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Study Is Hard on Hard Mattresses

Finds 'medium-firm' ones better for people with back pain

THURSDAY, Nov. 13, 2003 (HealthDayNews) -- When it comes to mattresses, harder does not necessarily mean better.

A new Spanish study has found "medium-firm" mattresses are actually better than firm ones for low back pain.

"What kind of mattress should I use?" is a common question asked in doctors' offices, and it's one that has no reliable answer because there's no reliable evidence, say the authors of the study, which appears in the Nov. 15 issue of The Lancet.

The query does seem to be an important one, with 95 percent of orthopedic surgeons in one survey saying they believed a mattress played a part in the management of low back pain.

This study looked at 84 men and 229 women with low back pain, or pain that is generally not linked to any underlying disorder such as a fracture and which, more often than not, has no apparent organic cause. All of the study participants reported having backache while lying in bed and upon getting up.

The participants were then randomized to receive a firm mattress or a medium-firm mattress. (The mattresses were rated on a European scale, with 1 being the firmest and 10 the softest; the firm mattress in this study was rated 2.3 while the medium-firm was rated 5.6.) The patients were unaware of what kind of mattress they had been given, as were the workers who installed the mattresses.

Overall, after 90 days, people who used the medium-firm mattresses were twice as likely to feel less pain when lying in bed, getting out of bed, and in disability associated with back pain. They also reported less use of painkillers.

"The effects of the mattress [were] superior to the majority of medical treatments for this type of patient," reports study author Dr. Francisco Kovacs, director of the scientific department at the Kovacs Foundation in Palma de Mallorca, Spain. "In fact, the change of mattress was associated not only with a marked improvement in pain, but it also improved the degree of disability, which few medical treatments have achieved." The Kovacs Foundation is a nonprofit organization devoted to medical research, health care and the promotion of public health.

Kovacs doesn't know why the medium-firm participants might have experienced such an improvement, but he hypothesizes that "a medium firmness mattress adapts better to the normal curves of the back, allowing for greater support."

The report, however, may have simplified a topic that is not at all simple.

"The study basically said that a density of 5.6 was the 'ideal' mattress. That's like saying who is the ideal mate for you," says Dr. Gerard Varlotta, director of sports rehabilitation at New York University/Rusk Institute and an associate professor of rehabilitation medicine at New York University School of Medicine. "That's multifactorial. It has to do with a lot of different variables, and it's the kind of thing that takes trying out. You have to go on a few dates."

Although selecting the right mattress (and the right partner) is highly individualistic, Varlotta generally counsels his patients to get a mattress that is "firm, but not too firm" and "one that contours to the body. You want a bed that can take pressure and equally distribute it and not put you in an abnormal position."

The best mattresses are often those with individual coils so they contour to the body, but these also tend to be the most expensive, Varlotta says. If you want to spend less money, pick a mattress that's "firm but not too firm," with a quilted pillow top. A box spring is nonessential.

Whatever you decide to spend, it's important to road test the mattress before committing. "You need to try one," Varlotta says. "If it doesn't feel good in the store, it's not going to feel good at home. It's like a shoe. You have to try it out to see if it's appropriate for you."

More information

For more on low back pain, visit the American Academy of Orthopaedic Surgeons or the American Academy of Family Physicians. The Kovacs Foundation also sponsors a Web of the Back site.

SOURCES: D. Francisco Kovacs, M.D., Ph.D., director, scientific department, Kovacs Foundation, Palma de Mallorca, Spain; Gerard Varlotta, D.O., director, sports rehabilitation, New York University/Rusk Institute, and associate professor, rehabilitation medicine, New York University School of Medicine, New York City; Nov. 15, 2003, The Lancet
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