Mattresses for Bad Backs — Firm vs Soft

Matress Firmness
Is your mattress firm or soft?. Soren Hald Collection: Stone

If you're one of the over 70 million Americans who deals with daily back pain, a lot may be stacked against you at bed time. You likely know first-hand how pain can limit things — like the number of hours of you get per night, how restful the sleep you do get is, how well you function during your waking hours, and how satisfying, overall, sleep is to you.

Your Mattress and You

Sleeping on a mattress that is not right for you, given your individual condition, may be one of your biggest obstacles to rest and repose.

And this may mean you need to go shopping. If that's the case, what type of mattress should you buy?

To a great extent, mattress choice is a highly personalized one. Likely the most important thing you can do is to match the firmness of your prospective mattress to your spine’s unique needs for support and comfort. 

Dr. Michael Perry, M. D., Medical Director of the Laser Spine Institute in Tampa, FL, recommends staying away from either extreme of firmness when selecting a mattress, stating that studies generally find a medium-firm mattress does the trick for most types of back problems.

A 2003 study published in Lancet confirms this, saying, "a mattress of medium firmness improves pain and disability among patients with chronic non-specific low-back pain."

There's nothing like a good dose of facts, so here's a quick run down on mattress firmness research as it relates to back pain.

Temporary Back Pain from Foam Mattresses — A Survey

One hundred Indian medical residents who slept on foam mattresses were surveyed about the effects of this on their spines in a 2000 study published in the Journal of the Association of Physicians of India. The mattresses in question were 10 centimeters in thickness — the kind one might find in a youth hostel. The residents experienced temporary backaches from the mattresses, but not the generally more serious type that is also accompanied by nerve symptoms such as sciatica, radiculopathy, or paresthesia (pins and needles.)

The sleep-induced pain was relieved for most of the residents (61%) once they returned to their own beds, and it came back when they again slept on the foam.

Firm vs Soft

In an effort to confirm that hard mattresses exert a positive effect on the sleep of people with chronic low back pain, as is commonly believed, participants in a study tested bedding with varying degrees of firmness.

The study, a randomized controlled trial, was published in the April 2008 issue of Spine.

A “soft” mattress group slept on a water bed.

A second group slept on a Tempur-pedic mattress, which is known for its ability to conform to your body shape without sacrificing support.

And the “hard” mattress group slept on a futon.

Overall participants favored the water bed and foam (Tempur-pedic) mattresses the most in terms of pain relief, ability to function and number of hours slept per night. That said, the difference in scores between these two types of mattresses and the hard mattress was small.

"A Tempur-pedic with a dial-in firmness feature would be my top choice," Perry comments. "When you need more support, you can simply press a button, and presto! The beauty of Tempur-pedic is that you can get support where you need it. You can also get on-demand softness."

He adds that a dial-in water bed also has advantages, clarifying that more water equals more firmness.

“Just remember not to dial in so much water that your mattress bursts,” he quips.

On the flip side, Perry says that if you don’t dial in enough water, your water bed mattress may surround and enclose your body, which can decrease the quality of your sleep.

In fact, he adds, “some of my patients report they feel smothered when their water bed isn't firm enough. This is because the lungs have less room to expand when you're sunken down. Of course, the cure is to firm it up by in dialing more water."

Even in light of this potential drawback, self-inflatable water beds may be the way to go. A 2015 review of studies published in Sleep Health confirmed all of Dr. Perry's opinions, concluding that a medium firm mattress with custom inflation capabilities proved the most optimal choice for spinal alignment and sleep comfort.

Keep in mind that few studies have been conducted on this topic overall. But those that can be found in the medical literature point to achieving the right firmness in your mattress as a key to sound sleep — despite the back pain.

 

 

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