Ninety-five percent of orthopedists surveyed say that mattresses have a role in managing back pain. Dr. Robert Oexman, one of the country's leading sleep surface experts and the director of a major ergonomics research facility, agrees. "In our research facility, we monitor and measure how the environment impacts sleep, and what we've found is that the sleep surface is one of the most important factors that disrupts sleep," says Dr. Oexman. That's because if you're not sleeping on a surface that is both supportive and comfortable, you're bound to develop pressure points during the night. "In our lab we have a pressure mat that allows us to measure the amount of pressure that is being applied to the sleeper's body," says Dr. Oexman, "and we find that people who do experience high pressure toss and turn a lot more at night, which actually fragments their sleep and doesn't allow them to get the quantity or quality of sleep that they need."

Unfortunately, much of the advice we've been given on sleep surfaces should be thrown out the window. The most frequently (almost 70% of the time) doctor- recommended mattress for back pain management is a firm one. No wonder there are so many back pain sufferers out there today! According to Dr. Oexman, a firm, flat mattress is not supportive because it doesn't contour well to the curves of your body, particularly in the low back region. "We can demonstrate this on a pressure mat," says Dr. Oexman. "When someone lies down on a firm mattress, we can see the high pressure areas, particularly underneath the hip and shoulder regions. This is what causes those aches and pains at night. This is what is going to cause us to be uncomfortable and to toss and turn, preventing the quantity and quality of sleep that we need."

Dr. Oexman draws a comparison between the ideal sleep surface and a tennis shoe. "The tennis shoe people do a great job. They know that they need cushion to reduce pressure on the runner's foot, and at the same time they also need to support the arch of the foot." The arch of the foot is like the lumbar curve in the lower spine. Used alone, a firm, flat mattress doesn't properly support the lumbar curve.

So, is it time to go out and purchase a brand new mattress? That's not necessarily the answer. There are products available that, when used in conjunction with your mattress, conform better to the shape of your body, thereby providing proper support and cushiony comfort for your aching back. Following are some tips for finding just the right type of mattress topper for you:

· Look for something that provides both comfort and support. Solid memory foam products are soft and conforming to the touch, but they can be very costly and tend to flatten beneath your body's weight.

· Egg-crate type mattress pads might provide a bit more cushion, but they don't do much to support the natural curves of your body.

· Try to find a mattress pad that mirrors the shape of your body. Remember, flat surfaces don't provide proper support. In order for something to be truly supportive, it must have shape. You wouldn't go running in a flat tennis shoe, so you shouldn't count on a flat mattress to provide proper support.

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If you are among those who have already experienced a bout with low back pain, then you know how debilitating it can be. In the western world, 80% of the population will experience disabling low back pain during their lives. Back pain is the second most common reason patients visit doctors and costs the U.S. economy $25 billion per year. Low back pain clearly represents the single greatest and most inefficient expenditure of health care resources in our society today.

Understanding the anatomy of the back will help you understand why and how back problems occur. The spine is composed of 24 bones called vertebrae. The lower back or lumbar spine has five vertebrae whose functions are to bear weight and provide a protective covering for the spinal cord. In-between each pair of vertebrae are cushions called discs. The main responsibility of the disc is to absorb the compressive forces to which the spine is subjected.

Most back pain is preventable and often is caused by too little exercise, overuse, poor exercise or work positioning, lack of flexibility, and poor posture. Smoking can cause decreased blood flow to the spine as well as a loss of bone density. Even obesity is a cause of low back pain due to the increase pressure the excess weight puts on the spinal discs. All of the above may result in arthritic or degenerative changes in the spine, disc herniations ("slipped discs"), muscle spasms, spinal joint irritation, and dysfunction and nerve irritation.

Over time, spinal arthritis may develop. The discs narrow and wear out and the vertebrae crumble, often forming spurs that narrow and compress the area through which the spinal cord and nerves pass.

A disc herniation occurs when the outer wall of the disc weakens and the jelly-like middle causes that outer wall to bulge out. This bulging may "pinch" the nerve exiting from the spinal cord or the spinal cord itself. The middle may even squirt out and form a separate fragment, like a piece of floating cartilage in the knee.

Non-musculoskeletal and potentially more serious problems like kidney disease, certain types of cancer gallbladder disease, prostate disorders (all men over 40 should have a prostate examination yearly), ovarian and uterine disorders and aortic aneurysm may also cause back pain. A thorough examination by a medical doctor, osteopathic doctor or doctor of chiropractic to properly diagnose back pain is essential.

Initial treatment for lower back problems includes stopping your activity immediately and icing the lower back for 20 minutes. Lie on your back directly on top of the ice pack with your knees bent. Keep a thin towel or shirt between the ice pack and your skin. If your low back pain persists, see a chiropractor or medical doctor.

