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Sleeping Positions & Related Back Pain
Sleeping Positions & Related Back Pain |
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Sleeping Positions and Related Back Pain Diagnosis and Treatments LOW BACK PAIN Low back pain is most commonly caused by muscle strain associated with heavy physical work, lifting or forceful movement, bending or twisting, awkward positions, or standing in one position too long. Any of these movements can exacerbate a prior or existing back disorder. Other conditions that can cause low back pain include spinal stenosis, arthritis (osteoarthritis), spinal infection (osteomyelitis), spinal tumors (benign and malignant), spondylolisthesis, and vertebral fractures. Acute Low Back Pain Low back pain is either acute or chronic. Acute low back pain may begin suddenly with intense pain usually lasting less than 3 months. Chronic Low Back Pain Chronic pain is persistent long-term pain, sometimes lasting throughout life. Even chronic pain may present episodes of acute pain. Other symptoms include localized pain in a specific area of the low back, general aching, and/or pain that radiates into the low back, buttocks, and leg(s), known as Sciatica. Sometimes pain is accompanied by neurological symptoms such as numbness, tingling, or weakness. Neurological symptoms requiring immediate medical attention include bowel or bladder dysfunction, groin or leg weakness or numbness, severe symptoms that do not subside after a few days, or pain prohibiting everyday activities. Diagnosis Pain felt in the low back is not always indicative of a spinal problem. A thorough physical and neurological assessment may reveal the cause of the low back pain. The physical examination begins with the patient's current condition and medical history. Range of Motion The patient's range of spinal motion is evaluated while standing straight, bending forward, and to the side. Asymmetry, posture, and leg length is noted. Methodical palpation of the spine can reveal muscle spasm, possible bony displacement, and tender points. Abdominal palpation is performed to determine if the cause of low back pain is possibly organ related (e.g. pancreas). Neurological Assessment The neurological assessment evaluates weakness, absence of reflexes, tingling, burning, pain, diminished function, and other signs that may indicate nerve involvement. In some cases electro diagnostic studies such as electromyography (EMG) or nerve conduction velocity (NCV) are performed to confirm a diagnosis or localize the site of nerve injury. Lab Tests If infection, malignancy, fracture, or other risk factors are suspected, routine lab tests may be ordered. These tests may include complete blood count (CBC), erythrocyte sedimentation (ESR), and urinalysis. Imaging Studies Plain radiographs (x-rays), CT Scan, and/or MRI studies are performed when fracture or neurological dysfunction is suspected. An MRI represents the gold standard in imaging today. An MRI renders high-resolution images of spinal tissues such as the spinal cord and intervertebral discs. X-rays are still the imaging methods of choice to study the bony elements in the low back. The results of the physical and neurological examinations combined with test results are carefully evaluated to confirm a diagnosis. Treatment Most patients with low back pain are treated without surgery. A conventional treatment plan may include bed rest for a day or two combined with medication to reduce inflammation and pain. Medications recommended by the physician are based on the patient's medical condition, age, other drugs the patient currently takes, and safety. Medication The first choice for pain relief is often nonsteroidal anti-inflammatory drugs (NSAIDs). These drugs should be taken with food to prevent stomach upset and stomach bleeding. Muscle relaxants may provide relief from muscle spasm but are actually benign sedatives, which often cause drowsiness. Narcotic pain relievers are prescribed for use during the acute phase. Physical Therapy Physical therapy (PT) is started as soon as the patient can tolerate activity. A managed PT program can help build muscle strength, flexibility, improve mobility, coordination, stability, balance, and promotes relaxation. Patients who participate in a structured physical therapy program often progress to wellness more rapidly than those who do not. This includes low back maintenance through a home exercise program developed for the patient by the physical therapist. PT may include ice therapy to slow nerve conduction thereby decreasing inflammation and pain. Heat treatments may be used to accelerate soft tissue repair. Heat increases blood flow and speeds up the metabolic rate to assist healing. Heat also helps decrease muscle spasm, pain, and promotes a relaxed feeling. Ultrasound is a treatment used to deliver heat deep into soft tissues. Sometimes a heat treatment is given prior to a session of therapeutic exercise. Surgery Seldom is surgery required to treat low back pain. Surgery may be considered if the patient is experiencing bowel or bladder dysfunction, increased nerve impairment, progressive weakness, incapacitating pain, or spinal instability. The surgical procedure depends on the