How to Determine if Your Pillow/Mattress is Right for You

Last Saturday night I celebrated 5280 Restaurant Week for the first time with dear friends. For those who live outside of the Denver area, Restaurant Week is a time of year when many local restaurants offer a special deal on a prearranged menu ($52.80/couple or $26.40/individual). It’s a great way to try out some of the more high end ($$+ in Zagat) places around town for a slightly more affordable price. Having lived here for 7.5 years, I figured it was about time I fork out the dough (pun intended) and join the masses. So Saturday night found my friends and I at Rodizio Grill, a Brazilian steakhouse that is now in my top 3 favorite places in Denver. Without getting into too much detail (because the restaurant itself has nothing to do with this post), let me just say that my experience involved everything I love about Thanksgiving dinner (which is my favorite meal of the year)–quality time with loved ones, laughter and story-telling, copious amounts of delicious food without end, plus not having to clean dishes after the meal!

How does Brazilian food relate to pillows and mattresses–except that we all looked forward to sleeping soundly with full bellies afterward? During dinner I was talking with two of my friends (Amanda and Zach) about different types of pillows. Since I’ve answered this question for many patients, I thought it’d be a good post for you in case you’ve wondered the same thing.

Question: What is the best mattress/pillow?
Answer: One that supports the spine and head.
Questions: What the heck does that mean?
Answer: read on…

How to Find Out if You Have an Appropriate Pillow

Lie on your side and have a friend/family member look at your spine (imagine a line down the middle like in the picture below). A good mattress/pillow combination should put your spine relatively horizontal or perpendicular to the floor.
Take a look then at the head and neck. If the crown of your head is higher than your spine, chances are your pillow is too full.

If the crown of your head is lower than your spine, your pillow is too flat.

You can also roll up a towel and stick it in the bottom of your pillowcase for added support of the lower neck where it meets the upper back. (Putting the towel inside the pillowcase helps it to stay in place if you’re the type of sleeper that rolls around a lot at night.)



You can also apply these same techniques if you’re a back sleeper–just have your friend/family member draw an imaginary line from your ears down to your hips. Ideally, that line should go through the middle of your shoulders too.

If you’ve adjusted the pillow to support the head and neck but your spine still looks really wavy, maybe it’s time to change your mattress. When you go mattress shopping, lie on your side and have your friend/family member assess your spine and head in the same way. Every person is going to have a different comfort level with soft vs firm mattresses. Just remember these two guidelines: “Does it support my spine?” and “Does it feel comfortable?”. It may sound general and cliche but the mattress and pillow that are correct for your body are going to allow you to fully relax as you sleep and wake with significantly less pain.

PS–If you and your friend/family member can’t tell if your head, neck and back are supported correctly, take a picture of you lying in bed and bring it with you to your next physical therapy appointment.

Thanks to my ever willing PT student/intern for “volunteering” to model for my pictures today.

Physical Therapy Mythbusters

One of my geeky indulgences is the show Mythbusters. In case you haven’t seen it, Jamie and Adam (along with the help of Kari, Grant, and Tory) take common–and not so common–myths, urban legends, and wives tales and put them to the test to see if it could actually happen. It’s a great way to learn science…and see all sorts of inanimate objects blow up!

Today, in honor of this show, we’re going to address some common myths that get voiced by patients in the physical therapy clinic.

1) Running is the best way to get in shape/lose weight
BUSTED–There is no “best way” that can be applied to all people. For most people, eating 2000-2500 calories/day and engaging in some form of aerobic activity (i.e. something that gets and keeps the heart rate elevated) for at least 30 minutes, 4-5x/week is an effective way to lose weight. Examples of aerobic activity can be as varied as your imagination–water aerobics, dance class, power walking, any number of Wii sporting games, and much more! Be sure to check with your MD or local physical therapist, however, before beginning a new dietary and/or exercise routine to make sure you choose a plan that’s specific to your body’s needs.

2) Situps and crunches strengthen your abs and back and are a good way to improve your core strength/stability
BUSTED–I wrote about this in a previous post and I encourage you to read it. In the mean time, there are much safer and more effective ways to improve core stability. (I wrote a post on that too!)

3) No pain, no gain
PLAUSIBLE–Some discomfort is evidence of growth (ex: the soreness you feel the day after a gym workout or a day of skiing) and is beneficial. However, some kinds of pain are evidence of trauma that needs to be addressed in order to avoid further breakdown. I talked about some of the latter in last week’s post.

