Mattresses and Back Pain

As is often the case, I had a few patients this week ask me, “What kind of mattress is best for back pain?”

Then I received an email from a patient about this same issue.  I have included portions of the email below and will try to communicate where the data stands (or sleeps in this case) on the issue.

Hello Dr. Mangrum:

I was your patient two years ago this spring for upper back and neck pain.  You treated me fairly successfully…

Here’s the reason for me bothering you.  My wife and I need to buy a new mattress.  I’d really appreciate your thoughts on what type might be best for me.  Specifically memory foam, vs latex vs a traditional innerspring mattress…

Any thoughts, caveats or wisdom you could share would be most appreciated.

This question is more complicated than it may seem at first blush.  One reason for this is that back pain is often worse first thing in the morning, regardless of what type of bed you sleep on.

The discs in our spine tend to lose around 20–25% of their water content “due to high loads imposed by muscle tensions during the day's activity; this water is regained during the decrease in load under rest at night.”[i]  So first thing when you wake up in the morning the disc is superhydrated and more stiff.   

Similarly, joints with inflammation or arthritis often are more stiff first thing in the morning.  One of the defining factors, in fact, for osteoarthritis is stiffness that lasts for less than 30 minutes after waking up.[ii]

With that in mind, I hate to recommend someone with back pain go out and spend hundreds (or thousands for that matter) on a new mattress when the mattress may not be the source of the trouble in the morning.

Recognizing that a mattress is not the only thing that can cause pain or stiffness first thing in the morning there is some evidence that updating your mattress or certain types of mattresses can be helpful for someone with back pain.

A study published in the journal Applied Ergonomics studied a group of people with chronic low back pain.[iii]  They had these study participants report sleep quality and rate back pain/stiffness for 21 days in their own beds.  Then the participants beds were replaced with medium firm mattresses layered with foam and latex.  The study found significant improvements in sleep variables and back pain at 4 and 12 weeks after changing mattresses. 

A related study published in Spine compared the effects of sleeping on:  (1) waterbed (Akva), (2) body-conforming foam mattress (Tempur), and (3) a hard mattress (Innovation Futon) for one month.[iv]  The researchers found that “Both the waterbed and the foam mattress seemed superior to the hard mattress” in terms of decrease in back symptoms, improved function and sleep.[v] 

So if nonthing else I know that my dad was off base when he told me it would be better for my back to sleep on the floor.

These studies, though, are complicated.  There is not an easy way to do a placebo controlled trial for mattresses.  As a result there are no great head-to-head studies for innerspring mattresses versus latex foam mattresses.  If one mattress maker touts their product as being scientifically proven to be superior to other mattresses you may want to take pause.  The range of sleep position preferences and varied anthropomorphic characteristics of the human body likely make a one fix for everyone impossible.

All this being said, there actually is pretty good evidence that getting a new mattress (especially if your mattress is older than 9 years old) can improve back pain.[vi]  This effect of new bedding improving symptoms plays out in a number of different studies (each with different “new” bedding systems).  This could be a placebo effect of sorts. 

Hopefully this information is useful for those of you considering buying a new mattress.  Let me know if you have comments or a preference for one specific type of mattress.  Leave comments below.  I am sure others are interested in a range of opinions and experience with this issue.

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[i] August 1993 Radiology, 188,351-354.

[ii] http://www.spine-health.com/conditions/arthritis/osteoarthritis-symptoms

[iii] Appl Ergon.  2010 Dec;42(1):91-7. Epub 2010 Jun 26.

[iv] Spine.  2008 Apr 1;33(7):703-8.

[v] Spine.  2008 Apr 1;33(7):703-8.

[vi] J Chiropr Med. 2009 March; 8(1): 1–8

Comments

[Chris Green, DC]

Hi Dr. Mangrum, I was turned onto your site and blogs by a colleague, Dr. Rob Block, and I enjoy them very much. Your "Mattress and Back Pain" article is a common subject in my office. I also have the two conversations regarding 'bed vs. anatomy' and weighing cost. I typically lead with the statment, "There is a vast difference between the things you do which seem to cause pain, ie sleep and the structures in your back which are actually causing the pain" and then re-explain OA and discogenic pain. Per cost, I too caution a patient about spending thousands. The only saving grace I have been able to give a patient thus far is here in Florida there is a 6% sales tax waiver if a MD, DO, DC or NP writes a script for a new mattress. Now I will also give them an excerpt from your article about Akva, Tempur vs. Futon as cited in Spine. Thank you.
Christopher M.Green, DC