Following on from our knuckle-popping post, it's time for the latest in our series of "Chiropractors' most asked questions". Today we’ll be looking at what kind of mattress works best and what your sleeping position should be.

Mattress Types

Firstly, how firm should your mattress be, and what should it be made of?

This review took in 24 different studies, and found support for 3 types of mattresses providing the most pain reduction:

• A medium-firm bedding system (where “medium firm” is based on the individual’s definition of firmness)

• An air mattress overlay system

• A prescribed individualised bedding system (where the firmness can be adjusted)

This study took over 300 people and gave them either a firm or medium firm mattress.

In most patients, changing mattresses associated with an improvement of pain while lying in bed. Pain-related disability improved in both groups, although results were significantly better for the medium-firm mattress than the firm mattress group.

Some patients did worsen, but even again the medium-firm mattresses performed better than firm.

These results tally with what we tend to see in clinical practice. Generally a change of mattress brings about positive change, although a minority have reported worsening symptoms. We’re not totally sure why that happens.

Mattress Material

As for the question of what material you should look for in a mattress, latex mattresses have been found to spread the pressure on joints more evenly than their polyurethane counterparts. However, this study did not measure pain or disability. Whether that reduced pressure translates to any differences in quality of life remains to be seen.

Sleeping Position

As for what position you should sleep in, this study found no relationships between sleeping position (whether on your front, side or back) and levels of morning pain. There are limitations, such as how much you might move or change position in the night; and from a clinician’s point of view, we would urge caution against falling asleep in any postures that put joints in extreme positions.

Pillow Heights

One sleeping position question we do have some concrete answers for is how many pillows should be used at night. This small study looked at three different pillow heights with a side lying position. The results were:

• The lowest pillow height (5cm or 2”) was the least comfortable

• The medium pillow height (10cm, 4”) was the most comfortable and showed the most relaxed muscles

• The higher pillow height (15cm, 6”) was the “middle of the road” in both categories.

Conclusions

In summary, the research suggests the following:

• Medium-firm mattresses perform best for individuals with low back pain

• If you have active control of bed properties (custom inflation), there is an improvement in sleep quality

• Latex mattresses decrease forces on joints – but we don’t know what the effect on pain is

• Pillows should be about 10cm high for maximum comfort

• No relationship between sleeping posture and morning pain has been found, but anecdotally most professionals would advise you avoid extreme positions.

If you’re doing everything right according to the research and still having problems, it’s likely that your night time routine is not the issue! The fitter and stronger you are, the better your body can deal with any stresses and strains you throw at it. For a brief chat about how we can help, contact us.