Mattress Selection Tips for People With Back Problems
While the jury is still out on whether a firm or soft mattress is the best option for people whose back pain keeps them up at night, most studies find that medium is best.
For example, in 2003 The Lancet published the results of a randomized controlled trial that assessed 313 people who had a backache while in bed and when they got up. The researchers randomly placed participants onto either a firm mattress or a medium firm mattress, and after 90 days evaluated them for pain reduction and disability. The medium firm mattress won. Study participants in the medium firm mattress group had significantly less pain and disability throughout the study compared to participants in the firm mattress group. Here’s what the researchers had to say:
“A mattress of medium firmness improves pain and disability among patients with chronic non-specific low-back pain.”
Michael Perry, M.D., Medical Director of the Laser Spine Institute in Tampa, Fla. concurs that a medium firm mattress is generally the way to go. But he firmly (no pun intended) adds that one size does not fit all. There are a number of other factors that should be taken into consideration when purchasing a mattress, he tells me.
Your Medical Status
Selecting the mattress that’s best suited to your spinal condition is about more than just how hard or soft the item is, Perry says. You (and your doctor) need to consider your medical history in some detail, so that you can tailor your purchase to your needs.
Perry suggests considering the following: What medical conditions do you have? What is your current diagnosis or diagnoses? What, if anything, have you been treated for previously?
It makes a difference. For example, symptoms of spinal stenosis tend to present themselves when you are standing and walking, but not when you are lying down. For this reason, the question of mattress firmness is not a big issue in people with spinal stenosis only. If this is you, choose a mattress that makes you feel comfortable.
But if you have degeneration along with your stenosis, that’s a different matter, Perry says. In this case, or if you have spinal arthritis without stenosis, disc problems or non-specific back pain, you do need consider the relative firmness or softness of your mattress. “People with these conditions do better with more support,” Perry says.
Perry also says that while everyone needs some support when they sleep, people who have undergone multiple back surgeries often need less, relatively speaking. After several surgeries, the tissues have been altered and may be stiffer, he says. In this case, a softer mattress may be more comfortable.
Related: Revision Back Surgery
How Old Is Your Mattress?
Dr. Perry warns that mattress springs break down over time, which makes your bed softer. “This can aggravate a patient’s back,” he tells me.
Based on this, does it makes sense for you to get a new mattress, or can you reduce pain and stiffness with your old one? While this is likely to vary among individuals, medical research may help shed some light on the question:
A study done in Oklahoma and published in Journal of Manipulative and Physiological Therapeutics in 2002 measured the pain, spine stiffness and quality of sleep in 22 adults to whom they gave a “prescribed” (and new) bedding system for 28 days. When they compared the ratings with participants’ ratings of their personal bedding systems for the same amount of time, they found that the prescribed bedding systems helped to improve all 3 measures significantly.
Your Sleeping Position
What position do you usually sleep in? This makes a difference in the type of support you need from your bed. Dr. Perry has some recommendations for back sleepers, side sleepers (whom he calls fetal position sleepers) and stomach sleepers:
- Side Sleepers Most people are side sleepers, Perry tells me. They sleep in the fetal position with their knees drawn up toward their chest. But this position tends to put pressure on your hips and shoulders. For side and fetal sleepers, Perry recommends a slightly softer mattress, such as one from the Tempurpedic brand. The foam the Tempurpedic mattress is made of conforms to your body, especially in the thoracic and lumbar regions of the spine, he says.
- Stomach Sleepers But for the stomach sleeper, soft mattresses such as the Tempurpedic may irritate the back. "A soft mattress encourages your abdomen to sink into the bed. The position that results is known to increase the arch in your low back and cause pain," he asserts. Perry suggests that a medium firm bed surface is good for stomach sleepers. The idea, he says, is to derive support from your chosen mattress, but without the abdominal sinking experience. By the way, the sinking effect is amplified if you have a large abdomen. For thin people, sinking may not be as much of an issue.
- Back Sleepers And finally, if you sleep on your back, Perry recommends putting a thin, rolled towel or pillow under your knees and low back for support. Pillowing under these areas will likely help support them, as well as provide you with more comfort, he says.
The same group of Oklahoma researchers mentioned above did another study that affirms Perry’s assertions. The study, which was published in Applied Ergonomics in 2010, involved 27 patients with low back pain and stiffness upon arising.
Researchers divided the participants up according to their usual sleep position. Participants were assigned to a medium firm mattress with combination of foam and latex layering that was based on their preferred positioning choice - choices that correspond to Perry's descriptions as noted above. The participants were rated for sleep comfort and quality every day for 3 months.
The researchers found that the patients’ back pain and stiffness improved with the new mattresses. For this reason, they concluded that sleep surfaces do relate to sleep discomfort and that it is possible to reduce your pain by replacing your mattress with one uniquely suitable to your particular spinal condition.
Individual People Deserve Individual Mattress Choices
Different people need different things but in general, support is better, Dr. Perry concludes. If you have back pain, the best way to go about buying a mattress is to do your research and base your final selection on your particular need for both support and comfort.
Related: Avoid These Sleeping Positions!
Jacobson BH, Gemmell HA, Hayes BM, Altena TS. Effectiveness of a selected bedding system on quality of sleep, low back pain, shoulder pain, and spine stiffness. Manipulative Physiol Ther. 2002 Feb;25(2):88-92.
Kovacs FM, Abraira V, Peña A, Martín-Rodríguez JG, Sánchez-Vera M, Ferrer E, Ruano D, Guillén P, Gestoso M, Muriel A, Zamora J, Gil del Real MT, Mufraggi N. Effect of firmness of mattress on chronic non-specific low-back pain: randomised, double-blind, controlled, multicentre trial. Lancet. 2003 Nov 15;362(9396):1599-604. http://www.ncbi.nlm.nih.gov/pubmed/14630439
Perry, Michael, M.D. Medical Director, Laser Spine Institute, Tampa, Fla. Phone Interview. March 11, 2012.