Transcript
CHARLIE: You got the right mattress, but are you using it correctly? Welcome back to Spine Cast with Dr. Sean Riley from Tulsa Spine and Rehab. Dr. Riley, earlier we were talking about the right kind of mattress, but I think it’s almost as important to having the right mattress is to how you sleep on it. What’s your stand on that?
SEAN: Absolutely. I’ve mentioned this in the past, that what type of mattress should I have is probably one of the most common questions that I get here in the clinic at Tulsa Spine and Rehab. The second follow-up question to that is, what sleeping position do you recommend? That is so, so very important that goes along with the mattress, because if we have the proper mattress and maybe we’re sleeping incorrectly, it still is gonna likely contribute to some problems. Previously mentioned, I said that the way we feel in the morning is typically a good indication of what’s going on that night. If throughout the day we feel pretty good, before we get in bed we feel relatively well, then the next morning we wake up with significant low back pain, I typically associate that to something going on with the sleep environment. Like we mentioned, what type of mattress they have, and then secondary to that, what type of sleeping position you’re in. Neutral is what I like to talk to patients about. I want to get patients in a neutral position. Many times they give me the deer in headlights look.
What is a neutral sleep position?
CHARLIE: A neutral position. What do you mean by that, Dr. Riley?
SEAN: Well, if you were to stand in front of a mirror, and I suggest that you actually stand in front of a mirror. Get someone to give you feedback because a lot of us subconsciously develop a new norm posturally. What I say by that is that we get slumped just from sitting all day long, and we feel like we’re in a pretty good position with maybe our shoulders back and our head held high, and a good lumbar support in our low back, but yet when we look in the mirror, have someone give us some feedback, we’re like, “Oh lord, I’m slumped over. My head’s maybe tilted to one side.” So, get in front of a mirror and just, your head should be in a neutral position. It should be between your shoulders. I don’t want you looking up or looking down. Your shoulders should be relaxed in a comfortable position. We have three different curves throughout our spine, a curve in your neck, mid, and low back. Those curves should work in conjunction as one. If you were to lie down on your back, I want you in that, somewhat in that position. So, I don’t want your head way up into flexion or looking up or way back into extension. So, I can’t tell patients what types of pillows to buy. I’ve never been a big fan of recommending these super expensive circular ergonomic pillows.
CHARLIE: Why is that?
SEAN: Well because I think they’re very expensive, first off. And everyone responds to something a little bit differently related to a pillow, just like a mattress. I get more concerned on the position their neck’s in when they’re sleeping. Back to if the patient’s lying on their back, I want their head in a relatively neutral position. I may be able to achieve that with half a dozen different types of pillows. I really preach positioning, and not necessarily what type. There are some suggestions that I like to make on certain types of brands and so forth, but I’ve gotten away from recommending because people spend a ton of money on pillows, $100, $150 cervical pillows, they’re very, very expensive. So, we want to maintain that relatively neutral position in your neck. If you do sleep on your back, we want … You could use something to go underneath your knees to provide a little decreased pressure off of the low back, and just focus primarily on keeping your neck in a neutral position.
Should I sleep with a pillow under my knees?
CHARLIE: So, you’re saying sleeping on your back, you should not only consider a pillow for your head, but one under your knees?
SEAN: Absolutely. Getting your knees bent just a little bit has a tendency to reduce pressure on the low back. I’m not suggesting that the legs should be elevated or high, but just maybe some type of a bolster or another type of a pillow, just to get under your knees to prevent a little pressure on the low back. On your back, the first thing I talk to patients about. Then next is on your side. Once again, if you are looking in a mirror and then you were to lie down on your right side with your right ear on the pillow, we want that head maintained in a neutral position. I don’t want the ear cocked to the right shoulder or hyper-flexed to the left side. So, once again, finding, playing with those pillows a little bit to get you in a relatively neutral position with your head. I don’t like to see patients … Could you imagine walking around with your head leaning towards the side all day long for six hours?
CHARLIE: Probably not.
SEAN: Right. It’s gonna have … you’re gonna put stress and pressure on certain joints, discs potentially, muscles and so forth. It creates inflammation, tightness, pain. The other thing I like to mention when patients are on their side is to have their knees bent. I talked about when you’re on your back, to have those knees bent a little bit, pillow underneath. That reduces pressure on your low back. The same thing goes for on your side. If you can get your knees bent a little bit, it will once again take pressure off the low back. I’ve even talked to patients about putting a small pillow between their knees. That should make them a little bit more comfortable as well.
CHARLIE: It takes a little stress off your pelvis in the other way then, right? It opens up your knees a little bit.
SEAN: Absolutely. So, sleeping on your back or your side are the recommendations that I make. At all costs, are you ready for it?
CHARLIE: I’m guessing you’re gonna tell me sleeping on the tummy’s a no-no.
Is it bad to sleep on your stomach?
SEAN: One of the worst things that we can do. Obviously, when we sleep on our belly, you’re gonna have to have your head rotated to the side. You could only imagine having your head rotated to the side for six hours, like I mentioned earlier. But not only rotated, but you have pressure on the other side of the head. It just increases, like I said, pressure irritation on certain joints. In addition to that, what happens is our pelvis or your lower body can sink down into that mattress, and it increases extension and pressure on the low back. So, not only is it potentially dangerous for the neck, it also has the tendency to create a lot of increased pain and dysfunction in the low back as well. So, it’s challenging, Charlie, because obviously when we get in bed at night, we want to go to sleep. So, I talk to patients about just being aware and making somewhat of an effort moving forward. Habits are very difficult to break obviously. If you feel yourself, you wake up and you’re on your belly, just try to get to your back or your side.
CHARLIE: That is a lesson that I learned as well from you. And you’re right, the habit, it was a very difficult habit to break because you just get used to doing it a certain way, but sleeping on your back just seems a natural thing. It’s just the way they teach you to put babies to bed, so why wouldn’t you continue doing it as an adult?
SEAN: Absolutely. Great example, Charlie.
CHARLIE: All right. The bottom line, sleep on your back. Keep your neck in a neutral position. Consider some pillows under your knee to take stress off that, and if you’re gonna sleep on your side, maybe put a little bend to your knee. Consider a small pillow between your knees. And again, keep your neck in a neutral position. That sums it up.
SEAN: Absolutely. Back, side, stay off your belly.
CHARLIE: There you go. You can learn even more about other topics that maybe you’re getting some pains from. Learn at TulsaSpineAndRehab.com under our Spine Cast tab on the website. You’ll find more of these interviews with Dr. Riley on there. Dr. Riley, thanks again for joining us.
SEAN: Thanks, Charlie.
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