diagnosis or the cause of low back pain. Recovery First and foremost, follow the treatment plan outlined by the physician and physical therapist. To enhance recovery from surgery, an episode of low back pain, or to help prevent future exacerbation try to maintain good posture, be consistent in a home exercise program, and eat sensibly to maintain proper body weight. POSTURE Poor posture is the leading cause of LBP (lower back pain) among individuals. Dr. Brad R. Lustick explains, "The aches and pains that the majority of folks suffer can almost always be related to what they do everyday. This may be working postures or conditions, lifestyle and hygiene habits, driving in traffic or in seats that fail to fit an individual's body type, sleeping in bad postures or with improper support in from a pillow or a mattress". He added, "We need to learn to perform in a way consistent with low postural stress, one that adapts our environment to us, rather than us adapting to the environment. In other words, what we do repetitively, unless done with proper tools and in an ergonomic way causes the body to ultimately succumb to poor postures or unsatisfactory surroundings." What is good posture? Posture is the position in which you hold your body upright against gravity while standing, sitting or laying down. Good posture involves training the body to stand, walk, sit and lie in positions where the least strain is placed on supporting muscles and ligaments. When lying on your side in the fetal position, your body is in correct posture when your spine is straight and parallel to the floor, not hammocking into your mattress. When lying on your back, your body is in correct posture when your lumbar lordosis rests at its natural convex curvature, in proper alignment. Proper posture : 1. Keeps bones and joints in the correct alignment so that muscles are being used properly. 2. Helps decrease the abnormal wearing of joint surfaces. 3. Decreases the stress on the ligaments holding the joints of the spine together. 4. Prevents the spine from becoming fixed in abnormal positions. 5. Prevents fatigue because muscles are being used more efficiently, allowing the body to use less energy. 6. Prevents backache and muscular pain. Proper posture requirements: 1. Good muscle flexibility 2. Normal motion in the joints 3. Strong postural muscles 4. A balance of muscles on both sides of the spine 5. Awareness of your own posture, plus awareness of proper posture which leads to conscious correction. BACK SLEEPERS & SIDE SLEEPERS Most people do not sleep on their back for the majority of the night. Often, we lie down on our mattress and try to fall asleep on our back but our instincts and reflexes eventually tell our lower back to readjust to a different position in search of relief from poor posture. Most people sleep on their side or stomach for the majority of the night. The reason we do this is because mattresses are not able to properly support the lumbar lordosis curve in our lower back. Mattresses cannot defy gravity and upwardly support your spine's natural alignment. Actually, they tend to do the opposite, as the heaviest part of the human body (lower back/midsection) tends to sink in, causing the "hammock effect" on your spine. (Remember, body weight and mattress flexibility are factors in reducing your support. The only problem with sleeping on your side is that while your lumbar lordosis may remain in its proper curvature, your body weight still causes your spine to bend laterally, which can be just as harmful for your lower back, not to mention your quality of sleep. Furthermore, shoulder, hip and neck stress can be uncomfortable when sleeping on your side. Often we will turn on to our stomach when this happens. Sleeping on your stomach is just as detrimental to your lower back, not to mention your circulatory and cardiovascular and respiratory systems. Tossing and turning is similarly problematic for back sleepers as it is for side sleepers. SLEEP DEPRIVATION If you are not getting enough sleep and or not getting high quality sleep, how could you possibly be in good health? In fact, you may not be aware that chronic sleep deprivation significantly affects your health, ability, safety, and finances. There are many causes of sleep deprivation. The stresses of daily life may intrude upon our ability to sleep well, or perhaps we trade sleep for more work or play. Or it may be something as simple as not getting enough support out of your mattress set. A flat mattress has difficulty supporting a body with curves, especially at your midsection, where we carry most of our body weight. Because of this, your lower back may be suffering every night, and you may not even know about it. When a person is unconscious, during the sleep cycle, his or her body tends to move around substantially, thought to be caused from improper posture. Your mind will tell your body to move in a new position when the stress of sleeping in the current position has become too harmful. This is often referred to as tossing and turning. However, it is critically important to understand that sleep deprivation is often due to "unrecognized" sleep disorders. After a typical night's sleep, you may not feel restored and refreshed and be sleepy during the