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Mattresses and Back Pain

How firm should a mattress be? When is it time to replace a mattress? What type of mattress is the best for lower back pain ? Read on...

Mattress Firmness

In the past a firm mattress was considered best for back health. That belief has been challenged in recent years. A medium-firm mattress may be the best mattress for back pain.

There has been little in the way of studies, but one double-blinded study published in the Lancet, "Effect of firmness of mattress on chronic non-specific low-back pain", demonstrated that a new medium-firm mattress relieved chronic low back pain better than a new firm mattress for people with chronic lower back pain. In this study, participants who slept on a new firm mattress also had back pain relief but to a lesser extent than those who slept on a new medium-firm mattress.

A Medium-Firm Mattress May be Best for Back Pain.

Though a mattress must be firm enough to support the spine, an overly firm mattress that results in gaps between the inward curves of the body and the mattress leaves parts of the back unsupported. Pressure points (areas where pressure cuts off blood flow) are created on the parts on the body that have contact with the mattress, as there is less area to distribute the weight of the body. The discomfort from pressure points and the extra tossing and turning to seek relief from painful pressure points interfere with proper sleep.

A soft mattress may initially feel very comfortable but after laying on it for a while the lack of support can lead to lower back pain. A very soft mattress lets the lower back sink too far into the mattress, throwing the spine out of alignment and placing extra stress on the muscles, ligaments and spinal joints.

The heavier a person, the firmer the mattress has to be to provide adequate support. Optimal Mattress Firmness is also affected by sleeping position. A person who sleeps on their stomach needs a firmer mattress than a person who is a side-sleeper. When sleeping on ones side, the mattress must be soft enough to allow the shoulders and hips to sink in enough to avoid pressure points.

Mattress Comfort

A Comfortable Mattress Provides a Better Sleep

Though a mattress must provide adequate support, a mattress must also feel comfortable to the person sleeping on it. A lack of comfort can interfere with proper sleep. A mattress that is uncomfortable may cause a person to awaken more frequently or may take one out of a deep sleep to a light sleep. Disrupted sleep is not as restorative as a solid block and a lack of proper sleep can cause an increase in pain perception.

Common causes of discomfort include a mattress that is too hard, not enough space to move freely (when two people share a bed), being too hot, etc. If two people share a bed there should be adequate space for each person to change sleeping positions without disturbing the other. (According to The Better Sleep Council, the average healthy sleeper changes body positions about 40 - 60 times during a nights sleep)

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When to Replace a Mattress

Because a mattress wears out gradually, a person may not realize they may need to replace their mattress until they have a substantial increase in aches and pain upon awakening.

Even if a mattress does not appear to be worn out, there is a gradual loss of support and comfort as the cushioning materials and/or foam or innerspring core gradually compress and lose the ability to recover height.

Though there is no set time to replace a mattress, it is generally recommended that a mattress that is used daily be replaced every 8 to 10 years. The Better Sleep Council (a division of the International Sleep Products Association) currently recommends that you evaluate your mattress to every 5-7 years. (A mattress that feels uncomfortable should be replaced regardless of its age)

The type of mattress, the quality of the construction and the materials used affects the life of the mattress. The heavier the person using the mattress, the more quickly the mattress will wear out.

A small study published in the Journal of Chiropractic Medicine, "Subjective rating of perceived back pain, stiffness and sleep quality following introduction of medium-firm bedding systems", at Oklahoma State University showed significant benefits from sleeping on a new medium-firm mattress. It was not a double-blinded study.

The participants slept in their own beds (beds were an average of 9.5 years old) for first 28 days then slept on new beds with a medium-firm sleep surface for another 28 days. The new sleep sets consisted of innerspring mattresses (Bonnell spring units encased in foam) on a semi-flex foundation.

The participants rated their perceptions of back pain, spine stiffness, and sleep quality and sleep comfort upon awakening. There were significant improvements after sleeping on the new mattresses. It should be noted that the new mattresses were medium-firm while fewer than 40% of the participants reported their own beds were medium-firm

Will a New Mattress Guarantee Relief of Back Pain or a Better Sleep?

No. There are many other factors that contribute to back pain and/or problems sleeping. Not everything can be blamed on ones mattress. Back strain is frequently caused by poor posture, being overweight, poor lifting techniques, weak core muscles, etc. Stress, anxiety and depression are linked to both back pain and poor sleep.

