A good night’s sleep is an essential part of a healthy lifestyle; however, an estimated 70 million Americans complain of sleeplessness. This October, during National Chiropractic Month, the American Chiropractic Association (ACA) is offering advice to help consumers select comfortable mattresses and pillows that can help limit unnecessary back and neck pain.

“Americans spend one-third of their lives sleeping, so it makes sense to invest in a sleep set that can improve your comfort and overall health,” says Scott Bautch, DC, DACBOH, spokesperson for the American Chiropractic Association. “Many people don’t realize the reason for their neck or back pain is literally right underneath them—it’s their mattress and pillow.”

A 2006 study published in the Journal of Chiropractic Medicine showed that sleeping on a new mattress can significantly reduce stiffness and back pain.  Researchers found that study participants reported immediate and sustained benefits after sleeping on a new mattress. This was especially true of participants who entered the study with back pain complaints, as they reported a 63 percent improvement in back discomfort with a new mattress.

When it comes time to purchase a new mattress, the ACA recommends the following:

Shop for Support
Look for a mattress that provides uniform support from head to toe; if there are gaps between your body and the mattress (such as at the waist), you’re not getting the full support you need.  Mattresses can be too firm; pay close attention to uncomfortable pressure on prominent body features such as the shoulders, hips and low back.

Shop for Comfort
When mattress shopping, give each option a good trial run before you buy; lie down on a mattress for a minimum of five to 10 minutes to get a good idea of its comfort level. If you cannot find a comfortable position, you probably have the wrong mattress.

Shop for Size
Does the bed provide enough room for both you -- and your sleeping partner if you have one -- to stretch and roll over?  The ideal mattress will also minimize the transfer of movement from one sleeping partner to the other, which means one person shouldn’t feel motion as the other leaves the bed.

Generally, a mattress should be replaced every 5 to 8 years to ensure proper support and comfort. Be aware that life’s changes can signal the need for a new mattress as well. For example, people who have lost or gained a considerable amount of weight, those who have a medical condition which has changed the way they sleep, or even those who’ve changed partners may need to consider a new mattress.

Pillows important, too
After investing in a quality mattress, don’t forget to choose an equally supportive pillow, advises ACA spokesperson Steven Conway, DC, DACBOH, Esq.  “People will spend thousands of dollars on a mattress and then skimp on a pillow that doesn’t support their head and neck properly,” he observes.

When selecting a new pillow, ACA recommends selecting one with ergonomically-designed features, which will enhance comfort and limit pain.  Look for pillows that are:

• Designed to keep the spine in natural alignment. When lying on your side, your head and neck should remain level with your mid and lower spine. When lying on your back, your head and neck should remain level with your upper back and spine.  Avoid pillows that are so thick or thin that they angle your head and neck away from your body.
• Designed to support different sleep positions, including side sleeper or back sleeper. (It’s best never to sleep on your stomach, as it’s the most back unfriendly sleeping position.)
• Hypoallergenic.

There is no such thing as a universal fit when it comes to pillows, Dr. Conway notes. “Find a pillow that is consistent with the shape and size of your body. If you find yourself sleeping on your side with one hand propped under your pillow, that’s a clue that you’re not getting the support you need from that pillow,” he explains.

Does it hurt when you chew, open wide to yawn or use your jaws? Do you have pain or soreness in front of the ear, in the jaw muscle, cheek, the teeth or the temples? Do you have pain or soreness in your teeth? Do your jaws make noises loud enough to bother you or others? Do you find it difficult to open your mouth wide? Does your jaw ever get stuck/locked as you open it?

If you answered “yes” to some of these questions, you may have a temporomandibular joint disorder, or TMD. TMD is a group of conditions, often painful, that affect the jaw joint.

Signs may include:

• Radiating pain in the face, neck, or shoulders;
• Limited movement or locking of the jaw;
• Painful clicking or grating when opening or closing the mouth;
• A significant change in the way the upper and lower teeth fit together;
• Headaches, earaches, dizziness, hearing problems and difficulty swallowing.

For most people, pain or discomfort in the jaw muscles or joints is temporary, often occurs in cycles, and resolves once you stop moving the area. Some people with TMD pain, however, can develop chronic symptoms. Your doctor of chiropractic can help you establish whether your pain is due to TMD and can provide conservative treatment if needed.

What Causes TMD?

Researchers agree that TMD falls into three categories:

• Myofascial pain—discomfort or pain in the muscles of the jaw, neck, and shoulders;
• A dislocated jaw or displaced disc;
• Degenerative joint disease—rheumatoid arthritis or osteoarthritis in the jaw joint.

