What is the best firm mattress for back pain

Sleeping on the wrong mattress can cause or worsen lower back pain. Lack of support from a mattress reinforces poor sleeping posture, strains muscles and does not help keep the spine in alignment, all of which contribute to low back pain.

Sleep comfort is also sacrificed if a mattress does not match one's individual preferences. A mattress that provides both comfort and back support helps reduce low back pain, allowing the structures in the spine to really rest and rejuvenate during the night.

See Mattresses and Sleep Positions for Each Back Pain Diagnosis

With the vast variety of mattresses on the market, choosing the right mattress can be difficult. The following practical guidelines are designed to help patients with low back pain choose the best mattress for both back support and sleep comfort:

  1. Personal preference should ultimately determine what mattress is best. There is no single mattress style or type that works for all people with low back pain. Any mattress that helps someone sleep without pain and stiffness is the best mattress for that individual. Patients with low back pain should choose the mattress that meets their standards for comfort and support and allows them to get a good night’s sleep.

    Read more: Chronic Pain and Insomnia: Breaking the Cycle

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  1. Understand and inquire about the physical components of the mattress. The coils or inner springs of a mattress provide the support. Different mattresses vary in their number and arrangement of coils. Padding on top of the mattress comes in many different thicknesses. Mattress depths typically range anywhere from 7 to 18 inches deep. Choosing the number of coils, type of padding and mattress depth should be determined by individual preferences.

    See Mattress Guidelines for Sleep Comfort

  2. Find a mattress with back support. A good mattress should provide support for the natural curves and alignment of the spine. The right amount of back support also helps the patient avoid muscle soreness in the morning. While there is not much clinical data about mattresses, one study found that medium-firm mattresses usually provide more back pain relief than firm mattresses.

    Read more about Posture to Straighten Your Back

In This Article:

  • Choosing the Best Mattress for Lower Back Pain
  • Considerations When Buying a New Mattress
  • How to Evaluate a Mattress
  • Video: What is the Best Mattress for Back Pain?

  1. Achieve a balance between back support and comfort. Overall comfort while sleeping on the mattress is equally important as sufficient back support. Sleeping on a mattress that is too firm can cause aches and pains on pressure points. A medium-firm mattress may be more comfortable because it allows the shoulder and hips to sink in slightly. Patients who want a firmer mattress for back support can get one with thicker padding for greater comfort.

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  1. Know when it’s time to get a new mattress. If an old mattress sags visibly in the middle or is no longer comfortable, it is probably time to purchase a new one. Putting boards under a sagging mattress to keep it from sagging in the middle is only a short-term fix for the sagging; a new mattress is still needed.

Back pain is the leading cause of disability in the UK and affects approximately one in six adults. It's aggravated by our sedentary lifestyles and bad posture, both at our desks and while we sleep. While no mattress will be a magic fix, an unsupportive one can compound the problem.

"Typically inflammatory pain is worse in the morning because as we lie, our heart rate slows down, circulation slows and any inflammation stays pooled in the area. Sleep position is key," says Dave Gibson, osteopath, sleep coach and founder of The Sleep Site. 

To avoid back pain you should ideally sleep with your spine in alignment. For back sleepers and front sleepers the main danger is that the spine settles into a U-shape while sleeping. For side sleepers it depends on the pressure points at shoulder, hip and head.  

"Lie on your side in bed and get your partner to take a photograph so you can see how your spine lines up," Gibson recommends. "Your pillow needs to be the right height and the mattress needs to be supportive enough so that when you lie down, your spine is in alignment. It can help to put a pillow between your knees. It also helps if the mattress is firm."

Should you sleep on a hard or soft mattress with back pain?

“If you look at all the research that has been done on mattresses and back pain, medium-firm comes out as what you should have,” Gibson says. “Firm, but not rock-hard. Remember, though, there’s no official grading of firmness. What one manufacturer calls firm, another might call medium-firm."

Heavier people generally need firmer support, whereas lighter people can get away with softer mattresses. Whether you sleep alone or with a partner also has a bearing on your choice of mattress. You both want to be able to turn round without disturbing each other or adopting unhealthy sleeping postures.

To find the best mattress for you, Gibson suggests first lying on one in-store. "Although you won’t be able to tell if it will help with your back pain, you will be able to tell if it’s too firm or too soft for your liking, so that can be worth doing as a first step.

