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How to Pick the Best Mattress for Back Pain

by Tuck(more info)

listed in back pain, originally published in issue 246 - May 2018

Republished from

Back Pain and Poor Sleep

We are not powerless against back pain. It can be alleviated or even prevented with one simple thing: how we sleep. Unfortunately, the reverse is also true. Some aches can be aggravated or even caused by how we position our bodies during slumber. How and on what we sleep can go a long way toward preventing or eliminating back pain completely.

Back pain is one of the most common complaints that people bring to their doctors. About 80 percent of adults report experiencing low back pain at some point in their lives. According to National Institute of Neurological Disorders and Stroke, a 1990 study ranked low back pain as sixth among the causes contributing to poor health and mortality. Two decades later, it moved to third place.

Studies point to a relationship between back pain and sleep. The Sleep in America poll — a national, random-sample survey of 1029 noninstitutionalized adults weighted to be nationally representative that was conducted by the National Sleep Foundation—found that 21 percent of Americans experience chronic pain and that 36 percent report having had acute pain in the week preceding the poll. Of those experiencing chronic back pain, 23 percent report having been diagnosed with a sleep disorder by a doctor, while 6 percent of all others have been.

Health specialists sometimes have a hard time figuring out why our backs hurt. A lot depends on where and when it hurts. There is no one single uniform category of back pain. Instead, there are many different types of back aches. 



Abnormal Spine Curvature

There are three main types of spine curvature disorders:

  • Lordosis, where the spine curves more inward at the lower back than normal
  • Scoliosis, where the spine curves sideways in a C or S shape
  • Kyphosis, where the upper spine is abnormally curved

Regions of the Spine

There are five regions to your spine, and all five need to be supported to ensure a restful and restorative night’s sleep, especially if you suffer from one of the above spinal curvature abnormalities The regions of the spine consist of five areas: the cervical, thoracic, lumbar, sacral, and the tailbone.

  • Cervical spine (neck): The 7 vertebrae of the cervical column support the skull, brain stem, and the spinal cord. The cervical spine serves the flexibility of the head, moving the neck. Bad pillows or whiplash often lead to pain in this area;
  • Thoracic spine (upper or mid back): The 12 vertebrae of the thoracic column are relatively stable because of their attachment to the rib cage and the ligament system. They help protect vital organs. Pain of the upper back, though rarer, includes muscular problems and joint dysfunction;
  • Lumbar spine (low back): The 5 (in some people 6) vertebrae of the lumbar column are located between the rib cage and the pelvis. They support the body’s weight and allow for movement. Muscle problems related to heavy lifting, degenerated discs, and herniated discs with the accompanying sciatica are most often the cause of pain in this region;
  • Sacral spine (lower back): The sacral column is a triangle-shaped bone that consists of 5 segments that are fused together. Sacroiliac joint dysfunction, which means pain on the one side of the low back that often radiates down to the knee, is a condition to which young and middle-aged women are most prone;
  • The coccyx (tailbone): The tailbone is the area made up of 3 to 5 small fused vertebrae. It is most likely to hurt from prolonged sitting.

Stress and Anxiety

Stress and anxiety become a part of a vicious cycle. Back pain, often worsening quality of sleep can, in turn, aggravate stress and anxiety. And, in turn, worry can lead to physical pain. According to The Anxiety and Depression Association of America, back pain is more prevalent in people with anxiety and mood disorders than those without them. The management of stress and anxiety involves proper diet, sleep, and exercise as well as cultivating social ties. Medication and talk therapy have also proven beneficial in some cases.

Strained Muscles

Pulled or even torn muscles, which commonly cause pain in the lumbar region of the spine, can be the consequence of improper use of the muscles during heavy lifting or exercise.