Severe injury to the jaw is a leading cause of TMD. For example, anything from a hit in the jaw during a sporting activity to overuse syndromes, such as chewing gum excessively or chewing on one side of the mouth too frequently, may cause TMD.

Both physical and emotional stress can lead to TMD, as well. The once-common practice of sitting in a dentist's chair for several hours with the mouth wide open may have contributed to TMD in the past. Now, most dentists are aware that this is harmful to the jaw. In addition to taking breaks while they do dental work, today’s dentists also screen patients for any weaknesses in the jaw structure that would make physical injury likely if they keep their mouths open very long. In that case, they may use medications during the procedure to minimize the injury potential, or they may send the patient to physical therapy immediately after treatment.  In less severe cases, they instruct patients in exercises they can do at home to loosen up the joint after the visit.

While emotional stress itself is not usually a cause of TMD, the way stress shows up in the body can be. When people are under psychological stress, they may clench their teeth, which can be a major factor in their TMD.

Some conditions once accepted as causes of TMD have been dismissed—moderate gum chewing, non-painful jaw clicking, orthodontic treatment (when it does not involve the prolonged opening of the mouth, as mentioned above), and upper and lower jaws that have never fit together well. Popular theory now holds that while these may be triggers, they are not causes.

Women experience TMD four times as often as men. Several factors may contribute to this higher ratio, posture and higher heels.

TMD Diagnosis and Treatment

To help diagnose or rule out TMD, your doctor of chiropractic (DC) may ask you to put three fingers in your mouth and bite down on them. You may also be asked to open and close your mouth and chew repeatedly while the doctor monitors the dimensions of the jaw joint and the balance of the muscles. If you have no problems while doing these things, then the problem is not likely to be TMD. Your DC can then look for signs of inflammation and abnormalities. Sometimes special imaging, an x-ray or an MRI may be needed to help confirm the diagnosis.

If you have TMD, your doctor may recommend chiropractic manipulation, massage, applying heat/ice and special exercises. In most cases, your doctor’s first goal is to relieve symptoms, particularly pain. If your doctor of chiropractic feels that you need special appliances or splints (with the exception of the “waterpack” and other guards against teeth grinding), he or she will refer you to a dentist or orthodontist for co-management.

In addition to treatment, your doctor of chiropractic can teach you how to:

• Apply heat and ice to lessen the pain. Ice is recommended shortly after the injury or after your pain has started. In the later stages of healing, you need to switch to heat, especially if you are still experiencing discomfort.
• Avoid harmful joint movements. For example, chomping into a hard apple is just as bad as crunching into hard candy (some hard candies are even called “jawbreakers”—for good reason). And giant sandwiches can cause the mouth to open too wide and have a destabilizing effect on the jaw.
• Perform TMD-specific exercises. Depending on your condition, your DC may recommend stretching or strengthening exercises. Stretching helps to loosen tight muscles and strengthening helps to tighten muscles that have become loose. Special feedback sensors in the jaw can be retrained, as well, if needed.

Walking upright on two feet has advantages, but it also puts intense pressure on the spine, as well as on other muscles and bones. Add to this improper sitting, lifting, or reaching—and the normal wear and tear of working and playing—and you have the perfect recipe for back pain. That’s why back pain is the 2nd most common reason for visits to the doctor’s office, outnumbered only by upper-respiratory infections. In fact, some experts say, as many as 80% of us will experience a back problem at some time in our lives.¹

Back injuries are a part of everyday life. They can cause a sharp pain or a dull ache and can be accompanied by a tingling, numbness, or burning sensation. You may also feel weakness, pain, or tingling in your pelvis and upper leg—a condition known as sciatica. The spine is quite good at dealing with back injuries. Minor injuries usually heal within a day or two. Some pain, however, continues. What makes it last longer is not entirely understood, but researchers suspect that stress, mood changes, and the fear of further injury may prevent patients from being active and exacerbate the pain.

Tips for Back Pain Prevention:

• Maintain a healthy diet and weight.
• Remain active—under the supervision of your doctor of chiropractic.
• Avoid prolonged inactivity or bed rest.
• Warm up or stretch before exercising or other physical activities, such as gardening.
• Maintain proper posture.
• Wear comfortable, low-heeled shoes.
• Sleep on a mattress of medium firmness to minimize any curve in your spine.
• Lift with your knees, keep the object close to your body, and do not twist when lifting.
• Quit smoking. Smoking impairs blood flow, resulting in oxygen and nutrient deprivation to spinal tissues.
• Work with your doctor of chiropractic to ensure that your workstation is ergonomically correct.