What is the best mattress for back pain?

I often meet people with back pain who have been told that a firm mattress is always the best mattress for back pain.

This seems to be a universally accepted fact.  I have met people who have recently spent fortunes on new hi-tech beds only to find that their back pain is not really any better.

I have also met some people taking more extreme measures such as sleeping on air beds or the floor in order to get a firm surface. Many of them don’t feel much better for doing it.


However, it’s not true that the best mattress for back pain is necessarily a hard one. Indeed an interesting research trial found that patients improved more on a medium firm mattress rather than firm (1).

The fact is that no two of us are the same when it comes to needing a bed. You need to think about the following things.

What shape is your body?

In an ideal world the spine should be kept in a more neutral position overnight – you don’t want it to be held in an uncomfortable position for too long or it will be painful and wake you at night or you will feel sore in the morning.

The diagram below shows an exaggerated ideal neutral position:

sleeping posture drawing


If you have larger hips and shoulders then you may need a slightly softer mattress to achieve this position.

  • If your mattress is too firm your lower back will have to sag to reach the mattress.

  • If you have a mattress that is too soft then you will sink into it and your lower back will have to accommodate by shifting the other way – equally uncomfortable.

What type of back problem do you have?

Different problems need different solutions.

  • Patients with spinal stenosis for example may prefer a flexed position and therefore a slightly softer bed.

  • If you have a lumbar disc problem you may find flexion very uncomfortable and need a firmer mattress.
  • People with simple low back pain may prefer either one or the other.

There is no way of knowing what the best mattress will be until it’s been tried. Discuss this with your physiotherapist or doctor.

Tips for choosing the best mattress

Invest in a new bed

If your mattress is 10 years old or more you probably need a new one. Before you rush out and get one though check the following advice to make sure you get the best mattress for your needs.


Before buying the most expensive orthopaedic mattress you can get try sleeping in another room or on a different type of bed in the house that can be used as an experiment. This will give you a clue to the best mattress firmness for you.

Firming it up

If you feel you need a firmer bed try making sure the mattress is on a solid base i.e. put a board between a softer divan base and the mattress or drag the mattress onto the floor for a few nights.

Softening it up

If you feel you need softer bed you can put a duvet over the mattress or try a memory foam mattress topper which can soften the bed up a bit.

Try it in the shop or at home

Make sure you lie down on the bed before buying it! You may feel daft but its best to try it out first. Some manufacturers will even let you have the mattress for a trial period.

Think about your partner

You can get beds now that have different density on either side so that you can both get what you want without compromising.

Advertisement - Article Continues Below


The Importance of Posture

Correct Sitting Posture
Office ergonomics and Correct Keyboarding posture
Proper Lifting Techniques

Lower Back Pain Toolkit Home Page


1. Kovacs, F. M., Abraira, V., Pe±a, A., MartÆn, R., Sbnchez, V., Ferrer, E., Ruano, D., Guillqn, P., Gestoso, M., Muriel, A., Zamora, J., Gil, D., & Mufraggi, N. 2003, "Effect of firmness of mattress on chronic non-specific low-back pain: Randomised, double-blind, controlled, multicentre trial", Lancet, vol. 362, no. 9396, pp. 1599-1604.