Mattress Firmness And Low Back Pain

Firm Mattress and Low Back Pain? Traditionally, you have heard that a firm mattress is the best for your back. I have known many individuals that have less back pain when sleeping on a very firm bed or even on the floor instead of a soft bed. Those are the same people that do not lie in bed to sleep more than 6-8 hours, even on Saturday morning! They do so after finding that sleeping in too long increases their low back pain.
Soft Mattress and Low Back Pain? There are also many individuals with low back pain that sleep on various types of mattresses that do not aggravate their backs. It would be extremely obvious to me if softer mattresses were the culprit of back issues because all my patients over the years would have reported this to me. So I cannot say that softer mattresses are bad. 
There is one statement that I have heard repeatedly from patients: “I need to replace my bed because it is old and I sink into it too much.” Clearly, if you sink down into the mattress excessively, your spine is likely being pushed out of alignment (so your back is not in a comfortable, neutral resting position at night). On the other hand, a too-firm mattress could also potentially put your spine out of alignment if your hips or buttocks cannot sink in sufficiently.
Research on Mattress Firmness and Back Pain:
I recently found one research article about this topic. The study included over 300 individuals with chronic low back pain, and they were divided into two groups: firm mattress or medium firm mattress. To my surprise, the study showed a better response to medium-firm than firm mattresses. Those in the medium-firm mattress group reported better outcomes about their back pain during various daily tasks than the firm mattress group.

Conclusion: Despite common recommendations, there is not overwhelming research that associates firm mattresses with less low back pain. Clearly, there is at least one study (see above) that links a medium-firm mattress with better back outcomes than a firm one. So find what works for you. Take the time to try out a lot of beds, and save up so you can afford the one you prefer, as some are very expensive. If you shop around, you should be able to find a good-quality name brand for $300-$400 (which includes a 10-year warranty).

Specific Mattresses with Good Back Support: Out of my recent personal experience of mattress shopping, here are some mattresses that I liked. Keep in mind that there is a wide range of mattresses within each name on this list, so you will need to shop around to find the one you prefer. Higher-quality mattresses come with longer warranties, so it may be worth it to pay more for a longer-lasting mattress.
1. Sealy Posturepedic
2. Simmons Beautyrest
3. Simmons Beautysleep (a cheaper option)

Reference: Kovacs FM, Abraira V, Pena A, et al. “Effect of firmness of mattress on chronic non-specific low back pain.” Evid Based Med 2004;9: 119.

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I am a Physical Therapist and Ergonomics Consultant, based out of Columbia, SC. My passion is to write about and speak about pain/injury prevention. I started Pain Talks as a consulting business in 2018.

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