To Be Firm Or Not To Be Firm

Close up. The man lifted the mattress to look at the bed frame on which he lay. He also inspects the mattress

A Tip to Avoid Low-Back Pain in McHenry, IL

There are many causes of low back pain, but it is a common belief that mattress firmness causes or perpetuates non-specific low-back pain. You've heard or seen ads that state that you can end your back pain if you use Brand X's mattress. To date, however, little evidence has been published to support these thoughts and claims. Because of this, a randomized, doubleblind, controlled, multi-centre trial was conducted in Spain in which 313 adults with chronic nonspecific low-back pain participated.

Non-specific low-back pain is defined as pain that occurs between the lower border of the ribs and the lower folds of your bottom. Typically (in 85% of patients), no organic cause can be attributed to the pain, and is therefore most often the result of one or several biomechanical factors. Also, those people who suffer from chronic low-back pain tend to be more sensitive to mattress firmness.

In the study the participants were provided a mattress. Rated according to the European Committee for Standardization scale, the mattresses supplied were of two variants - firm and medium-firm -allocation of which was randomized. The subjects were initially questioned the day they were given the mattress and 90 days later. The authors examined two primary outcomes - intensity of the pain while lying in bed and on rising, and the degree of the disability.

At the conclusion of the study, it was clear that mattress conditions did indeed affect the degree of pain experienced by the subjects. Although the difference in variables was small, all favored the use of mattresses of medium firmness; the use of these mattresses improved the clinical course of low-back pain in a higher proportion of patients than those who had used the firm mattress. While the focus of the study was on low-back pain endured while lying in or rising from the bed, beneficial effects seem to extend far beyond the time spent in bed and as such warrant further study.

There were a variety of questions that were not clearly answered. Nevertheless, the findings of the study indicated that recommendations for daily living (such as the type of mattress used, for example) may affect the clinical course of low-back pain.

While it may be a common belief that a firm mattress is best, these study results would suggest otherwise. In most cases, it seems wise to make decisions and recommendations based on evidence rather than commonly held beliefs.


We have sent out many months of newsletters. We hope that you find them valuable and have learned a little bit more about what physical therapy can offer you, your family, and friends. If you have any comments or suggestions for additional content, please let us know.


Medical choices can be confusing with the Internet and the information age. Who or what is best for my muscle and joint problems? This month we have provided you with a short list of references for common orthopedic conditions. There are some instances in which there is little question that physical therapy is the best choice.

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