With back pain, getting out of bed can help

If you have back pain, bed rest can be useful, especially if you are in severe pain while sitting and standing. But it's best to limit bed rest during the day to a few hours at a time, for no more than a couple of days. That's because too much time in bed can do more harm than good.

If you need to be horizontal, lie down on a bed or sofa, in any comfortable position. To ease the strain on your back, try putting pillows under your head and between your knees when lying on your side, under your knees when lying on your back, or under your hips when lying on your stomach. These positions reduce the forces that sitting or standing impose on the back — especially on the disks, ligaments, and muscles.

Bed rest is no longer the go-to treatment for moderate back strain. Although it does minimize stress on the lower spine, it can also create other problems. Too much time in bed weakens muscles, including those needed to support the back. Some people develop gastrointestinal problems, such as constipation. Inactivity also boosts the chances of developing a blood clot in the veins of your pelvis and legs. This can hurt, and damage the affected vein. If a piece of the clot breaks away, it can lodge in the lungs. This condition, called pulmonary embolism, can be deadly.

But there's another good reason to limit bed rest: well-designed research trials show that an early return to physical activity or work — with some restrictions or light duty, if necessary — is preferable to bed rest and staying home from work for an extended period.

What type of mattress is best for people with low back pain?

If you are like most people, you spend roughly one-third of your life in bed. So it's worth taking a few minutes to think about whether your mattress is giving you, and your back, the support you need.

There hasn't been a great deal of research on this topic, yet a few studies offer some guidance. In the past, doctors often recommended very firm mattresses. But in one study, in which 313 people slept on a medium-firm or firm mattress for three months, those with the medium-firm mattresses reported less pain when lying in bed as well as less pain-related disability compared with those with the firm mattresses. Another report, based on a waiting-room survey of 268 patients with low back pain, found that people who slept on orthopedic (very firm) mattresses had the poorest sleep quality, while there was no difference in sleep quality between medium and firm mattresses.

While a softer mattress that conforms to your body's natural curves may help your joints align favorably, you might also sink in so deeply that your joints twist and become painful during the night.

One way to find your dream mattress is to try out different ones. If you spend a night at a hotel or in someone else's house, make note of how you feel after sleeping on the "new" bed. You can also try putting a plywood board under your current mattress (which will dampen any movement from bedsprings) or sleep for a few nights with your mattress on the floor (which simulates the feeling of a firm bed).

For more on healing your aching back, buy Low Back Pain by Harvard Medical School.