October 30, 1996

Media Contacts: Sarah Goodwin, 404/727-3366 -
Kathi Ovnic, 404/727-9371 -

More than 90 percent of orthopaedic surgeons surveyed believe a bed or mattress plays a role in the treatment of patients with low back pain, believe sleep quality is particularly important in patients with back pain and have been asked by back pain patients to recommend a bed or mattress, reports Emory University physician Howard I. Levy, M.D., in the fall 1996 issue of the Journal of the Southern Orthopaedic Association.

During his analysis of the relation of mattresses and sleep for patients with low back pain, Dr. Levy queried members of the Atlanta Orthopaedic Association on their experiences with that subject in their own practices. More than 67 percent of the orthopaedic surgeons said they would recommend "firm" mattresses to back pain patients; nearly 9 percent said they would recommend "hard" mattresses, 0.8 percent said they would recommend "soft" mattresses and 1.6 percent said they would recommend a waterbed. None would recommend sleeping on the floor.

"The most important results to emerge from our survey are: (1) there is a clear perception among orthopaedic surgeons that the mattress does play a role in the management of back pain, (2) a firm mattress (not hard, not soft) is the one most frequently recommended, and (3) there is a need for a scale (or standard) of hardness for the comparison of different mattresses," says Dr. Levy, who is an assistant professor of Orthopaedics at the Emory University School of Medicine and a physician at the Emory Spine Center.

"One of the difficulties in comparing different studies (and different mattresses) is the lack of a defined quantitative method of comparison (ie, a standard)."

According to Dr. Levy, "Back pain is one of the most frequent reasons for a visit to a primary care physician, second only to upper respiratory infections. Conservative treatment generally includes bed rest, oral pain medication, and back-specific exercises."

He explains that mattresses should provide support without causing awkward pain-producing contours of the spine.

"In addition to the obvious benefits of sleep, when we lie down at night, loading on the intervertebral disks is reduced, and their relatively unopposed swelling pressure results in fluid absorption and increased volume," Dr. Levy explains. "The absorbed fluid is expelled during the day when the loading of the spine is increased. Thus, there is a diurnal variation in fluid content and height of the disks. This fluid exchange plays an important part in supplying nutrients to the intervertebral disk cells.

"Loads acting on intervertebral disks are lowest in the recumbent (supine) position. This tends to support bed rest as a preventive treatment for patients with low back pain. However, the support given by the mattress (even in this low load position) could influence strain on the spinal ligaments. In other words, an overly soft mattress might give little support to maintaining correct apposition of individual vertebrae, thus stressing the adjacent disks and ligaments."

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Copyright ©Emory University, 1996. All Rights Reserved.
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