You can also listen to this in the Back Talking Podcast here!
In my last post, I discussed the best type of mattress and pillow you should be sleeping on. There are many options out there when it comes to mattresses. Firm, soft, pillow tops, sleep number, temper-pedic foam, and I’m not even sure if they still sell water beds, but I’m sure there are some out there. There isn’t much research out there that applied to this topic, but there were 2 very good pieces of research in the literature. The first dealt with sleeping on a firm vs medium firm mattresses, the second dealt with the age of and the quality of (more importantly known as cost), of the mattress.
The recommendation for those suffering from back pain was, for years, a firm mattress, and if that mattress wasn’t firm enough, throw a piece of plywood under the mattress to help stiffen it up. Well that recommendation has been thrown out the window with the first research article, they found that those who suffered from chronic lower back pain fared better sleeping on a medium-firm mattress. They had less pain while in bed, less pain upon arising, less disability due to back pain, and less day-time back pain, compared with those who slept on the firm mattress. The reasoning is that a medium-firm mattress helps support the body more evenly, maintains it’s proper neutral alignment, and doesn’t create pressure points. A mattress that is too firm can create pressure points in the shoulder, hip, and heel regions, or your heavier body parts, which can lead to pain in those regions. It’s almost like sleeping on the floor. On the flip side, a mattress that is too soft doesn’t offer enough support to the spine, allowing the spine to be bent or twisted into awkward angles. This can place undo stress on joints, ligaments, tendons, and muscles which can cause injury to those structures.
The second study showed essentially that the newer a mattress is, and if it is of higher quality, the better someone feels upon arising. They found that the average age of the mattress when people were buying a new one was 9.5 years. Mattresses definitely have a lifespan, they begin to break down and lose the ability to support your body. And you kind of get what you pay for, the higher quality mattress ( meaning the more expensive ones) tended to afford the person a better night’s sleep.
But it doesn’t matter the surface that you are sleeping on, what is most important is, the position that you sleep in. So what am I talking about? The best position to sleep in is one that keeps your spine in a neutral posture, and there are 2 positions that can accomplish this. What is neutral posture you say? When someone is standing, balanced evenly on both legs, looking at them from the side, there is a normal forward curve in our lower back, there is a backward curve to our midback, and our neck, if you could see inside of it, should have a forward curve to it as well. This is the neutral spine position. It is not flexed forward, nor extended backward, or flexed to the side, or rotated at all.
So the best position to sleep in is on our back. When we lie on our backs we are in a neutral spine posture, provided that you don’t have a stack of pillows under your head so that your chin is touching your chest. And from the last episode, we discussed that back sleepers should be using a contoured pillow, one that has a hump in the front to help support the neck, and an indentation in the middle to help support the head. But not everyone feels comfortable on their back, or they snore at decibel levels that rival a jet engine on takeoff.
Sleeping on your side is acceptable as well, with some pointers. Again we need to maintain that neutral posture. We should be able to draw a straight line from top of your head, through your nose, center of your chest and your pelvis. What gets people in trouble is that they like to flop the top leg over the bottom leg, essentially twisting the bottom half of their body. When we do that we place our lower back into rotation, which is a no-no. This again places the discs, ligaments, joints, muscles and tendons into a position of stress which could cause them injury. This may explain why you may wake up in the morning stiff and sore. Finally, when sleeping on your side, the pillow should be thick enough to fill the gap between the mattress and our ear, to again keep our neck in a neutral posture.
So you should get the point by now, it’s all about maintaining a neutral posture where your spine is not bent, flexed or rotated. Back sleeping is best, but side sleeping is acceptable as well.