Hi SleeplessinDallas,
I think that dealing with back pain (or any pain) and how it may relate to a mattress can be one of the most frustrating “projects” possible. Part of the reason for this of course is that there are so many variables involved that getting to the actual cause and it’s solution can be difficult at best. There are so many different causes that can mimic each other that sometimes even knowing where to begin can be frustrating and even a quick search on the internet can lead to more confusion and questions than it can answers. Often there are multiple causes that interact and no single one seems to help. To make it even more difficult, many of the causes are not even related to a mattress even though a mattress can either help aggravate or alleviate some of the issues involved so it can sometimes appear that something obvious such as a mattress change is the cause when it may only be one additional factor that put something over the edge.
So I thought I would explore some of the issues that may be involved in this post … not because you may not know them but because your post gives me a chance to explore possibilities that may apply to many people.
The first thing that can be part of the difficulty with a mattress is that change itself can cause problems. Change for the better that may help in the long term can often cause short term symptoms. These tend to become less over time as the body makes “good” adjustments. Change for the worse can cause the same symptoms. Of course these tend to get worse over time as the body makes “compensating” adjustments. Both of these tend to happen in cycles with periods of improvement followed by periods of worsening. A spine for example that has become used to a “learned” curvature (rather than a neutral curvature) or has become less flexible than it should be from lifestyle or other issues can cause pain when sleeping in better alignment even though in the long term it may be part of a longer term solution. It’s often really difficult to know if pain is the result of an improvement process or a worsening process. Because there are so many variables involved … it can also be difficult to know if what we are assigning as the “cause” (such as a new mattress) is only one of several factors (such as diet, lifestyle, injury, or other underlying issues).
To make all these matters more frustrating … there is often a tendency to make too many adjustments too quickly which don’t take into account the gradual nature and the cycles of changes in either direction. We “react” to each symptom of change and often try to “fix” it without taking into account or in many cases even knowing whether this is an “improvement” symptom or a “worsening” symptom or part of a natural cycle where things get worse or better because of an ongoing process that has roots in longer term patterns rather than short term (and seemingly more obvious) changes.
Imagine an ocean for example where there are hills, valleys, and mountains on the ocean floor which are all covered by water. The variations in height of the hills, valleys and mountains on the ocean floor are the odds we will experience certain symptoms. The depth of the water which covers the hills and mountains is our overall health, strength, and vitality. The actual symptoms we experience are the peaks or “islands” which rise above the water level of the ocean. Both the water level and the ocean floor can change over time. As the water level is lowered (our health and vitality is reduced), or new hills and mountains grow in the ocean floor (changed tendencies through habits, environment or circumstances), new islands are exposed or get bigger and we experience symptoms that have been previously covered by the water. What we are born with, our exposure to things like accidents and changes in environment or circumstance can raise the peaks while our overall health practices can raise or lower our water levels (and our ability to keep our symptoms covered). New islands (symptoms) appear and disappear all the time as a result of normal patterns in life.
Changes in circumstance or environment which make new hills and valleys grow increases the odds of certain symptoms (like eating something poisonous, changing to a job that requires us to use our muscles more, sudden emotional changes, or a new mattress for example) and usually leads to more specific symptoms as only one or two new islands are exposed. The water also has waves on top which are the natural fluctuations that we go through and if the water level is too low then these waves can lead to cycles of symptoms (exposures of the peaks just under the water) that seem to come and go. This is usually a first symptom of water levels that are too low. The amount of water over the hidden peaks is our sensitivity to symptoms and determines how much the “normal” waves of life will affect us.
The trick of course is to know whether a symptom is “caused” by the raising of a peak (an accident or injury, a sudden change in circumstances, or the progressive effect of a bad habit) that increases the odds we will experience a symptom … by the more gradual lowering of the water levels that lowers our resistance or adaptability to symptoms … or a combination of both.
Examples of the first is posture habits such as sitting at a computer all day with poor posture, exposure to an environment which is more risky (toxins or stressors) or needs more effort (muscle fatigue), environmental or circumstantial stress, or injury. Examples of the second include diet and lack of exercise or poor health or sleeping habits which reduces the natural ability of the body to accommodate or adapt to the ongoing changes or rhythms of “normal” living.
If the water level is just above the peak, then small changes of either type can lead to symptoms. This is where the natural tides and waves (normal stuff) or small environmental changes can cause symptoms that come and go. The other possibility is a more sudden (and often obvious) change that leads to a peak (the odds that you will experience a symptom) that grows much faster. These tend to be more sudden and long lasting (they don’t come and go as much) and involve a change that is easier to identify (like an injury or a more sudden change in circumstance or environment that puts a “symptom peak” above the water and keeps it there). One comes more suddenly in other words and tends to stay while the other tends to come and go with the tides and waves or even ripples of normal life.
On to some specifics of back pain as it relates to sleeping and mattresses. Bear in mind that I am not a doctor and that this is more about the general tendencies of how a mattress may affect things rather than an attempt to “diagnose” anything.
