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."Yesterday, several people called my Columbus Circle office with urgent appointment requests. It turned out three of them had a common, suddenly severely painful condition some doctors don't believe exists -- sacroiliac joint derangement. Like several other back problems, sacroiliac joint derangement is difficult to diagnose and while injections can be helpful, they aren't always effective.
Here's help in figuring out whether you have it -- and then what to do. The sacroiliac joints are on each side of your back, a little below the waist and in line with your kidneys. All our upper body weight, all our twisting, lifting and other movements must be supported by them. Because of their structure and placement, these joints need powerful ligaments to hold them in the proper position. The three-dimensional structure of the SI joint is complex and irregular, and it works like a complicated key in a lock with many notches and tabs that must fit exactly into one another. The normal range of motion of this joint is very small -- so small it must be measured in millimeters. But when it is out of alignment, it is extremely painful. Unfortunately, when it is out of alignment it doesn't easily return to its proper position the way a shoulder that has gone "out" may slide back where it belongs. Instead, the ligaments, whose strength is a powerful ally in strenuous activities when the joint is functioning normally, become formidable adversaries when it isn't, holding the joint in misalignment.
The pain of sacroiliac joint derangement, which occurs just below the small of the back, can change from side to side. Often the grinding or gnawing ache worsens with certain movements, such as lifting the feet when getting into or out of a car, reaching up while standing, bending down while knees are locked and getting out of bed in the morning. Twisting to one side hurts more than the other. Shifting your weight can help, but not for long. The pain can get worse all of a sudden, at any time of the day. One leg may feel shorter than the other. You might find it difficult to spread your legs apart. But there is never pain, numbness or unpleasant sensation going down the leg. If you have pain in the small of your back when you lie on the bed and your leg hangs off on one side, you may very well have sacroiliac joint derangement. Carefully try this test on both sides. Get a diagnosis from a doctor who knows how to find this elusive condition through hands-on tests. One of these diagnostic tests is done when the physician places his or her thumbs on your pelvic bones just above and beside the sacrum.
When you bend forward -- in both standing and sitting positions -- the doctor can feel the misalignment. Physicians like myself who are specialists in Physical Medicine and Rehabilitation, as well as some chiropractors, are often adept at diagnosing sacroiliac joint derangement. Physical therapy can help you with strain/counterstrain techniques, muscle energy techniques and methods of intentional muscle fatigue,all of which can bypass the usual rigidity caused by bone displacement, and open up the possibility of manipulation to put the joint back in its proper place. Yoga and back care classes can also be useful. Help Yourself By Lifting and Leaning Properly Keep the object close to you; keep your torso over your feet throughout the process of lifting. Don't make the mistake of using your back muscles instead of the buttocks and thighs -- powerful muscles that are meant for use when people are hefting heavy weights. Bend your knees so that you have a solid foundation for your spine.