FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

MORNING BACKACHE? TAKE A CAREFUL LOOK AT YOUR MATTRESS!

Question: I have some trouble with backaches, particularly first thing in the morning. By the time I've gotten ready to go to work, it is largely gone. I think our old mattress may be the cause, and that is the source of my question. What type of mattress is best for someone with back trouble? Some salespeople have advised us to get a very firm mattress, while others have suggested softer ones.

Answer: Most people spend about eight hours of each day in bed. That means one-third of our lives are spent there! Certainly the mattress upon which we sleep makes a difference in the quality of sleep as well as the aches and pains one experiences upon waking.

A lumpy mattress with its "hills and valleys" is a frequent cause of morning backache. The body, and particularly the joints of the spine, aren't supported uniformly by the worn mattress. This places increased stress on the ligaments and muscles that support the joints. The increased mechanical stress causes morning aching and stiffness. A half-hour's worth of morning activities usually relieves the stress to the ligaments and allows the joints to move smoothly, making "morning backache" fade away.

Turning your mattress on a regular basis, once every six months or so, will prolong its life. This delays the formation of those body-shaped hills and valleys. Occasionally turning over a worn mattress will make it serviceable again, although replacing it is often a better choice.

Most authorities recommend a firm mattress for those with back injuries or chronic back trouble, however, no consistent definition of "firm" seems to exist. Firm can accurately describe my living room floor, but every time I fall asleep there usually an unplanned afternoon nap I wake up with a "morning backache" in the afternoon. My floor is too firm. A normal spine has a gentle "S" shaped curve to it. A very firm mattress, like a slab of rock or my floor, supports the shoulders and hips. However, because it does not support the curved parts of spine, these areas are under increased stress and are subject to backache.

A properly firm mattress has some "give" to it. That is, the mattress should compress sufficiently to allow support of the entire back. This is usually accomplished by having a firm inner structure, usually of springs or dense foam, that is then covered with a layer of softer material. The suppleness of the mattress surface is often further enhanced by supporting it on box springs. Therefore, a mattress that is too soft can be made more acceptable by putting a board between the springs and mattress or by placing the mattress directly on the floor. A mattress that is very firm throughout can be made more comfortable by covering it with a foam mattress topper. These are relatively inexpensive and readily available.

Water and air beds take an alternative approach. The entire structure of the bed is soft so that the person "floats" on the water or the air cushion. This avoids creating "high pressure" areas over the shoulders and hips. This is particularly helpful for those that sleep on their side and have shoulder problems. Many find waterbeds are the most comfortable while others sleep better on a traditional mattress. I can offer no good way to predict which type of bed someone else will like best.

One additional point to consider is the ease with which you can get in and out of bed. This makes relatively little difference for those with simple "morning backache" but is of much greater significance for those with more serious back problems. A low bed is often more difficult to climb in and out of than is one that is 24 to 30 inches high. Also, a traditional waterbed is harder to get out of than is a soft-sided water bed or a regular mattress and springs.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.