May 23, 2009

Back Pain and Your Mattress


Remember the good old days when shopping for a mattress meant heading down to your local department store and simply choosing between soft, medium or firm? Now days it seems like you need a crystal ball just to decide which boutique mattress store to chose from.

Then, once you've narrowed down your list of retailers, you still have to decide on the type of bed to get:

If you're as indecisive as I am, you probably just do what I do. Which is nothing.

How I Was Almost Bamboozled

As a journalist, a lot of press releases pass through in my inbox every week informing me of the latest studies and new product releases. I ignore most of them because they usually have nothing to do with back pain.

However, one such announcement caught my eye recently that had to do with a study on back pain and mattresses. It came courtesy of Select Comfort, the folks who make the Sleep Number bed.

The study, conducted by Harvard researchers at Massachusetts General Hospital, found that the right mattress could significantly reduce back aches as well as improving other quality of life factors.

Intrigued, I headed over to the website in question to find out more about this seemingly prestigious sleep study.

Intrigue Hits a Pothole

My first disappointment came when I couldn't find a citation for this study anywhere in, on or around the article. Apparently the only place this study is published is on Select Comfort's own website.

So I decided to do the only sensible thing. I headed over to the PubMed archives to see if there were any published sleep studies that might shed more light on this subject.

And as you might guess, there were several studies comparing various different mattresses and their impact on back pain and sleep quality.

Changing Things Up

Now my normal process is to pick out the significant studies, select what I consider the relevant quotes, comment on them and then attempt to draw a conclusion.

But I'm going to do things a little differently this time.

Rather than force you to wade through a quagmire of quotes I decided to cut to the chase and simply give you a summary of what I discovered.

(All the citations and what I consider to be relevant snippets from each study are listed at the end of this article in the References section. Read through them and follow the links provided to conduct your own review of the literature. Perhaps your conclusions will differ from mine.)

My Sleep Study Summation

1. Your mattress does matter.

2. A quality mattress is better than a cheap one.

3. The type of mattress you buy does not appear to be relevant.

At least, no study has yet proven one to be superior over the others.

It almost appears that -- depending on the circumstances and the testing criteria -- almost any quality mattress will win at any given time.

In one study, memory foam ties with a waterbed, while both beat out a hard futon. Another study shows that a medium firm mattress was preferable to a hard mattress.

This leaves one to wonder how a "medium firm" conventional mattress would compare with memory foam, a waterbed, or a sleep number bed. It appears we will never know.

4. A New Mattress Beats an Old Mattress

In several of the studies the mattress being tested is new and easily wins out over an old mattress.

For example, in one study new mattresses were compared to 8-year old hotel mattresses. Not too surprising, the new mattresses resulted in less back pain and a better night's sleep.

In the Harvard / Select Comfort Study that I introduced at the start of this article, the new Sleep Number bed wins over the participants' own old mattress. (No doubt the average age of said old mattresses would exceed 8 years.)

My Take Away: If you're waking up with aches and pains, then you might want to consider purchasing a new mattress.

How To Rig a Sleep Study

So far, it appears that no reliable study has been done to determine which mattress is actually the best.

In almost every case where a single manufacturer supplies the bed or mattress being tested, the opponent is always an old mattress. Thus insuring that the odds are conveniently stacked for an easy win for the sponsor's bed.

I can't say for certain if manufacturers are actually trying to stack the deck in their favor, but if you read through the various studies, a pattern definitely emerges.

As far as I'm concerned, it doesn't really matter.

I don't have a bone to pick with Select Comfort or any other manufacturer. I believe they all make a quality product and their marketing department isn't going to influence my buying decision one way or another.

Next time I go looking for a new mattress, I'm definitely going to check out the Sleep Number bed right along with the others.

The Bottom Line

Perhaps someday someone will do a real sleep study comparing the various mattresses on the market. Until that glorious day arrives, here's all you can do:

Until next time,



New Mattress Beats Old Mattress

1. The Select Comfort Sponsored / Harvard Sleep Study

A total of 84 participants, 38 men and 46 women, enrolled in the study between May 1 and July 19, 2008.


Once accepted, each individual and couple participated in a six-week protocol in which they filled out a series of questionnaires … each subject received a SLEEP NUMBER® mattress that was the same size as their current bed, along with pillows of their choice based on their usual sleeping positions.

RESULTS: After six weeks, the majority of the participants who switched to a different bed reported a significant improvement in sleep quality, the ability to fall asleep faster and sleep longer, a decrease in back and neck aches and a significant decrease in soreness, stiffness and pain.

2. Enck P, et al., Associations between back pain, quality of sleep and quality of mattresses. Double-blind pilot study with hotel guests. Schmerz. 1999 Jun 11;13(3):205-7.

