Q&A with Richard Christianson, Musculoskeletal Physiotherapist

An expert's advice on beds and back care.

Finding the right mattress that offers all the comfort and care for your body and back while sleeping is important and daunting!

We sat down with Richard Christianson, Musculoskeletal Physiotherapist with the Australian Physiotherapy Association to get his thoughts and advice on beds and back care.

Q. You probably get asked this all the time, but in your own words, what is the role of a physiotherapist and how does it differ from a chiropractor and an osteopath?

The role of physiotherapy is, as its namesake suggests, a therapy. A physiotherapist will analyse movement patterns, behaviours, along with strength and length imbalances to problem solve ways to improve an individual's function and help them manage their pain. All three professions are university acquired degrees in the allied health field. They all attempt to restore functional movement and to assist in pain management.

However, the way of obtaining these goals may differ. Physiotherapists are trained in a broader variety of therapeutic treatment techniques to assist the individual to get back to a self-sustaining level. Physiotherapists may use a combination of interventions including manual 'hands on' therapy, exercise based therapy, cognitive behaviour therapy and retraining of biomechanical movement patterns. Chiropractic and osteopathic interventions will predominantly consist of 'hands on' techniques with a reliance on regular scheduled maintenance sessions. Physiotherapy is more aligned to a medical model using evidence based practices, which makes them a GPs most recommended allied health professional.

Q. What advice would you give the general population in regards to caring for their back?

Some of the more common modifiable risk factors for lower back pain include sedentary lifestyle, overweight, stress and smoking. So when it comes to back care, maintaining a general level of strength and fitness is important. Identifying and changing negative lifestyles and habits both at work and at home will also go a long way in reducing the risk of back pain.

Q. What advice would you give someone who is looking for a mattress? What are some of the key things to look for?  

My advice is to test the mattress and make sure you test it in your preferred sleeping position (stomach, side or back). Spend time lying on it to get the feel of it. You want enough firmness to support your body but with it still to offer flexibility to the contours of your body. There is a difference between firm support and firm feel. You want firm support with a comfortable feel and comfort will be determined by your personal preference. There is no strong evidence to date that suggests one mattress is better for your back than another.

Q. Does age impact the different types of mattresses that people need? If so, how? 

Yes.

There is some research that suggests higher-specification foam mattresses (high density or visco-elastic foam) are less likely to cause pressure ulcers in the elderly population as they distribute the surface pressure more evenly.

Q. Should you get your health care professionals help/advice in choosing the right sort of mattress to suit their body? Why or why not? 

When it comes to choosing a mattress, this will come down to self evaluation of comfort. Comfort is a personal choice, no medical practitioner can relate to your own preference. However, a health professional may be able to assist in deducing whether or not your bed is a contributing factor to your pain. Your physiotherapist will help determine if your injury is being affected by your current mattress, or is it more to do with your particular sleeping position, or is it a coincidence and the pain whilst in bed or upon waking the next day is actually due to the stress and strains of the prior day.

Q. If a person is recovering from injury or accident what should they be looking for in a mattress to care for their back? 

Firstly, get assessed by your health professional and determined whether or not your current mattress is a contributing factor to your pain. As I am unaware of any reliable research to date of certain mattresses being better for your back, from my clinical experience alone, clients with back pain regularly state they prefer to sleep on a firmer supportive mattress. The more supportive a mattress is, the less effort needed to manoeuvre around on the bed. Most back pain is elicited when you attempt to reposition in bed or get out of bed. Once again remember, there is a difference between firm feel and firm support. You want firm support with a comfortable feel and comfort will be determined by your personal preference.

Q. What is the benefit of a Physiotherapy industry-endorsed mattress? What is the process of endorsement? How much input really goes into it?

In the physiotherapy industry, the general process of endorsement will begin with an expression of interest from a producer or manufacturer. An experienced practitioner in the clinical field will review the background of the product, gathering information about the product from the producer or manufacturer, along with performing a literature review of current research to get an understanding of the evidence behind applicable theories to do with the product. Then the product will be tested for practicality and usability within a physiotherapy clinical environment. The benefit of a physiotherapy industry endorsed mattress is the consumer will know that the product has undergone a thorough review process by a health professional with their interest at mind.

Q. Finally, what are 3 important things that you can do to help your body recover from injury or accident? 

1. Education. Seek answers and explanation for why you are feeling pain and what needs to be done to assist in a full recovery. Identify your risk factors and improve your self – efficacy.  

2. Stay active. Perform your rehabilitation exercise within your capacity. 

3. Sleep. The body needs sufficient sleep to assist in the repair process for both mind and body. Good sleep hygiene is considered being able to fall asleep within 20-30 minutes of going to bed and being able to stay asleep for the first five hours.