What’s a Good Mattress for a Bad Back?

We spend close to one-third of our life in bed.

Well, some of us do.

For the rest of us, the night is not a pleasant experience. In fact, one in three adults get insufficient sleep according to the Centers for Disease Control and Prevention. at least a few nights per week. And roughly 65% have pain during the night that interferes with sleep resulting in less  sleep, poorer sleep quality, lower daytime energy, and a depressed mood.

As for beds, there is very little science that supports one bed over another. One study conducted in Spain in 2003 showed that people who slept on a medium-firm mattress had less pain in the morning and during the day than people who slept on a firm mattress.

There are at least three things to consider when it comes to sleep and back pain.

The Flexibility of Your Spine

Flexibility is the amount of motion that can be produced at one or more joints passively as opposed to the amount of motion you can create actively (mobility).

If your spine is relatively inflexible, then during the night the positions your body assumes may place excessive force on the soft tissues and create high strain rates. Anytime you apply load to joints near the end of their available range you run the risk of excessive tissue strain. For example, try placing your hand on a firm surface, palm up, press down until your wrist is fully flexed and then just stay there. You’ll get the idea of how stress at the end of range can create pain.

Spine Fatigue

The culprit for most spine fatigue is sitting, standing, or being too still for too long. Healthy joints can withstand substantial loads and still maintain tissue homeostasis. But, weakened joints – from injury, disuse, surgery, disease – are more easily overloaded although you may not experience symptoms from the overload at the time it occurs since it can take up to 24 hours for post-traumatic cytokine to be produced (cytokines are proteins that help regulate inflammatory processes). So, for example, if you sit for a few more hours than usual one day, you may find yourself in bed with lower back pain that night or the next morning even though you had little to no pain during the sitting event.

Leg and Arm Support

When you sleep on your side, most people find the upper leg and arm will fall forward of the body. This creates a turning or rotation of the trunk and over the course of a few hours can strain tissue (sort of like wringing out a wet dish rag). I usually suggest a firm, large pillow between the legs or under the upper leg (if you prefer the leg to be in front of your body) and a pillow under the upper arm. This will reduce the twisting effect and make sleeping more comfortable.

Now About Mattresses….

Most articles you read about what type of mattress to buy suggest a “medium-firm” mattress as in the study I mentioned earlier.

But what exactly is a “medium-firm” mattress?

Someone who weighs 120lbs will likely say that a “medium-firm” feels more like concrete than a person who weighs 220 lbs. My wife and I had a Tempur-Pedic mattress for, oh, about two days. I loved it. I sank into it and found it very comfortable. Ellen sprained her lower back sleeping on it and she’s not a restless sleeper.

And to compound the problem, most people choose a mattress with a 10 minute test – lying on it in a store. You’re awake. You have the added benefit of muscle support of the spine. When you sleep, and move into deep sleep, you lose muscle support (which is why you can run in your dream and not run around the house). So, the best way to pick a mattress is to sleep on it for a period of time. Some stores now have a return / exchange policy that makes this possible.

So, the bottom line is that there is no ONE mattress for everyone but with that in mind, here are two suggestions:

1. Tempur-Pedic . The Tempur-Pedic is a high density foam that will both support your spine and conform to it and within that brand there are several levels of “density”.
2. Select Comfort Sleep Number. The Sleep Number is an air-based system that allows you to determine the degree of firmness that seems best for you. I think having some control over the firmness is helpful physically and there is a subtle mental boost as well.