As a healthcare provider who often treats chronic back pain suffers, I frequently get asked to give advice on mattresses and sleeping positions. The first thing I usually ask the concerned patient is does their low back hurt while lying down, or do they regularly wake in the morning with a stiff/painful low back that was not painful the night before? If the answer is yes, then they likely need to address the surface they are lying on and/or the position they are lying in. The easiest solution is correction of the sleep surface as many of us are unaware or cannot control the many positions we adopt in our sleep.
According to a study by Kovacs et al in 2003, a medium firm mattress was best for a group of chronic back pain sufferers compared to a firm mattress. The problem consumers in the USA face, Is the lack of standardization in the terms firm, medium firm, medium, and soft. The Kovacs et al study selected their mattress firmness based on a scale developed by the European Committee for Standardization. The European scale starts at 1.0 (firm) and goes to 10.0 (soft). Medium -firm was described as 5.6 on the scale. To my knowledge the various mattress manufacturers in the USA do not adhere to a standardized scale. So the consumer should be aware of this and spend ample time in the show room lying on the different surfaces before purchasing. For more information on mattress shopping visit the better sleep council.
If you are unsure if your surface is the problem, I often suggest people attempt to sleep on a different mattress in their home or temporarily change the firmness of their mattress by placing plywood between the mattress and box spring, or simply placing the mattress directly on the floor to temporarily change the firmness. If any of these solutions are helpful, then you can reasonably assume a new mattress is needed.
Signs that You May Need a New Mattress:
Evaluate your mattress for replacement when you change your clock twice a year. Gaining or losing sleep is already on your mind.
When discussing sleep positions I often ask my patients if they sleep in side lying. If this is their preferred position, I educate them on the variations of side sleeping, often a fetal posture is adopted or a rotated position with one leg in front of the other is maintained, both of these positions can cause or aggravate mechanical back pain of various types. I will typically recommend lying on the side with knees only slightly flexed and on top of the other to avoid these extreme flexed or rotated postures.
In many patients with significant sleep disturbance due to low back pain, I will recommend using a supportive lumbar roll around their waist to support the natural curvature of the spine while lying on the side or back. These rolls can be fabricated from an over-sized beach towel or blanket or purchased from optp.com (McKenzie night rolls). This type of support roll in conjunction with proper physical therapy exercise often bring about significant long lasting relief after only a few nights of use and then can be discontinued once the patient’s condition has resolved or significantly improved.
Many people I encounter have been warned by others not to lay face down when they are having low back pain. This is for reasons unknown to me, as many of my patients with low back pain report significant relief in this posture. I do typically warn them about potential neck pain in this posture due to the rotated position the head is placed in, and as a result do not recommend they try to sleep 8 hours in this position, but instead regularly relax for a few minutes off and on throughout the day lying face down.
If you have tried these suggestions without benefit, you should consult my office or another physical therapist that has been trained in Mechanical Diagnosis and Therapy (MDT) for an evaluation of your condition, as other exercises, manual therapy techniques, or advice may be required to resolve your problem.
Kovacs, et al. (2003). Effect of firmness on chronic non-specific low-back pain: randomized, double blinded, controlled, muliticentre trial. The LANCET, 1599-1604.
McKenzie, R. (2006). Treat Your Own Back. Spinal Publications New Zealand Ltd.
Replacing a Mattress. (n.d.). Retrieved October 10, 2014, from The Better Sleep Council: http://bettersleep.org/mattresses-and-more/caring-for-a-mattress/replacing-a-mattress/
Don Stover PT
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Thanks for visiting my blog page. My name is Don Stover. I am a seasoned physical therapist in Oklahoma City OK. with over 20 years in the biz. I have a lot of knowledge and training in orthopedic PT and spine care. I will be sharing my thoughts on physical therapy for orthopedic problems such as spinal pain, extremity joint pain, sports injuries, health/fitness, and life in general. I hope you enjoy reading!
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