Sleep Disorders

Poor quality of sleep and not getting enough of it are common complaints. According to the Centers for Disease Control and Prevention, sleep disorders chronically afflict 50 to 70 million Americans. A 2012 survey found that 6 in 10 Americans crave sleep more than sex. According to Thomas Roth, director of the Sleep Disorders Center at Henry Ford Hospital in Detroit, data suggest that “disturbed sleep can worsen your pain.” The reverse is also true. One of the studies conducted by the team Roth oversaw found that sleeping longer decreases sensitivity to pain. Sleep loss and pain increase inflammation, he said, “but getting more sleep may help decrease it.”

What is the Best Mattress for Back Pain?

A healthy spine serves three main functions:

  • It protects the spinal cord, considered the body’s communication system, the nerve roots, and the internal organs of the body.
  • It provides structural support for an upright posture.
  • It facilitates flexible movement.

An unhealthy spine means an unhealthy body and mind. The spinal column needs proper support at night. A well-chosen mattress can help in the maintenance of proper posture.

The Mayo Clinic advises that “there doesn’t appear to be one type of mattress that’s best for people with back pain.” Instead, a helpful mattress is “a matter of what feels most comfortable to you.” According to a report by the National Institutes of Health, “having a comfortable mattress and pillow can help promote a good night’s sleep.”

In the 2015 Sleep in America poll by the National Sleep Foundation, people with acute and chronic pain reported that environmental factors often disturbed their sleep. The environmental factors that affect quality of sleep included noise, light, temperature, and, indeed, an uncomfortable mattress.

While no one type of mattress is a fix for all, in general, a firmer mattress - one that supports the spine at all points throughout its natural curve- is preferred by back sufferers. According to, an independent, peer-reviewed website whose contributors are medical doctors and doctoral degree holders, a firm mattress can work, but it some mattresses can be too hard. In those cases, “it can cause aches and pains in pressure points such as the hips.”

The caution about a mattress that’s too firm was confirmed by a peer-reviewed study published by the medical journal The Lancet. Researchers tested 313 adults with chronic, nonspecific low-back pain and who complained about back ache when sleeping and upon rising found that after 90 days. Some of them were randomly assigned firm mattresses and others medium-firm mattresses. Mattresses of medium firmness improved pain and disability among patients with chronic nonspecific lower back pain. Doctors and manufacturers agree that if a mattress helps you sleep well and wake up rested, regardless of its firmness and composition, it’s a good mattress for your specific back pain.

What to Look for When Buying A Mattress and Alleviating Back Pain?

Buying a mattress is a significant and consequential expense, so it is best to try out a mattress before committing to it. Does this mean that a mattress from a box is out of the question? Not at all, if the manufacturer offers the standard 100-day money-back guarantee. A hundred days is a much more thorough inspection period than whatever customers can find out during the time they spend trying out mattresses at a store.

There are four key factors to consider when buying a mattress:

