Many dairy cows are housed in tiestalls, but few experimental studies have investigated ways to improve cow comfort through tiestall design. Studies on commercial farms show that tie-rail placement affects lying and may be linked to neck injuries. Our objective was to develop new recommendations for tie-rail placement combining both vertical and horizontal positions. Four treatments were tested: 2 new tie-rail positions that follow the neck line of cows (N1, N2), current recommendation (CR), and the tie-rail position commonly found on farm (CF). Forty-eight cows blocked by number and stage of lactation, were divided between 2 start dates and randomly allocated to a treatment for 10 wk. Live injury scoring was performed weekly using a 4-point system; 0 being no injury and 4 being severely injured. Cows were recorded 1 d/wk by overhead cameras and 6 lying and rising events were evaluated per recording. Differences over time were analyzed using a mixed model with a Scheffé adjustment for multiple comparisons and a Dunnett adjustment to compare N1, N2, and CF to CR. CR (difference from wk 0: +0.9 ± 0.16) had an increase in proximal neck injuries compared with N2 (+0.1 ± 0.15; P ≤ 0.05). N2 (+0.8 ± 0.16) and N1 (+0.5 ± 0.16) had an increase in medial neck injuries compared with the CR (−0.1 ± 0.18; P ≤ 0.05). All treatments showed a decrease over time in average lying intention time (−5.9 s/event; P ≤ 0.05), lying-down time (−1.1 s/event; P ≤ 0.05), contact with stall (−32.5%; P ≤ 0.05) and slipping (−9.4%; P ≤ 0.05) during lying. All treatments showed a decrease over time in average backward movement on knees (−10.8%; P ≤ 0.05) and contact with tie-rail (−14.3%; P ≤ 0.05) during rising, and overall abnormal rising (−15.7%; P ≤ 0.05). Results suggest that the injury location on the neck shifted based on tie-rail placement. For all tie-rail placements lying and rising ability improved over time, suggesting that cows adapted to their housing. All placements resulted in neck injury, leading to questions of whether the metal bar is the issue and alternatives such as a flexible bar or chain should be investigated further.