Soft, Medium or Firm
Which is the best mattress
By John Reggars

Like most chiropractors I am often asked by patients what is the best mattress. My stock standard answer is usually along the lines of “One that gives your spine adequate support and minimizes biomechanical stress”. Then I recommend the COCA endorsed Chiro-Osteo bed made by Sleepeeze. In a survey of orthopaedic surgeons, 95% believed that mattresses played a part in the management of low-back pain, with 76% recommending a firm mattress.(1) However, evidence supporting this advice is lacking. The effect of mattress characteristics on low-back pain has been analysed in a limited number of studies, but the results are weakened by shortcomings in the methods.

In one study conducted at Macquarie University, Centre for Chiropractic, Hayek et al (2), the researchers measured electromyographic activity of volunteers resting on mattresses with different levels of firmness. The researchers found that there was an increased activity when subjects used a firm mattress and concluded that people with muscle disorders may benefit from a bed which produces muscle relaxation while those with osteoporosis may benefit from a firm mattress.

In a recent randomised double blind controlled trial Kovacs et al (3) studied 313 adults who suffered from chronic non-specific low back pain and assessed them for daytime low back pain, pain while lying in bed and pain on arising. Subjects were randomly assigned to use either a firm or medium-firm mattress, which was installed in their homes to replace their own beds. The subjects were not told which bed they were using, although most guessed whether it was a firm or a medium-firm bed they were using. At the end of 90 days and throughout the study, the results showed that those subjects who slept on a medium-firm mattress had better outcomes for all three criteria. Those people using the medium-firm mattress were twice as likely to report improvements in pain levels and disability and half as likely to need painkillers as those using the firm mattress. The authors noted several limitations to their study including, the Hawthorn Effect, placebo effects and the lack of long-term follow-up.

References

1. Levy H, Hutton WC. Mattresses and sleep for patients with low back pain: a survey of orthopaedic surgeons. J South Orthop Assoc 1996;5(3):185-7.
2. Hayek R, Eaton S, Bonello R. Para-spinal muscle electromyography changes with varying mattress hardness. Proceedings International Conference on Spinal Manipulation Vancouver Canada July 1998.
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;362(9396):1599-604.