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The crux with the lower back, part 2 - - - In the first part of my article “The crux with the lower back” I described the common sources and consequences of chronic spinal column pain as well as therapeutic approaches to specifically treat this problem. In addition to obligatory exercise therapy, attention should also be paid to regenerative aspects in the treatment of back problems, since it is imperative that stress on the axial skeleton is well balanced. Based on the physiological principle of sleep, the reduction of strain on and regeneration of the active and passive locomotor apparatus basically occurs during the night. Therefore, I wish to outline the influence of individual sleeping habits in this second article and demonstrate how you can actually do something for your back “while sleeping” by taking a few aspects into consideration. Many of my “back patients” often tell me during their first visit that they suffer from back pain early in the morning – and quite often while still lying in bed. This should not be the case! If sleep intensifies the pain instead of relieving it, it is important to get to the root of the cause. This is the reason why I always ask my patients the following three questions first: 1. Which sleeping position do you most commonly use? 2. What is the size of your pillow, and what is it made of? 3. How hard is your mattress? The aspects behind these questions are: The sleeping position - - your front forces the lumbar spine into a harmful hollow back position – already described in the first part of this article – that is commonly referred to as hyperlordosis. This is even more profound if the sleeper has positioned a pillow underneath his/her head and upper body. As a result, sleeping on your front puts more pressure on your spine, causing increased pain. The pillow Guest article In contrast to pillows in other countries, a “German pillow” is usually 80x80 cm. This size of pillow is, physiologically speaking, not only inappropriate, but also bad for your back. In a standard two-metre long bed, a pillow of this size only leaves 120 cm of space for the entire torso, measured from the shoulder girdle to the feet. With a few exceptions, this is insufficient space for an averaged sized person. What is the result? Unless you spend the night in the socalled “foetus position”, you have to – in order to have your shoulders on the mattress and not on the pillow – either fold the pillow in half or roll it up into a sort of parcel. However, if the pillow unfolds during the night, you will be forced to sleep in an uncomfortable and non-physiological position Straight spine due to an ergonomic pillow, source: www.tempur.de. with parts of your upper body resting on the pillow. Subsequently, the pillow no longer achieves its main purpose of supporting the natural curve in the spine by ensuring that your head does not drop past your shoulders while you are asleep. The only sleeping positions that are physiologically feasible The mattress are the side and – with restrictions – the back position. Sleep- Why not ask yourself a few simple questions: “How much ing on your front – something patients often tell me they do – time does it usually take to choose a new car? How much causes you to turn your head in order to breathe. This turning money are you prepared to spend on a new car? How much of the head puts your spine out of alignment, “twisting” your time will you actually spend each day in this new vehicle entire spine right down to your pelvis. Moreover, sleeping on 12 compared to the time you spend in bed?”
Allow me to spell it out for you: statistically speaking, we spend a third of our lives in bed. But we are quite prepared to spend several thousand euros every few years on a car just for special features, such as a metallic finish or aluminium wheel rims. In comparison, how much time and money do we invest when choosing a new mattress on which we will spend between five and eight hours each night? Do you, as a possible sufferer of back pain, really believe that a quick trip to your local discount mattress store, listening to all the spin from the salesperson and having a quick test is good enough? I know this comparison is a little simplistic, but it does illustrate important points. And although it is recommended to replace a mattress about every eight years, some mattresses remain in use for up to 20 years. Yet the purchase of a suitable mattress could be the key to alleviating back pain! So the next question is: What can you do? What do I recommend if you can relate to one of the points above? Your sleeping position Try sleeping in a back-friendly position even if it is initially difficult and unusual. From a physiological point of view, the side position is the most favourable. It guarantees easy breathing, a natural alignment of the spine and by slightly bending the legs even enables a “reduction of hyperlordosis”, taking pressure off the lumbar spine. The back position, as the second best sleeping position, does not offer this opportunity. Furthermore, if you are prone to snoring, beware of sleeping on your back, as it can decrease the supply of oxygen to the body and stop your partner from getting a good night’s rest. As previously explained, sleeping on your front is not recommendable at all. Your pillow Use a smaller rectangular pillow, preferably one which is 40x80 cm. A viscoelastic foam pillow is highly recommendable. However, it does not need to have an ergonomic design. Some people find an anatomically shaped neck rest better, while others prefer a traditional “box shape”. Seek the advice of a specialist retailer, as it is important that your pillow is suited to your mattress. Allow plenty of time to test and compare different pillows and mattresses. It will also take a little time before you forget your old “favourite” pillow and get used to the new one. The first few nights may feel strange, but do not despair. You will soon become accustomed to it! Humans are creatures of habit, and, as the old saying goes, “good things take time”. Your mattress And last but not least, a mattress is the foundation for a relaxing and healthy night’s sleep. On the one hand it has to be soft enough to avoid pressure points developing. And on the other hand it must support your body in a relaxing sleeping position. I believe that two types of mattress currently satisfy these 13 demands. They are cold foam mattresses made of viscoelastic material and water beds. I prefer the latter version, as they not only mould naturally to the body’s contours providing excellent support, but also provide many other benefits. They are heated, allowing the temperature to be set to individual requirements, and this warmth promotes relaxation and blood flow in tired muscles. A water bed is also better than a traditional mattress in terms of hygiene. People who are allergic to house dust mites profit greatly from the simple way the top cover can be cleaned in a washing machine, thus preventing dust mite infestation. And, not surprisingly, the actual core of the mattress, in comparison to a traditional mattress, cannot become home to these “unwanted guests”. And despite all the tales you may have heard, you will not get seasick. A specialist retailer will also be able to reassure you that the weight of the bed will not damage your house or flat by causing the floor to sag. It is still difficult to assess the benefits of air beds, which are not only popular in clinical environments nowadays. But one thing is sure: you will notice the difference. A mattress that provides you with a relaxing sleeping position helps to prevent “tossing and turning” at night, while allowing you to fall into a deeper sleep and to wake up with more energy. The following is important when buying the “right” mattress: Pressure relief mattress, source: www.tempur.de. seek the qualified advice of a specialist retailer and take plenty of time to test and compare different mattresses. Obviously, I have only been able to give you a brief insight into the complex problem of back pain in my two articles “The crux with the lower back”. More is unfortunately not possible on these few pages. However, I have hopefully been able to “shed a little light” on this subject, to dispel some old myths and to provide you with some helpful tips on how to find a cure to your back problems. Until next time ... stay healthy … and keep moving! Dr Henning Jäschke, M.D. Kindly supported by:
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