Treatment guidelines published by the U.S. Agency for Health Care Policy and Research, entitled Acute Low Back Problems in Adults, stated "relief of discomfort can be accomplished most safely with nonprescription medication and/or spinal manipulation." The key to low back pain is really prevention. A proper warm-up before any sports activity is important to preventing low back pain. This means walking for at least five minutes and then stretching after the walk. Many of us are simply out of shape. Too many of us play a sport to get or stay in shape. It should be the reverse - you must get in shape to play a sport. This means a complete exercise program including aerobic exercise (30 minutes a day, at least three times a week), strength training (twice a week working on all the major muscle groups) and stretching. The most important area to exercise is the midsection: the abdominal muscles, the twisting muscles or obliques and the lower back muscles. A strong midsection will protect you against low back pain.

Steven M. Horwitz, D.C., of the White Oak Chiropractic Center in Silver Spring, Maryland, is a graduate of both Cornell University and the National College of Chiropractic. He is certified as a Chiropractic Sports Physician, Strength and Conditioning Specialist, and Personal Fitness Trainer. He served as the chiropractor for the 1996 U.S. Olympic Team and was appointed by the Governor to the Maryland Council on Physical Fitness. Dr. Horwitz is the author of You Can Be Fit and is a popular guest on many radio programs. An avid athlete, he has run marathons and is a champion bodybuilder.

"Core stability" refers to the ability to keep your spine straight -- from your tailbone to the top of your head, with your shoulders level and in line. This may sound simple, but many people cannot maintain this position for very long while sitting in a chair much less during activity. Why should you care? Because core stability helps you avoid injury, affects your posture and allows you to perform optimally.

Your core, or torso, is your internal base of support. To move your body effectively or to move an object through space, you must keep your core stable. Think of a surfer balancing on a surfboard as he or she rides a wave, or a quarterback throwing a Hail Mary pass. Those movements epitomize core stability.

To improve your core stability and balance, you need to know where your body is in relation to external objects and the ground. You also must be aware of where your body parts are in relation to each other. Core stability also requires that you strengthen the abdominal and low back muscles, which are your core stabilizers. The exercises need to safely challenge your ability to stabilize your core by putting you in a position of relative instability. An unstable base of support forces you to become more aware of proper body position and work the muscles that help you maintain balance. Stability balls, slide boards, yoga, tai chi and Pilates all help improve core stability.

Below is a core stability exercise you can try. It will tone and tighten your buttocks, as well as your inner and outer thighs, while developing your core stabilizers. All movements should be performed in a slow and controlled manner.

Core Stability Exercise

· Face a mirror with your feet shoulder width apart.

· Lift your right leg so that your thigh is parallel to the floor and your toes point down.

· Next, extend you knee completely so that your right leg is parallel to the floor. Use your hands and arms for balance, if necessary.

· Hold this position for a moment; then flex the knee, keeping your foot in the air and thigh parallel to the floor.

· Next, lean forward with your torso and extend your right leg in a line parallel to the floor. (For balance, bend your left knee.)

· Hold this position for a moment.

· Repeat the exercise five to 10 times. Repeat on left side. When you've mastered this exercise, try it with your eyes closed.

This article was reprinted with the permission of isyndicate.

Are You At Risk For Back Pain or Injuries? Take this quiz and find out if you are at risk for back pain or injuries. Answer Yes or No to each of the following questions. Check your answers at the end of the column.

1. I am 10 or more pounds overweight. Yes No

2. I have young children (under age 3). Yes No

3. I am age 30 or older. Yes No

4. I have experienced back pain in the past. Yes No

5. I have missed work because of back pain. Yes No

6. I often carry heavy objects. Yes No

7. I wear high heels five times or more in a week. Yes No

8. I smoke. Yes No

9. I exercise at least three times a week. Yes No

10. I practice safe lifting techniques. Yes No

11. I wear my seatbelt while riding in or driving a car. Yes No

12. I stretch and flex my muscles every day. Yes No

13. I sleep on a mattress that comfortably supports my spine and joints. Yes No

14. I sleep with a pillow between my knees. Yes No

Scoring: Answering Yes to questions 1 to 8 are indications that you are at increased risk for back pain and injuries. Be aware of these risk factors. Try to reduce the risks under your control, such as losing weight or quitting smoking.

1. Being overweight by 10 more pounds can place strain on your back.

2. Picking up or reaching for young children is a common cause of backaches.

3. Over 75% of people age 30 and older experience back pain at least once.

4. Back pain is often recurring.

5. Back pain is the second leading cause of missed work.

6. Underestimating the weight of an object or your strength can lead to back injuries.

7. Wearing high heels or poor fitting shoes can increase the strain on your spine.

8. Smoking restricts blood flow.

Answering Yes to questions 9 to 14 indicate positive behaviors that can help reduce your risk of back pain and injuries. Keep up the good work!

9. Regular exercise helps strengthen muscles.

10. Improper lifting is a leading cause of back injuries.

11. Back and neck trauma are among the most common injuries suffered in car accidents.

12. Regular stretching and flexing helps prevent back strain.

13. Back strain is sometimes environmental and can be caused by an improper sleeping surface.

14. A pillow can help align the spine and joints, and relieve stress and pressure.