People over 40 may benefit the most from replacing their mattresses more frequently as the body becomes more sensitive to pressure and vulnerable to aches and pains with age. Any degenerative changes in the spinal joints and/or discs further increase the need for ample cushioning and/or support in a mattress.

The more worn out the mattress being replaced is, the more likely there will be noticeable improvement in sleep quality and back pain relief.

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What Type of Mattress is Best

There are many different types of mattresses to choose from - innerspring, memory foam, air, latex foam, innerspring mattress with memory foam, and more.

Many people want to know if a memory foam mattress or an innerspring mattress is better for the back. There is no best type of mattress for everyone. A memory foam mattresses has a much different feel and response than an innerspring mattress. People vary widely in what they find comfortable. Choose a mattress that feels comfortable and provides adequate support. Being comfortable helps one sleep soundly and proper sleep is beneficial for back pain.

Each type of mattress comes in a variety of configurations that affect comfort, support and durability.

Differences Between Innerspring Mattresses

In an innerspring mattress the type, amount and quality of materials used in the upholstery layer varies greatly. There may be several layers of padding that may contain polyurethane foam, convoluted foam (egg-crate foam), memory foam, latex foam, cotton or polyester fiber. Polyester fiber tends to pack down more quickly than polyurethane foam. Convoluted foam (egg-crate foam) feels softer and helps reduce pressure points more than a solid layer of the same type of foam.

The coils in the innerspring unit (the core of innerspring mattress) vary in number, gauge and type. Bonnell Coils are used in the majority of innerspring mattresses. Offset Coils are similar to Bonnell Coils though they may conform more to the body and are found in more expensive mattresses. Pocketed Coils (also called Marshall Coils) are individually wrapped coils that move independently of one another, which helps to provide motion separation (the movement from one person cannot be felt by the other). Continuous Coils provide very firm support.

When used with a box spring, which absorbs shock from the mattress and reduces wear to the mattress, the innerspring mattress will have a softer, springier feel.

Differences Between Memory Foam Mattresses

In a memory foam mattress, the density of memory foam affects its feel, response, and durability. The thickness of the memory foam also affects the feel. Higher density memory foam slowly conforms to the shape of the body in response to body weight and heat. This helps distributes body weight evenly to reduce pressure points. Because high-density memory foam recovers slowly from body impressions, more effort is needed to change body positions. Low-density memory foam acts more like regular polyurethane foam.

In memory foam mattress the core is usually regular high-density polyurethane foam but some have a latex foam core. (Memory foam does not provide enough support to be used in the support layer) There may be a one solid layer of memory foam or several layers of varying density glued together. A common configuration is 3" of high-density memory foam over a 7" polyurethane core.

Differences Between Latex Foam Mattresses

A latex foam mattress may be a solid piece of latex or have layers of varying densities of latex. The latex foam may be synthetic or natural or a blend of both. A latex mattress may have a polyurethane core, as it is less expensive, though latex is supportive enough on its own to be used as a support layer. Latex foam is effective at distributing the weight of the body and reducing pressure points yet recovers quickly and has a springy feel. Most manufacturers claim their latex mattresses will not cause or aggravate latex allergies.

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Tips for Choosing a Mattress

When choosing a mattress, test it by lying on it to determine how firm it feels. Dont rely on the labeling. Dont just sit on the mattress - when you sit on a mattress, you will sink into it a lot more than when you lie down and your weight is more widely distributed.

Keep in mind that a mattress that is too firm can be softened up with the addition of a mattress topper but a mattress that is too soft cannot be firmed up. The padding in the comfort layer will soften up during the first few months of use - even in good quality mattresses.

Beware of extremely inexpensive mattresses - corners may have been cut. There may be too little padding or there may be poor quality padding that wears quickly. That said, beds do go on sale frequently, often at substantial price reductions.

It is generally recommended that you test a mattress by lying on it in your preferred sleeping position for at least ten minutes. Testing it in other positions is also recommended. If two people share a bed they should test the bed together.

Sometimes it takes a few weeks or even a few months of use to really know if you really like a mattress. Some retailers offer a 30-90 day comfort guarantee where you can exchange a mattress you do not find comfortable for one of equal or greater value.

Whatever type of mattress is chosen, it should be firm enough to keep the spine in proper alignment, but not so firm that it causes pressure points.

Tips for reducing back pain in various sleeping positions