In general … pain that can be connected to a mattress will come from one of two primary sources. The first is muscles and their connected tissues and the second is joints and their connected tissues. There is a also a third category which is “other causes” (such as health or illness issues which can “mimic” back pain) which have little to do with the joints or muscles themselves. This last group needs to be ruled out (with the help of a medical professional) because of course no solution that involves the muscles or joints can work if they are not the primary cause.
The “joints” part is generally from alignment and can range from the joints in the spine to other joints such as the hips, sacroiliac, shoulders, etc. The muscles part is generally from circulation and/or tension issues caused by pressure of some type. These can also interact with joint issues such as when excess pressure on a hip aggravates its alignment and causes pain. Each of us can have a different tendency to experience either (the number of hills and valleys on our ocean floor) and can have a greater or lesser resistance to experiencing these symptoms (the depth of our water).
With pressure issues … or with joint issues that come from excess compression on the joint (usually the hips and shoulders) then the upper part of the mattress is often at “fault” (in terms of either softness or thickness) assuming that our overall water level is high enough above the peaks and valleys of our ocean floor so that natural waves aren’t the real issue. These symptoms tend to be more vague and can involve numbness, burning, tingling, or generalized pain.
With joint issues that are more connected with alignment … then the lower layers of the mattress (or sometimes the thickness of the upper layers that separate the body from the lower layers) are most often at “fault”. These symptoms tend to be more specific and often localized to a specific part of the spine. The most common here is lower back pain and particularly lumbar issues where either the small of the back is not well supported (the gaps are not filled in) because the mattress overall is too firm or the heavier pelvic area is sinking in too far because the mattress overall is too soft. These usually lead to a type of pain that is easier to identify as coming from a more specific part of the spine.
Some “combination” types of problems can be from shoulders that don’t sink in far enough leading to poor alignment of the upper spine, pillows that are not suitable for a particular weight or sleeping position which can lead to neck and shoulder issues, or twisting that can come from poor sleeping habits or a mattress that isn’t quite right and the body tries to “fix” an alignment or pressure issue while we are sleeping and we shift one part of the body (like the torso) without shifting the other.
Some possible solutions or at least some ideas that can help or give an indication of what may need to change …
Changing pillows to better accommodate alignment needs of the head and neck. This can also have an affect on shoulder pressure. Pillows often need to be changed with a change in mattress because our shoulders may sink in more or less than the old mattress which means that the gap from the head or neck to the mattress that needs to be supported may increase or decrease.
A pillow under the pelvis for stomach sleeping can help offset the natural tendency of the pelvis to sink in too far on the stomach which can lead to a hyper-extended lumbar or “swayback” and back pain
A pillow under the knees for back sleeping can rotate the pelvis and flatten the arch of the lower back which can result in better support and lessen back pain.
A pillow between the knees for side sleeping can help align the hip joint and reduce hip pain or a tendency to twist the lower back and spine (part stomach and part side sleeping).
A body pillow can reduce the tendency to shift onto the more “risky” stomach sleeping position and can help with spinal twisting and alignment.
Raising the foot of the bed slightly (with a wedge or an adjustable bed) can help alleviate back pain or hip pain (similar to a pillow under the knees on the back or between the knees on the side).
Raising the head of the bed slightly can sometimes also help with issues such as acid reflux or snoring that can be the source of tension but this is not good for stomach sleepers as it can aggravate some of the problems connected with stomach sleeping in particular.
These are all outside of the changes in a mattress itself in terms of layer thicknesses or firmness that are dealt with in other posts or in other areas of the site.
Overall … the key with symptoms of any type are changes that are “just enough” as there is usually a range where symptoms that are connected with a mattress can be helped the most. Just enough firmness, just enough thickness, and more gradual and slower changes so your body can keep up with the changes themselves can get you into the “just enough” range without reacting to symptoms that may be caused by something that happened during the day rather than the mattress itself. Patterns are always more revealing than symptoms which happen only once or randomly.
Changes that are too large can put us on the other side of our optimal range and produce similar symptoms for different reasons. A tendency to make adjustments too quickly can make it very difficult to tell which change is connected to which symptom or even if a normal daily event or “wave” was the real cause. Changes may take a few days (or sometimes longer) to be effective and reacting too quickly to either “nothing happened” or “something happened” can make it much more difficult to end up inside your “just right” range. Patterns and the general direction of improvements over time are always more accurate than individual instances of a certain symptom and will tell you more about whether a symptom is connected to getting better or getting worse.
I’ve only covered here a small part of a very complex subject (and there are many things that I’ve left out completely) but overall the best suggestion is to go slowly before you assign any “causes” to certain symptoms and give each change time to show its pattern and in which direction it’s heading. Give real thought to whether the symptoms you are experiencing are part of getting better or worse (a gradual tendency towards improvement vs a gradual tendency of symptoms getting worse or more frequent) and make changes small and incremental so that you increase the odds of getting into the range of pressure relief or alignment which is optimal for you and your long term comfort and health.
Phoenix