  • Spinal Alignment
    • Maintaining the natural curve of the back helps promote restful sleep. This means that the back ought not to be excessively arched, but not flat either. Some of this can be accomplished with; an appropriate sleeping position.
    • For back sleepers, placing a small pillow under the knees and a flatter pillow under the lower back will reduce pressure on the spine;
    • Sleeping on the stomach is not recommended for back pain sufferers because it does not preserve the curvature of the spine. But for those who cannot help but sleep that way, using a flat pillow or no pillow at all for the head is recommended. Some doctors also advise placing a small flat pillow under the stomach, hips, pelvis;
    • For side sleepers, placing a pillow between the knees in a way that promotes the alignment of the hip bones can bring relief. The American Academy of Family Physicians points to this position as the healthiest for low back pain. It advises sleeping with knees bent and a pillow under the head and neck and a pillow between the knees;
    • Mayo Clinic offers a helpful slide show showing positions that promote pain-free backs;
    • In addition to smartly situating our bodies during sleep, mattresses can play a role in promoting the proper alignment, too;
    • In 2015, Consumer Reports found that medium-firm to firm mattresses tend to promote the natural curvature of the spine. For back sleepers, mattresses that best accomplished this goal ranged from an innerspring mattress (not the best choice for those back sleepers who tend to roll over to their sides), memory foam beds dubbed by the manufacturers as “ultra-firm,” which CR found to be medium firm, to adjustable air mattresses (which are also good for those who occasionally roll over to their sides);
    • The American Academy of Family Physicians recommends using a firm mattress to promote the proper alignment. This recommendation is, however, is challenged by some data, including the already mentioned Lancet study;
    • Medium-firm to firm mattress can work well for those who end up sleeping on their stomachs or for larger people (those weighing 230 pounds and above) who need more resistance to hold up their weight. But some softness - provided by a pillow top, for example—is often needed to cushion the shoulder and hip bones of side sleepers. A mattress that is too firm can “push on [the] main pressure points and take you out of alignment,” according to Arya Nick Shamie, associate professor of Orthopaedic Surgery and Neurosurgery at Santa Monica UCLA Medical Center. “If it’s too soft, those pressure points won’t be properly supported, so your whole body flops back.”
  • Comfort
    • Comfort is the most subjective of criteria. How comfortable a mattress is amounts, ultimately, to one consideration: who sleeps on it;
    • One size doesn’t fit all. Yes, some universal basic considerations apply - the mattress should support the natural curve of the spine and, as a result, most doctors and sleep experts recommend medium-firm mattresses. But if a softer mattress offers the kind of cushioning and buoyancy that consistently relieve the back pain of some sufferers, it would make little sense for them to switch to a firm mattress. Smaller people (under 120 pounds) often find softer mattresses enough to provide an appropriate support to their frames.
  • Pressure point relief
    • The areas of the body that are particularly sensitive to pressure are known as pressure points. They can often be felt in bony areas. People suffering from fibromyalgia are particularly prone to developing areas of tenderness;
    • Any mattress that distributes the sleeper’s weight evenly throughout works to relieve the pressure points.
  • Temperature
    • Does the comfort layer of the mattress have a cooling effect? Or does it hold your body heat and leave you sweaty and uncomfortable? These questions have become increasingly important to mattress shoppers. The National Institutes of Health counsels cooler temperatures for sleep. Cooling increases blood flow, and that, in turn, leads to oxygenation;
    • Memory foam, especially in its earliest forms, had the problem of enveloping the body with too much heat and was particularly bad for the sleepers prone to hot flashes or night sweats or who lived in warmer climates. Mattress technology has advanced to address this issue through techniques like body temperature-absorbing materials (phase change materials or PCMs), and through the use of cooling gels, copper, or other materials in the top layer. Cooling mattress toppers, bought separately, too, purport to offer the same remedy;
    • When Consumer Reports tested mattresses, it found that gel does not provide a cooler sleep. The mattresses with “a layer of gel-infused foam that’s supposed to provide a cooling effect” do not have that effect because “that layer is buried beneath other layers,” the testers reported. “While our tests have shown that innerspring mattresses containing gel did tend to sleep slightly cooler, the reverse was true with gel-infused foam beds.”

How do Various Mattress Types Relate to Back Pain?

Memory foam mattresses conform to the body in response to weight and heat.

  • Pros:
    • Even distribution of the body weight and in turn relieve pressure points;
    • Motion isolation
  • Cons:
    • Off-gassing;
    • Little support for stomach sleepers;
    • Too much firmness can aggravate pressure points.

Innerspring or coil mattresses rely on springs or coils to provide support.

  • Pros:
    • Firmer support;
    • Good for heavier people and stomach sleepers.
  • Cons:
    • Motion transfer.

Hybrid mattresses can offer the best of all worlds, combining coils with a top layer of foam or latex, or both foam and latex.

  • Pros:
    • Deliver the medium firmness preferred by back pain sufferers;
    • Better at cradling the body than the innerspring mattresses;
    • Provide more buoyancy than memory foam mattresses.
  • Cons:
    • Hybrid mattresses tend to be quite expensive;
    • Salespeople sometimes falsely claim that the more coils the better the mattress.

Latex mattresses are made from either synthetic or natural rubber.

  • Pros:
    • Tends to be firmer than foam;
    • Does not heat up as easily as other materials;
    • High point elasticity means more comfort and pressure point relief.
  • Cons:
    • Some sleepers are allergic to latex;
    • Motion transfer is sometimes an issue;
    • Some latex gives off an odour similar to that of a wet Band-Aid.

