Related to Back Pain Best Mattress for Lower Back Pain Study Disputes Long-Held Belief by Some Doctors That Firmer Bedding Is Better Nov. 13, 2003 -- For years, many people with back pain have been advised to sleep on a firm mattress. But a new study shows that might just add to the nightmare of their morning-after misery. Researchers in Spain say that people who sleep on a medium-firm mattress were twice as likely to report improvements in lower back pain compared to those sleep on more firm bedding. They reach this conclusion after replacing bedding of 313 patients with a history of back pain with new "firm" or "medium-firm" mattresses. The patients didn't know which mattress type they received. This study, published in the upcoming issue of the Lancet, is among the first to test the popular belief -- at least among some orthopaedic doctors -- that the firmer a mattress is, the better it is at preventing or relieving lower back pain. While there's little hard scientific data to support that firm mattresses are better -- only a handful of studies have been conducted -- the Spanish researchers say that about three in four orthopaedic doctors recommend firm mattresses to their patients.
In fact, a survey of Atlanta-area orthopaedic surgeons indicates that two in three said they recommend a firm mattress to their patients, and most believed that a mattress' firmness had a definite role in managing back pain. This finding, by Emory University orthopaedist Howard I. Levy, MD, was presented at the 1996 annual meeting of the American Association of Orthopaedic Surgeons. But chiropractors have long argued that firm mattresses are not the best choice, says George McClelland, DC, spokesman for the American Chiropractic Association. "Traditionally, what we have recommended is that a moderately-firm works best, or when using a firm mattress, you should add a 1½- to 2-inch thick padding on top of it," he tells WebMD. "It's wonderful to be validated by some form of research." McClelland says that this extra padding -- or using a medium-firm mattress without the extra padding -- better adapts to the natural curvatures in the spine. This padding is available at most stores that sell mattresses or bedding supplies.
"The spine is not a straight line, and padding or a moderately firm mattress 'gives' better to the concavities and convexities of the spine," he says. "A younger spine may tolerate a firm mattress perfectly well. But as we get middle years any beyond, when back pain is more prevalent, we find that more equalized support seems to be better." The researchers, led by Francisco Kovacs, PhD, who operates an independent medical research company in Palma de Mallorca, Spain, say that a medium-firm mattress leads to better "pressure distribution" when lying in bed, resulting in less pain while lying or after getting up. But McClelland and others say you also shouldn't use a soft mattress, because it doesn't provide enough support. "From my own perspective, if a mattress is soft or too hard, it's not comfortable," says orthopaedic surgeon Dana C. Mears, MD, PhD, of the University of Pittsburgh Medical Center. "Something in the middle works best for me -- a medium-firm mattress.
If a mattress is too firm, you might as well be sleeping on the floor." When buying a mattress, McClelland advises against relying on store ratings as an accurate guideline. "These numbers are all over the place," he says. "Individual companies use different rating systems, so you don't really know what you're getting." In fact, in the U.S., firm mattresses typically have a higher rating number; in Europe, a lower number goes to firmer mattresses. His advice: "When testing for a mattress, don't push on it or bounce up and down, as many people do. What's better is to lie on it for 10 minutes or so -- on your back, on your side, every way. It shouldn't be too hard. If it is, get some padding to place on top of the mattress." Ratings > Mattresses and Bad Back Problems Unbiased Comparisons Based on 22,478 Owner Experiences Some mattresses perform significantly better than others in preventing / relieving pain, including back, hip and shoulder pain. Before discussing which are best, three interrelated terms are important to understand: support, conforming ability, and firmness.
Support refers to how well a mattress keeps the sleeper's body on a flat and level plane. Owner experience data shows that support is a key factor in preventing and alleviating pain, especially back pain. Support can be undermined by excessive softness and excessive firmness – but it is most often undermined by sagging of the mattress. Sagging is the top complaint of mattress owners overall with at least 30% reporting a significant problem. Sagging occurs when part of a mattress, usually the middle, becomes compressed and lower than the rest. Sagging often puts a person's spine into an unnatural position – especially for side and stomach sleepers. Consequently, mattress owner experience data shows a clear connection between sagging and pain, especially back pain. The greater the sagging depth the more likely it is that sagging will cause a person to have discomfort or pain in bed and possibly out of bed. * especially for side and / or stomach sleepers.
It should be noted that despite the fact that back pain for many people may occur with less than 1.5 inches of sagging depth, many mattress warranties cover sagging only if it has a depth greater than 1.5 inches. Conforming ability refers to how well a mattress conforms or molds to the contours and curves of a person's body. A mattress has good conforming ability if all of one's body is supported equally by the mattress. A lack of conforming ability means there are gaps in support. The result can be that at least one part of the body – such as the lower back – is placed in an unsupported, unnatural and therefore stressed position which can cause pain. A lack of conforming ability also often results in some parts of the body – namely shoulders and hips of side sleepers – feeling more pressure than other parts because of unequal support. Such pressure can be a source of significant discomfort. Having the right firmness is an important factor in preventing / relieving pain.
Learn more: Mattress Firmness Guide & Comparison. The graph below shows the pain-relieving ability of the different mattress types based on actual owner experiences. The types that are better at reducing (back, hip and shoulder) pain are more supportive, less likely to sag and more likely to have effective conforming ability. Keep in mind that the chart represents what is often but not always the case; model or individual mattress may go against these findings somewhat. Sagging and loss of support (barring mechanical breakdown) is usually less of a problem with airbeds compared to most other bed types. And the air chambers inside an airbed provide at least fair conforming ability and allow for adjustable firmness / support to suit personal preference and sleep position. Airbeds, however, with little or no comfort layer can be too firm on hips and or shoulders of small- to average-sized side sleepers. While memory foam mattresses can develop problems (sagging, excessive softness, and loss of support) these problems tend to not be as common or serious as they can be with innerspring-based mattresses (memory foam's main competition).
Memory foam also provides good conforming ability for average- to large-sized people. Firmness levels tend to be mostly medium to medium-firm. Smaller-sized people may experience excessive pressure points as they tend to not exert adequate pressure on the mattress to benefit from the foam's conforming ability. Latex can develop body impressions and soften to some extent, but these problems tend to not cause widespread pain problems. Latex often conforms moderately to the body. Firmness tends to be medium to firm (but soft varieties are available). Hybrid mattresses often provide above-average support, but such support breaks down for at least 18% of owners within three years due to sagging. Conforming ability tends to be good if at least two inches of memory foam is present. A variety of firmnesses are available. While waterbeds are often highly conforming, their support is questionable. At least 15% of owners claim that their waterbed causes back pain because of poor support.
Firmness can be adjusted somewhat by adding or removing water. Innerspring mattresses often provide at least fair support, but such support breaks down for at least 20% of owners within three years due to sagging. Models with a significant comfort layer often provide fair conforming ability, while models with a minimal comfort layer often provide poor conforming ability especially for small- to average-sized people. Futon mattresses offer mostly fair support and conforming ability. Futons tend to be more firm than soft. While mattress support, mattress conforming ability, and mattress firmness are crucial factors for preventing / relieving pain, they are not the only factors. One's choice of pillow is important as well. If your pillow – specifically its loft or height – is not compatible with your mattress – specifically its firmness level – then neck, upper spine, head and shoulder discomfort or pain are possible. See our pillow loft guide and calculators to learn how much loft may be best for you.