Tips for Choosing a Mattress If You Have Back Pain

The jury is still out on whether a firm or soft mattress is the best option for people whose back pain keeps them up at night. That said, most health experts in the know say the choice is yours—that the mattress that makes you feel most comfortable is likely your best option.

Person jumping back-down on three mattresses stacked on a wood floor
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And what does research say so far? That medium firmness seems to yield the most painless sleep.

A 2015 review gathered information from 24 controlled trials where participants used mattresses that were soft, medium firm, firm, or custom inflated. The results found that the medium-firm and self-adjusted mattresses were found to be best for sleep comfort, quality, and spinal alignment.

Dr. Michael Perry, former medical director of the Laser Spine Institute in Tampa, Fla., agrees that a medium firm mattress is generally the way to go. But he firmly (no pun intended) adds that one size does not fit all in the choosing of a mattress by those with spine pain. A number of other factors play a role, as well, he says.

Your Medical Status

Selecting the mattress that’s best suited to your spinal condition is about more than just how hard or soft the item is, Perry says. You (and your healthcare provider) need to consider your medical history in some detail so that you can tailor your purchase to your needs.

Before purchasing a mattress, Perry recommends asking yourself the following questions: What medical conditions do you have? What is your current diagnosis or diagnoses? What, if anything, have you been treated for previously?

It makes a difference. For example, symptoms of spinal stenosis tend to present themselves when you are standing and walking, but not when you are lying down. For this reason, the question of mattress firmness is not a big issue in people with spinal stenosis only. If this is you, choose a mattress that makes you feel comfortable.

But if you have degeneration along with your stenosis, that’s a different matter, Perry says. In this case, or if you have spinal arthritis without stenosis, disc problems or non-specific back pain, you do need to consider the relative firmness or softness of your mattress. “People with these conditions do better with more support, i.e. a firmer mattress,” Perry says.

Perry also says that while everyone needs some support when they sleep, people who have undergone multiple back surgeries often need less, relatively speaking. After several surgeries, the tissues have been altered and may be stiffer, he says. In this case, a softer mattress may be more comfortable.

How Old Is Your Mattress?

Dr. Perry warns that mattress springs break down over time, which makes your bed softer. “This can aggravate a patient’s back,” he says.

Based on this, does it makes sense for you to get a new mattress, or can you reduce pain and stiffness with your old one? While this is likely to vary among individuals, medical research may help shed some light on the question:

A study in Applied Ergonomics measured the comfort and quality of sleep for 27 patients with low back pain and stiffness. The participants recorded their sleep comfort and quality in their own beds for 21 days and then with a “prescribed” (and new) bedding system, which they used for 12 weeks. The study found that the participants showed progressive improvement in back pain and stiffness on the new mattresses and their quality of sleep improved significantly.

Your Sleeping Position

What position do you usually sleep in? This makes a difference in the type of support you need from your bed. Dr. Perry has some recommendations for back sleepers, side sleepers (whom he calls fetal position sleepers), and stomach sleepers:

  1. Side Sleepers Most people are side sleepers, Perry tells me. They sleep in the fetal position with their knees drawn up toward their chest. But this position tends to put pressure on your hips and shoulders. For side and fetal sleepers, Perry recommends a slightly softer mattress, such as one from the Tempurpedic brand. The foam the Tempurpedic mattress is made of conforms to your body, especially in the thoracic and lumbar regions of the spine, he says.
  2. Stomach Sleepers But for the stomach sleeper, soft mattresses such as the Tempurpedic may irritate the back. "A soft mattress encourages your abdomen to sink into the bed. The position that results is known to increase the arch in your low back and cause pain," he asserts. Perry suggests that a medium-firm bed surface is good for stomach sleepers. The idea, he says, is to derive support from your chosen mattress, but without the abdominal sinking experience. By the way, the sinking effect is amplified if you have a large abdomen. For thin people, sinking may not be as much of an issue.
  3. Back Sleepers And finally, if you sleep on your back, Perry recommends putting a thin, rolled towel or pillow under your knees and low back for support. Pillowing under these areas will likely help support them, as well as provide you with more comfort, he says.

The same group of Oklahoma researchers mentioned above did another study that affirms Perry’s assertions. The study, which was published in Applied Ergonomics in 2010, involved 27 patients with low back pain and stiffness upon arising.

Researchers divided the participants up according to their usual sleep position. Participants were assigned to a medium-firm mattress with a combination of foam and latex layering that was based on their preferred positioning choice—choices that correspond to Perry's descriptions as noted above. The participants were rated for sleep comfort and quality every day for three months.

The researchers found that the patients’ back pain and stiffness improved with the new mattresses. For this reason, they concluded that sleep surfaces do relate to sleep discomfort and that it is possible to reduce your pain by replacing your mattress with one uniquely suitable to your particular spinal condition.

Individual People Deserve Individual Mattress Choices

Different people need different things but in general, support is better, Dr. Perry concludes. If you have back pain, the best way to go about buying a mattress is to do your research and base your final selection on your particular need for both support and comfort.

2 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Radwan A, Fess P, James D et al. Effect of different mattress designs on promoting sleep quality, pain reduction, and spinal alignment in adults with or without back pain; systematic review of controlled trialsSleep Health. 2015;1(4):257-267. doi:10.1016/j.sleh.2015.08.001

  2. Jacobson B, Boolani A, Dunklee G, Shepardson A, Acharya H. Effect of prescribed sleep surfaces on back pain and sleep quality in patients diagnosed with low back and shoulder painAppl Ergon. 2010;42(1):91-97. doi:10.1016/j.apergo.2010.05.004

By Anne Asher, CPT
Anne Asher, ACE-certified personal trainer, health coach, and orthopedic exercise specialist, is a back and neck pain expert.