day, but be totally unaware that you are sleep-deprived or have a sleep disorder. You might think, "It’s just the stress of work or the kids," or you might have "always felt this way" and had no idea that you should feel differently. This lack of awareness compounds the consequences, because so many people remain undiagnosed for years. Consequences of Sleep Deprivation Short term: The good news for many of the disorders that cause sleep deprivation is that after risk assessment, education, and treatment, memory and cognitive deficits improve and the number of injuries decreases. Long term: The clinical consequences of untreated sleep disorders are extensive. They are associated with numerous, serious medical illnesses, including: The problem with all mattresses is that they "hammock" where more body weight is applied. It just so happens that our lower back is the heaviest region of our body and also the most crucial region for adequate and proper support during sleep. Since you will sleep for approximately one-third of your entire life, be cautious when making a decision to sleep on a new mattress, every night, for the next decade. If consumers were able to sleep on better quality, more properly supportive mattress sets, people would probably sleep better, although maybe not more. They could also have a healthier back, considering that a person's sleep posture affects their well-being for one third of their lives, especially on our musculoskeletal system. Our mothers didn't tell us to "stand up straight!" for no reason. Firm Mattresses Physicians commonly recommend firm mattresses because they tend to keep the body more supported, rather than "hammocking" or "sagging". However, hard mattresses are actually ineffective for proper sleep posture because our spine bends unnaturally into them. For example, imagine laying on a hard surface, such as the floor. If your posture is correct, there will be an arched space between your lower back and the floor. But, as soon as you relax your body, your spine will bend toward the floor as gravity causes your vertebrae to hinge, ultimately causing stress to the region. This unnatural posture can unhealthy to your anatomy over long periods of sleep, causing tremendous stress to vertebrae, disks, nerves and muscles in the lumbar region night after night. Furthermore, firm mattresses are not optimal for relieving pressure points as they may constrict blood flow and be significantly uncomfortable. Soft Mattresses It may feel like you are resting on a cloud in the mattress store, but how well are you going to sleep for the next 10 years? The fact is, trying a mattress out in a showroom is much different than having it as your primary source of sleep. Remember, the softer your mattress is, the less support it will provide to your lower back and the more rapidly it will wear out. In fact, it is considered "normal" by many mattress manufacturers if you find "body impressions" in your mattress within the first 30 days of use. This is because soft materials usually "bread down" more rapidly than firmer ones. Since your lower back region is applying the most weight to your mattress, it will not only be lacking support, but will also cause the most important part of your mattress to wear out more quickly than at the head or the foot. This uneven weight distribution is what commonly leads to the "hammock effect". Alternative Bedding Water and Air beds are similar because air and water actually disperse as weight is applied. Foam beds can be comfortable and supportive, but they can break down easily, overheat your body and still do not apply pressure upward to properly support and align your lumbar spine. The fact is, no mattress is capable of supporting the natural alignment of your spine. Insomnia : per Webster's dictionary is defined as a, "Prolonged and usually abnormal inability to obtain adequate sleep." One in three Americans, 90 million people, have trouble sleeping. The average adult is chronically sleepy, resulting in decreased work productivity and increased automobile accidents. The Mattress Investing in the right mattress can make a huge difference in sleeping ability! Because we spend so much time sleeping, our mattresses should be right for us. A mattress should conform to the curve in the low back. To check whether your mattress is too firm, too soft, or just right, lie on your bed for a couple of minutes, giving the mattress time to adjust to your body weight. Then test two areas - the one supporting your low back and the one under your neck. Slide your hand under your back. Your hand should just fit between your body and the bed. If you have extra space there, the mattress is too firm for you. If you cannot get your hand in that space, the mattress is too soft for you. You can repeat this test under your neck. Rotating the mattress every few months helps it wear evenly. However, because of body weight, the mattress is an individual matter. A mattress may pass the "hand test" for a 100-pound person yet be the wrong mattress for a 170-pound person. Some mattresses now better accommodate two sleepers, providing varied firmness for each half of the mattress. Information courtesy of Sleep Therapeutics |
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