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."Back pain is one of the top reasons that people begin to lose mobility in middle age. Pain can keep people from engaging in physical activity, making it more difficult for them to maintain a healthy weight and keep up their strength, stamina, and balance as they age.
So treating and managing back pain that results from injuries or health problems is crucial for staying on the path of a healthy and active life. Considering that most people spend roughly a third of their lives lying in bed, choosing the right mattress is essential for managing low back pain. It can make the difference in whether you can sleep at night and function the next day. In the past, doctors often recommended very firm mattresses. But one survey of 268 people with low back pain found that those who slept on orthopedic (very hard) mattresses had the poorest sleep quality. There was no difference in sleep quality between those who used medium-firm and firm mattresses. Soft mattresses, on the other hand, can also be problematic. While a soft mattress that conforms to your body's natural curves may help the joints align favorably, you might also sink in so deeply that your joints twist and become painful during the night. If you want to find out whether a firmer mattress would feel better than the one you're currently using, try putting a plywood board under your mattress to dampen the movement from the bedsprings, or try placing your mattress on the floor.
Of course, you can also go to a mattress showroom and test a variety of models. But keep in mind that what feels comfortable for a few minutes in a store might not translate into a good night's sleep. A more reliable test is to observe how you feel after sleeping on different types of mattresses while away from home — for example, at a hotel or a friend or relative's house. For more on how to preserve your mobility so you can stay active, buy , a Special Health Report from Harvard Medical School.Mattresses have become so technological – some are even based on research from the US space agency NASA – that they now sometimes go by the name 'sleep systems'. And at up to £40,000 a throw, some even cost as much as a mid-range BMW and command the same sort of social status. But is it really necessary to fork out to get a good night's sleep? The consensus is that a cheap mattress is indeed a false economy – spending, say, less than £200 is almost certainly not going to ensure a good night's sleep unless you are very young, very light and frequently sleeping somewhere else.
Cheap mattresses also need replacing more often, perhaps as frequently as every two years. Spend a bit extra, say, more than £1,000, and you should not need to change the mattresses for 10 years, or, in the most luxurious pocket spring cases, up to 25. "Spend as much as you can afford," advises Andy Hills of And So To Bed. "The minimum should be about £700 on the mattress and bed base combined. It always strikes me as absurd that people will spend £3,000 or £4,000 on a sofa which they sit on for an hour or two some evenings, and much less than £1,000 on a bed where they will spend a crucial eight hours every night." Once you have fixed the budget, the next priority is looking for the right kind of support. "People often ask for orthopaedic mattresses, but all that means is a hard one," says Hills. "Very few people actually need a hard mattress unless they have crushed a disc. For most other people, they will simply be uncomfortable, particularly for lighter women, creating shoulder pain and pins and needles sensations."
Indeed, your body weight will largely dictate the sort of tension you require – the softer ones are better for an eight-stone woman, a firmer mattress will benefit a 16-stone rugby player type. Of course, many suppliers sell combination mattresses with different tensions on either side, catering for couples with greatly varying weights. Always remember to lie down on a mattress in the showroom and ask for professional advice Others sell two mattresses zipped together, a technique much improved on the old days, making it now almost impossible to tell that there is a divide. "We say if couples feel the zip, we'll give them their money back," says Hills. With spring mattresses, the firmness is largely dictated by the number of springs. High-quality mattresses such as Vi-Spring, such as the superb double model, will often have soft cotton and lamb's wool to enhance the springs; the very best will have horsehair filling, which breathes well and acts like more tiny springs.
Vi-Spring offer a comfort promise – try the mattress for up to 90 days, if need be, they will replace it with a softer or harder one. Tempur, a manufacturer of memory foam mattresses using material developed at NASA to relieve g-force pressures during space launches, offers a 60-night free trial. The viscoelastic foam is designed to eliminate pressure points by spreading body weight evenly. The foam cell mattresses, that start at around £1,040 for a double, reorganise themselves constantly to mould to the exact contours of a body, and because they do not harbour dust mites in the same way as more traditional mattresses, they are excellent for asthma sufferers. Although good mattresses are expensive, they are surely worth it for health and happiness, even if it means making savings elsewhere. "People often put up with wakeful nights, constant tiredness and sore backs for a long time before connecting it to the mattress," warns Lucy Benham of John Lewis. "A good test is sitting on the edge and seeing whether the whole side of the mattress collapses.
If so, the mattress needs urgent replacement. "Also, when looking at a new one, remember that quilted ones tend to be of lower quality. Tufted ones, which look like they have buttons going through them, are better as this means the filling is contained to avoid it moving around. Good stitching around the sides indicates that the springs are contained in pockets, which will be much more effective than open spring mattresses. "But always remember to lie down on a mattress in the showroom and ask for professional advice. Choosing a new mattress is a very important decision indeed." Make sure the bed base is suitable for your mattress. A poor base will make even the most expensive mattress uncomfortable. Divan or upholstered ones are best for spring mattresses as the springs in both components complement each other. Memory foam mattresses are better if you have only a wooden slatted base. To gauge the right tension for you, lie on the mattress in the showroom, and push your hand under the small of your back.
If there is a large gap, the mattress is too soft, no gap at all, then it's too firm. Just being able to pass your hand through suggests that the tension is spot on. If the mattress is too hard, your body will try to compensate by frequently tossing and turning during the night, up to 60 times. This will impair your and your partner's sleep. A good mattress will reduce turning to 17 times a night. A too-hard mattress makes the body do the work, rather than the bed. The shoulder and hips cannot sink into the mattress, so they curve towards each other, resulting in a bent and stressed spine. A too-soft mattress lets the body sink into a hammock position, causing hips and shoulders to pinch in, the spine to curve and putting pressure on joints and muscles. Numbness and tingling can follow. The best spring mattresses tend to be pocket-sprung, where each individual spring is kept separate to respond to pressure from your body. Five of the best mattresses 1. Vispring wembury superb small double mattress, £1550
Made from British fleece wool, cotton and horsehair to added breathability, this Vispring mattress is guaranteed to give you a comfortable night's sleep. 2. Tempur sensation deluxe 22 memory foam mattress, £1899 The NASA developed Tempur material works to redistribute body weight and reduce pressure points while you sleep. The supportive foam layer also cradles the body throughout the night, making sure you achieve optimum relaxation. 3. Sealy Activ Geltex 2800 box top pocket spring, £1150 Sealy combines the latest technology and eco-friendly luxury fillings to provide the ultimate in quality sleep solutions. The mattress is fitted with a gel infused foam to provide pressure relief, body support, and breathability - giving you the best environment to ensure a good night's sleep. 4. Top Dog Mattress, from £645 Loaf pride themselves on selling just five mattresses, and their 'Top Dog' model - filled with cashmere, silk and natural fabrics and boasting double-decker layers housing 2,200 individual pocket springs (for the kingsize version) - is one of the best.