4) A physical therapist’s job is to cause you pain/P.T. stands for “pain and torture”
CONFIRMED-ISH–I feel like I can’t totally deny these statements because some amount of discomfort while going through physical therapy treatment is warranted. But I need to clarify that the purpose behind the “torture” is always to improve motion and/or strength in the body (contrary to some belief, we are not sadists who take pleasure in your pain). Plus, the reason why you as patients feel pain in the first place is because the body is letting you know that it’s no longer operating as it was created to work. Yes, having a tight muscle massaged or stretched is uncomfortable. Yes, your muscles will be sore after your exercises. Yes, tissue can be painful to the touch after an injury. No, PTs are not creating new injuries as they treat you–regardless of how it feels!

 

These are just some of the sayings I hear at work and from friends/family. I’ll try to address more in later posts. In the mean time, what are some you’ve heard or wondered about?

(Mythbusters picture from http://upload.wikimedia.org/wikipedia/en/thumb/c/cf/Mythbusters_title_screen.jpg/230px-Mythbusters_title_screen.jpg)

Everybody Hurts

REM’s “Everybody Hurts” is one of those timeless songs from my childhood. Listening to it playing on my computer always evokes a feeling of emotional ache lined with hope. (cue waving lighters and cell phones) To take nothing away from such an iconic band of the 1980s and 90s, I’d like to reinterpret their message today and apply it to physical therapy and how we therapists understand and treat pain. (After all, this is a blog written by a physical therapist on behalf of her clinic.) So I ask that you extend me grace for the metaphorical leap I’m about to take. (Commence jumping now…)

We’ve all experienced physical pain of some sort–from a bruise or a stubbed toe all the way up to a rotator cuff tendon tear or herniated disc. At times it lasts for a couple of minutes, but some people struggle with pain all day, every day. Sometimes we can identify the cause, but other times the reason for our pain may seem nebulous and unclear. This confusion can add to stress/anxiety/depression/feelings of hopelessness that so often coincide pain, especially chronic pain.  But what exactly is “pain” and why does it occur? Whole week-long seminars and advanced degrees are based on understanding and explaining it, but I’m going to try to focus on pain as it pertains to my job.

First, a little physiology lesson: The nervous system is basically the roadway for the body; all communication between body parts happens because of the signals transmitted via nerves. A specific kind of signal carried from nerves in the body to the brain is interpreted as pain.  For the sake of time and hopefully lessening confusion, I want to divide pain into two basic categories: mechanical and chemical.

Mechanical
Let me explain this with an example: Grab your left ring finger with your right hand and slowly bend it backwards. At some point you’ll start to feel some discomfort and then pain. Continue to hold it in this spot and the pain will continue (although it might change in location or quality). Push the finger back further and the pain will intensify. Release the finger and as it returns to its normal resting position the pain will decrease and eventually disappear. Mechanical forces cause pain when they deliver a load or strain to a tissue beyond what that tissue can typically withstand. If the load approaches but doesn’t exceed the tissue’s capability for recovery, while there is pain, there is no tissue damage (like what happened when you bent your finger backward). If the load is excessive, however, the tissue is traumatized (ex: bruise, strain, sprain, tear, dislocation, etc)–which leads to our next type of pain…

Chemical
Cell or tissue damage initiates the inflammatory response and also results in the release of specific chemical irritants, which continue to accumulate in the traumatized area. When the concentration of these chemicals reaches a specific level they “irritate” the nerve receptors, which trigger the release of that specific signal our brain interprets as pain. (Side note: Certain inflammatory and infectious diseases and some chronic degenerative conditions can also produce chemical pain, but for our purposes, let’s just say that the majority of chemical pain is caused by trauma or damage to the tissue.) The buildup of these chemical substances over time can explain why we may experience a trauma (ex: a car accident) and might not feel pain until a day or two later.

So what’s the connection between physical therapy, pain and REM?  Whether you’re struggling with acute pain from a recent injury or chronic pain from something that happened a while ago, I would encourage you to make an appointment with your local physical therapist. Physical therapists are trained to evaluate and diagnose mechanical pain and the chemical pain that comes as a result. We will develop a treatment plan that includes not only long-term benefits but the management of your current pain. In the dark cloud that is physical pain lies a hope-filled silver lining. As Bill Berry, the drummer for REM, wrote, “Don’t throw your hand/If you feel like you’re alone/No, no, no, you are not alone.”

[Disclaimer: Pain is a very complicated subject and today I attempted to simplify it according to the majority of patients I treat. This post is in no way all inclusive in its description, nor is it meant to replace a visit with an MD, DO, or PT.]