Question to an expert: Is it true that you need to sleep on a hard

Posted onMay 29, 2021 in Medical news

We are used to searching online for ANSWERS TO MOST OF THE QUESTIONS THAT HAVE ASKED US . In the new series of materials, we ask just such questions: burning, unexpected or common – to professionals in various fields.

“Orthopedic” pillows, mattresses, sandals and insoles have flooded the market, special pharmacies have appeared for their sale, but it is not clear whether everyone needs them in such a way. Is it true that orthopedic insoles prevent spinal diseases – or do they just make shoes more comfortable? Should you sleep on a firm mattress or on a pillow with a notch so that your back and neck don’t hurt? We asked these questions to an expert.

Vera Kachurina

doctor – traumatologist-orthopedist of the Rassvet clinic

In Greek, ortos means “correct, direct”; everything related to orthopedics or called orthopedic is often perceived as correct, useful and even necessary for everyone. In fact, this is a rather narrow term that refers to the treatment of orthopedic diseases or deformities. It is difficult to imagine that products sold in the mass market without a doctor’s prescription can cure or correct deformation. In fact, “orthopedic” in relation to mattresses, pillows or shoes for healthy people is not quite the correct definition. Something like “ergonomic” would be much better.

There is a strong belief that sleeping on a soft one is harmful, and on a hard one – it is useful, that for the prevention of back pain, a special “orthopedic” mattress is absolutely necessary, and in case of scoliosis or injury, you should generally sleep on boards. All these are, of course, myths. If we turn to the history of the issue, it turns out that humanity has not slept on (and continues to sleep): on stoves, beds and chests, mats and thin futon mattresses, on high sloping beds with a million pillows at the head, on soft goose feather beds, cots and squeezed sofas, or even hammocks. And it cannot be argued that at the same time all the polls suffer from lack of sleep, back pain or have spinal deformities.

The rationale is that during sleep the most natural position of the spine should be maintained with minimal muscle tension. Sleeping on too soft, theoretically, can contribute to muscle overstrain due to the fact that the spine “collapses” and the muscles try to “hold” it. Sleeping on a hard surface leads to discomfort due to excessive pressure on the bony protrusions, especially in thin people. Thus, best of all is the golden mean, that is, a semi-hard mattress.

To support this theory, a randomized clinical trial was conducted in Europe comparing the effects of semi-hard and hard mattresses on lower back pain. It turned out that in patients who slept on semi-hard mattresses, the pain syndrome decreased. However, the study used a European hardness scale, which is not generally accepted, and only spring mattresses. The concept of “semi-rigid” can hardly be universal at all – if only because people differ from each other in weight.

There is little evidence that water beds or special foam mattresses that follow the physiological curves of the body can improve sleep quality compared to rigid mattresses, but the level of evidence is still poor. In general, if a person does not have diseases of the spine, and in the morning he gets up vigorous and rested, it means that the existing mattress performs its function. If there are any problems, it is advisable to discuss them with a doctor, and, perhaps, a properly selected semi-rigid mattress can improve the situation – and the criterion for success will be an improvement in subjective feelings.

The situation is similar with orthopedic pillows. No serious research has been carried out on this topic, there is no evidence base. Interestingly, the habit of putting something under your head (for example, a hand or a stand) is historically associated with the need to free the other ear – this helps to hear the danger signal. None of the clinical guidelines for the treatment of neck pain provide guidance on the use of special orthopedic pillows – so common sense and individual comfort considerations should be used.

Pillows with a bolster under the neck and a notch under the head seem to be a logical way to keep the cervical spine in line with the chest (although this is completely meaningless for those who sleep on their stomach or wake up, hugging a pillow, not in the position in which they lay down) … In orthopedic salons, they suggest measuring the distance from the shoulder to the ear with a centimeter and, focusing on this value, choose the height of the pillow – however, this approach, alas, does not always give the desired results in terms of sleep quality. Since there are no uniform recommendations, the pillow should be selected based on your own feelings – specifically, the one that allows you to get up in the morning with good health is suitable for you. Height, filler, stiffness, price and manufacturer do not matter. Only one thing can be said for sure: children under two years of age definitely do not need a pillow, because they have not yet formed physiological lordosis of the cervical spine.


Orthopedic insoles are a useful purchase not only for people with diseases of the musculoskeletal system, but also for completely healthy ones.

But orthopedic insoles are a very useful purchase not only for people with diseases of the musculoskeletal system, but also for those who are completely healthy. We all mainly walk on a hard surface (asphalt) and when choosing shoes we focus more on its appearance. As a result, the feet are forced to work in not the most favorable conditions, and a properly selected orthopedic insole helps to reduce the load on the feet and leg joints, correct the biomechanics of gait, compensate for the negative consequences of wearing the wrong shoes and prevent the development of problems in the future.

The use of soft, shock-absorbing insoles when playing sports reduces the likelihood of injury. Of course, if a person already has a deformity of the feet, one should not count on miraculous healing. The task of orthopedic insoles is not to correct the structure, but to improve the function. There are studies that support the effectiveness of insoles for pain in the feet. True, such an effect can hardly be obtained from gel insoles sold in underground passages, or even ready-made insoles made according to universal templates from orthopedic salons.

The insoles must be made individually after examination by an orthopedic surgeon or podiatrist (foot health specialist). First of all, it should be comfortable with insoles. Pain, discomfort, calluses when wearing an insole indicates that it has been fitted or made incorrectly. Frame, rigid insoles are a thing of the past and, according to modern orthopedic concepts, are not effective; now they are made from softer materials like polyurethane, which in the process of use finally adapt to the shape of the foot.

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