POLYURETHANE FOAM - Various shapes and sizes available. Pre-formed shape usually with depressions and multiple lobes of varying size. Also used in cervical rolls. Some manufacturers provide same pillow in several sizes. Density, resiliency, firmness vary from brand to brand. Advantages: Inexpensive. Choice of levels of support. Disadvantages: Difficult to fit. One size does not fit all. Often not tolerated well. Foam breaks down or softens and level of support changes over time. May be overly aggressive or provide inadequate support. Not washable.

VISCO-ELASTIC FOAM – Specialized type of urethane foam originally developed by NASA for the space program. Also known as memory foam, temperature sensitive foam, or slow recovery foam. Has improved pressure relieving properties. Conforms better to body shapes. Density, firmness, resiliency vary from manufacturer to manufacturer. Some are temperature sensitive and soften with body heat. Advantages: Less need to change positions due to pressure relieving qualities. Less compromise of blood flow in area being compressed. Durable. Can be rolled up tightly for travel then returns to shape when unrolled. Selection of different sizes available. Disadvantages: Expensive. May provide adequate support and comfort in one position but not in another. Tend to build up body heat. May feel warm to user especially when room is warm or humid. May not fit all users well. Not washable. WATER PILLOW - Water bladder base covered by synthetic fiber batting for enhanced comfort. Water layer provides support for the head and neck continuously responds to changes in sleeping positions, adjusts to fit patients shape, firmness can be individualized to preferred comfort level. Advantages: Inexpensive. Adjustable level of firmness for user defined level of support. Disadvantages: May provide adequate support and comfort in one position but not in another.

BUCK WHEAT HULL - Used extensively in the Orient for hundreds if not thousands of years. Natural and generally hypo-allergenic. Like lying in the sand at the beach. Flows to conform to body shape. Provides firm support that can be infinitely adjusted for user defined level of comfort. Useful in all sleep positions. Advantages: Firm support. Adjustable. Inexpensive. No heat build up. Lasts for years. Hulls can be removed from case for laundering. Increasingly popular. Disadvantages: May be considered too firm or noisy for some users. SYNTHETIC FIBER - Stuffed into compartments and usually open in center to allow head to drop down for lordotic cervical support when supine. Lobes on each side for side sleeping or butterfly shaped. Also used in cervical rolls. Advantages: Inexpensive. Not overly aggressive for most users. Accommodates back and side sleeping positions. Disadvantages: Not completely adjustable. Often not tolerated well. Limited sizes available. Level of firmness changes over time. May provide adequate support and comfort in one position but not in another.

The most important considerations are to make sure that the cervical pillow you recommend is not only comfortable, but supportive as well. Consider that the pillow you recommended could be overly firm or aggressive for the patient or be providing inadequate support in their predominant sleep position - and that changing to another type or brand of pillow may be required. Patients should be advised that although you believe that a specific cervical pillow is indicated for the management of their condition it is possible that they may have difficulty adapting to the pillow that you recommended. In such cases they should bring this to your attention so that you can access whether they may need more time to accommodate to the pillow that you recommended. Advising the patient to discontinue further use may also be necessary occasionally, especially when a pillow seems to be worsening the patients condition, perhaps switching to a different size or style of pillow may indicated at such a time.

Whenever you recommend a cervical pillow make sure to document your recommendation accordingly. Also be sure to explain to your patient why you are recommending a cervical pillow to support the lordosis and cervical spine more correctly. Provide your patient adequate instructions for usage, pricing information, and ordering information or sources if you don’t stock the item in your office. If you dispense the pillow from your inventory be clear with the patient about your return or non return policy and that pillows are recommended or sold without guarantee of results. Staff involvement in the sales process will help you cover the bases - detailed information of these topics can be found in previous articles in this series, “Product Sales in Your Practice”.

A well fitted cervical pillow can help protect the spine from injury by supporting the lordosis and sleeping posture in a more neutral position. In most cases patients having difficulty getting comfortable at night, or who are waking up with increased pain realize that the pillow they are using may be part of their problem. They will appreciate your recommendations and the benefits of improved cervical support they will obtain from a pillow that fits them more correctly.

Links to websites related to various types of cervical pillows discussed in this article are available at . References to research articles related to cervical pillows are also posted there for review.

Future articles in this series “Product Sales in Your Practice” will explore other health products such as supports, fitness balls, ergonomic chairs, and inversion devices that are often recommended by chiropractors to their patients. Articles will focus on reviewing specific product design features related to health benefits - as opposed to specific product brands.

The "Product Recommendation Form" and MI Sales Tax information described in previous articles are available free of charge at for you to review and reprint for use in your practice. To obtain the “Product Recommendation Form” by fax, email, or regular mail contact FitCare Products at (248) 661-5088 or email

Stuart Firsten, DC is a licensed chiropractor in Michigan. His company FitCare Products an MCS Member Supporting Business developed and introduced the new AirFit™ BackRest last year. The AirFit™ is recommended by many MCS members, and hundreds of chiropractors, health care professionals and medical suppliers. The product is also available online to learn more visit . To contact Dr. Firsten with your comments or for additional information you can call (248) 661-5088, or email him at .

© 2005 Stuart A. Firsten, DC. All Rights Reserved.

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