Airbed mattresses that use adjustable air-filled chambers instead of coils and are topped with foam.

  • Pros:
    • Pressure can be adjusted throughout the mattress;
    • Bed-sharing partners can have the kind of firmness they each want.
  • Cons:
    • In cheaper airbeds, with fewer air chambers, a big air “bubble” can pop up when someone sits or lays down on the other side of the bed;
    • Can be expensive.

In addition to mattress type, another factor to which back pain sufferers need to pay attention is the frequency of replacing the mattress. Watch for signs of age such as sagging and how long, it takes for the mattress to recover from body impressions. The conventional advice is to replace the mattress every eight years. However, chronic back pain sufferers might realize that the best mattress for lower back pain requires to replacement more frequently.

What Else Should You Consider?

Once you’ve decided on a mattress type, there are just a few more things for you to consider.


Pillows for Back Pain

You know the saying, it takes two to tango? Both your mattress and your pillow(s) play a role in reducing back pain. You’ll want to choose a different pillow based on your sleeping position to reduce stress on your spine and keep your neck properly aligned:

Back sleepers should tuck a small pillow underneath their knees to allow the lower back to curve naturally and comfortably. For the head, choose a pillow of medium height and firmness to keep your neck and spine aligned. If snoring is an issue, prop your torso up using a few firm pillows.

Side sleepers should tuck a pillow between their knees to relieve stress on their hips. For the head, opt for a firm or extra firm pillow around 4 inches in height to keep your spine straight from neck to hips.

Stomach sleepers should tuck a small, flat pillow beneath their stomach and pelvic area to prevent the spine from sinking. For the head, a thin pillow is best because it keeps your neck flat and in alignment with the rest of your body.

Adjustable Beds

If lying in a recliner feels more restful than lying straight on your back, you may want to consider an adjustable bed. Adjustable beds let you lie at a 30-45 degree incline, making them a good fit for back sleepers recovering from back surgery or living with degenerative spondylolisthesis, osteoarthritis, or spinal stenosis. These beds can be adjusted by remote control, often have timers or massages built in, and come in multiple sizes. However, they can be quite expensive and many couples find the design to be awkward.

Mattress Price

Mattresses vary widely in price. Depending on the type of mattress, the quality, where you bought it from, and whether you added any customizations, you can expect to pay somewhere between a few hundred to several thousand dollars. We recommend planning to spend between $800-$1,000 on a mattress you plan on using full-time.

Mattress Return Policy and Trial Period

Recognize that the five minutes you spend in the store isn’t really a great proxy for how the mattress will feel to sleep on for several hours each night. Fortunately, a good return policy and long trial period can help make up for that. Look for a trial period of at least 30 days (online mattress retailers often offer up to 100 days) and make sure you understand the fine print. It typically takes 30 days for your body to fully adjust to the mattress, so use the trial period for all it’s worth.

Additional Resources for Dealing with Back Pain

“Can Switching Your Sleep Position Ease Back Pain?” by Everyday Health
Henry Ford Macomb Spine Center

John’s Hopkins Medicine Health Library: Low Back Pain
Low Back Pain Fact Sheet by the National Institute of Neurological Disorders and Stroke

Mayo Clinic’s Website: Back Pain
The 2015 Sleep in America poll by The National Sleep Foundation
“The Structure and Function of a Healthy Spine” by the Cleveland Clinic

“Research on the Alexander Technique for chronic and recurring back pain” by The BMJ

Acknowledgement Citation

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About Tuck

Tuck aims to improve sleep hygiene, health, and wellness through the creation and dissemination of comprehensive, unbiased, free resources. Boasting the largest collection of aggregated data on sleep surfaces on the web (over 95,000 customer experiences from nearly 1,000 individual sources), Tuck aims to power consumers, sleep professionals, and the troubled sleeper looking for answers. Check back often for updates and expanded sleep product information. For further information visit their website at


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