Hard or Soft bed?
There is nothing like a comfy bed when you are not feeling 100% especially if your back is painful but as most back sufferers know the last place you want to be is lying down. Getting horizontal for even a short period of time is often excruciating for those with certain types of back conditions and waking up in the morning and trying to move is positively dreadful.
For some the natural conclusion to be drawn by the early morning nightmare is that the bed needs replacing but with what? By common assent one should lie on a hard bed if you suffer with your back. Preferably an old door, so the story goes. And there one should stay until mended. But is this true?
Hard beds often aggravate bad backs and although the reason is not absolutely clear it would seem that the arch formed by the lumbar spine when lying on your back seems to be accentuated by a hard surface. When that happens the back stiffens and becomes painful. There is probably a role for the fact that intervertebral discs ( IVD) swell over night acting like sponges as they absorb local tissue fluid complete with its nutrients ( the IVD has very little blood supply.) Whatever the reason the harder the bed the worse the stiffness and pain in the morning in most cases.
I often advise patients who have this problem to try lying on a folded quilt as a bottom sheet for a few nights, or if they have a softer bed in the house try that. They can then tell if the bed is making a big difference to their back condition. Many are under the illusion that their beds are too soft!
Having said all that, I think that beds are rarely the whole cause of pain in the back; they may contribute to the discomfort but spending £1000 on a new bed might get you a great lay but will rarely completely rid you of all your morning aches. If you feel like getting a new bed, experiment with the beds and quilts in your house to alter the hardness or otherwise of the surface you lie on so that you can be sure when you order that new bed that it’s going to be comfortable.
The General Chiropractic Council
It's of limited interest to those outside the profession but for those inside a real sea change occurred last week when the General Chiropractic Council finally put to bed an old chiropractic tenant that manipulation on a regular basis improves health. This defunct idea has been called the subluxation theory.
Most chiropractors who have considered the evidence have realized this for decades however there are chiropractors who to this day promulgate the subluxation theory and practice accordingly.
Still the shift that this most official of chiropractic bodies has described is welcome and cannot be overstated. Chiropractic should involve itself in the practice of musculoskeletal (MSK) medicine, expanding the evidence base as we are well placed with our daily exposure to the primary care presentation of back pain and other MSK conditions to learn more about what helps and what doesn’t.
Most sensible chiropractors junked the so called “subluxation theory” years ago – it’s good to see it in black and white from the GCC.
I often tell some of my more anxious back pain patients that "backs get better". And for the most part this is perfectly true; of course there are people for whom back pain will be ever present and for these people we can only have the greatest sympathy. Long term pain of any kind is a truly awful thing.
Even so, for many, backs do get better and this little nugget of information is often a complete surprise. Back pain is so incredibly common that should I grab the first 100 adults emerging from my local Tescos, 20 of them would be suffering low back pain at that very moment. How many of them would be sneezing with a common cold? It is estimated that over 60% of us have at least one major episode of back pain at some stage during our lives. If we look at it in the light of all this suffering it is self evident that most back trouble does resolve or the majority would be bent double for most of the time.
But perhaps we should be a little more cautious. Patients do not continue to consult their GP, Chiropractor, Physio etc if they feel that the problem has not resolved despite treatment. A study for the BMJ by Croft et al in 1998 about the outcome of GP management for low back pain concluded that,
"The results are consistent with the interpretation that 90% of patients with low back pain in primary care will have stopped consulting with symptoms within three months. However most will still be experiencing low back pain and related disability one year after consultation."
Many appear to just simply put up with the discomfort and alter their lives to accommodate it, disillusioned with the care they have received and not confident to seek any more until perhaps their problems are intractable and they become a self fulfilling prophesy.
Maybe then it is not that backs get better - perhaps it is patients who simply stay away.
Keith Walker is a chiropractor and manual therapist . He provides evidenced based care for his patients in Plymouth, Devon.
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