BACKGROUND: Associations between back pain, the quality of sleep and the quality of mattress …

Nine rooms had been equipped with new mattresses of three different qualities and prices, but this was kept blind to the hotel staff and the guests. Sleep quality … was analyzed in comparison to the remaining 8-year old mattresses of the hotel,.

RESULTS: The three qualities of the mattresses correlated significantly and positively with the perceived quality of sleep, but the difference to the "old" mattresses was most pronounced …

CONCLUSION: At least for chronic sufferers from back pain and sleep problems, the association between sleep quality and quality of the mattress is significant.

Medium firm mattress beats firm

3. Kovacs FM, et al., Effect of firmness of mattress on chronic non-specific low-back pain: randomised, double-blind, controlled, multicentre trial. Lancet. 2003 Nov 15;362(9396):1599-604.

… we assessed 313 adults who had chronic non-specific low-back pain, but no referred pain, who complained of backache while lying in bed and on rising.

FINDINGS: At 90 days, patients with medium-firm mattresses had better outcomes for pain in bed … pain on rising … and disability … than did patients with firm mattresses. Throughout the study period, patients with medium-firm mattresses also had less daytime low-back pain … pain while lying in bed … and pain on rising … than did patients with firm mattresses.

INTERPRETATION: A mattress of medium firmness improves pain and disability among patients with chronic non-specific low-back pain.

Memory foam and waterbed beat a hard futon

4. Bergholdt K, et al., Better backs by better beds? Spine. 2008 Apr 1;33(7):703-8.

One hundred sixty CLBP patients were randomized to 1 of 3 groups, having a mattress/bed mounted in their sleeping room for 1 month. The beds were: (1) waterbed (Akva), (2) body-conforming foam mattress (Tempur), and (3) a hard mattress (Innovation Futon).


Both the waterbed and the foam mattress seemed superior to the hard mattress, … There were no relevant difference between the effects of the water bed and the foam bed.

CONCLUSION: The Waterbed and foam mattress' did influence back symptoms, function and sleep more positively as apposed to the hard mattress, but the differences were small.

Another Air Adjustable Study

5. Lahm R, et al., Physiologic responses during rest on a sleep system at varied degrees of firmness in a normal population. Ergonomics. 2002 Sep 15;45(11):798-815.

It was concluded that in a population of normal participants, although mattress inflation pressure induced significant changes in spinal alignment, these changes were of little physiological consequence.

New Bed Beats Old Bed

6. Jacobson BH, et al., Effectiveness of a selected bedding system on quality of sleep, low back pain, shoulder pain, and spine stiffness. J Manipulative Physiol Ther. 2002 Feb;25(2):88-92.

OBJECTIVE: To determine whether clinical and statistically significant changes in back pain, shoulder pain, spine stiffness, and quality of sleep may be documented after use of a prescribed bedding system.


CONCLUSIONS: Results suggest that subjects obtain significant improvement in shoulder and back pain, back stiffness, and quality of sleep after 28 days of prescribed bedding system use as compared with 28 days of personal bedding use.

New Air Adjustable Bed Beats Old Bed

7. Monsein M, et al., Short-term outcomes of chronic back pain patients on an airbed vs innerspring mattresses. MedGenMed. 2000 Sep 11;2(3):E36.

OBJECTIVE: To compare … pain … and sleep … outcomes of an adjustable airbed with innerspring mattresses in a population of chronic back pain sufferers. STUDY DESIGN: A-B-A trial, in 3 phases: the patients on their own bed for 1 night, on an adjustable airbed for 28 nights, and on their bed for 14 nights.


Eighty-five percent preferred the adjustable airbed.

DISCUSSION AND CONCLUSION: SF-36 and VAS outcomes measures showed a highly significant benefit for the airbed design in this short-term comparison. The airbed appears to be a useful sleep aid and an adjunct to medical and physical therapies for chronic back pain sufferers.

Hard Bed and Waterbed Beat Soft Bed

8. Garfin SR, et al., Bed design and its effect on chronic low back pain--a limited controlled trial. Pain. 1981 Feb;10(1):87-91.

This study examines the effect of 4 different types of beds on chronic low back pain patients' symptoms and signs. The beds employed were an "orthopedic" hard bed with 720 reinforced coils and a built-in bed board, a softer 500 coil bed, a standard 10 in. thick waterbed, and a hybrid bed of foam and water. Subjectively the majority of patients preferred the hard bed and felt that their back pain improved to a greater extent after 2 weeks on the hard bed as compared to the other beds. The next largest group of patients to show improvement used the waterbed.


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