"But a better way to spot a good orthopaedic mattress is to see how long a trial the manufacturer will give you. Some do up to a year’s trial.  If they can afford to do that, you can be fairly sure it’ll be a good one. Certainly get one with at least 30 day’s free trial, because some of the research has shown that it takes four weeks for people’s back pain to reduce when they switch to a new mattress." 

Which type of mattress is best for back pain?

Memory foam or hybrid mattresses contain foam that moulds to your body as you sleep, so are likely to have a slightly softer, more cocoon-like feel. “Memory foam mattresses these days will probably have two or three layers of foam," Gibson says. "At the top will be open-cell foam, which has more breathability. That’s a big advance over older memory foams which held your body temperature."

Traditional pocket-sprung mattresses might offer better weight distribution and feel slightly firmer (although there are sub-categories of firmness). Hybrid mattresses combine a layer (or multiple layers) of memory foam with pocket springs. 

Gibson is skeptical of claims to be "contoured", with different support zones for your shoulders and hips, because so much depends on the weight of the sleeper, among other factors. He also believes one of  the best things you can do to improve your sleep is to rotate or flip your mattress: "You'll be blown away by how different it feels." 

Finally, his biggest piece of advice is the simplest: get a bigger bed. "When you’re sleeping as a couple in a double bed, you’ve each only got the space that a baby in its cot would have. Someone with lower back pain needs to move around. What you need is a superking. Most of the research that you see on sleep quality indicates that the bigger the mattress, the better you sleep."


Which is the best mattress for back pain? 

  • Best overall – Emma Premium Hybrid
  • Best hybrid mattress – Simba Hybrid Pro
  • Best memory foam mattress – Nectar Memory Foam
  • Best boxed mattress – Eve Premium Hybrid
  • Best firm mattress – SilentNight Eco Comfort Miracoil Ortho

The best mattresses for back pain

1. Emma Premium Hybrid Mattress 

£1,448 for a king size, Emma

Best overall for back pain

Key features 

  • Type: hybrid
  • Depth: 25cm
  • Trial: 200 nights

An award-winning foam and pocket-spring hybrid mattress that’s worth considering if you suffer from back pain. It uses the brand’s specially designed “HRX Supreme™ Foam,” which stands for “high resiliency extra foam”, and isn’t just jargon – it’s extra durable and designed with different zones of density to align and support your spine (and so reduce the risk of waking up with a bad back). As per Gibson’s advice, this mattress is described as “medium firm,” but the brand will provide extra layers of memory foam topping to soften it or firm it up should you require.

Five layers of alternating high-tech memory foam and pocket springs combine for a springy – yet supremely supportive – feel, so it's no wonder Emma won a wide array of consumer awards for comfort. Emma offers a lengthy 200 night trial and a ten year guarantee. 

2. The Simba Hybrid Pro Mattress 

£989.40 for a king size, Simba

Best hybrid mattress for back pain

Key features 

  • Type: hybrid
  • Depth: 28cm
  • Trial: one year

It’s no secret that the Telegraph Recommended team are big fans of Simba, and the sleep tech brand is featured in tried-and-tested guides to the best pillows and duvets as well as mattresses. This mattress is expensive, that’s for sure, but it’s the product of an almost-obsessive attention to detail, and is a worthy investment if you want a truly outstanding hybrid mattress.

The first layer is natural wool, which is naturally hypoallergenic and temperature-regulating, so the Simba Hybrid Pro is a better choice for hot sleepers than a traditional memory foam mattress. Then there’s a layer of Simba’s open-cell memory foam, a double layer of pocket springs, two more layers of foam and a base. It’s a thick, luxurious-feeling mattress that provides unparalleled support without compromising on comfort. It comes with a one year risk free trial period. 

3. Nectar Memory Foam Mattress

£521.95 for a king size, Nectar Sleep

Best memory foam mattress for back pain

Key features 

  • Type: memory foam
  • Depth: 25cm
  • Trial: one year

The Nectar mattress is billed as a medium-firm mattress – although it’s slightly firmer than competitors – that’s made from three layers of different types of memory foam. This is crucial, as a top temperature-regulating layer keeps you cool at night and provides that soft, cushioned feeling, while the lower, sturdier layer is responsible for supporting your spine and relieving pressure beneath your hips and shoulders as you sleep. The bottom layer is a ‘zoned’ base foam. 

Thanks to the slightly firmer than usual memory foam, this mattress minimises motion transfer very effectively – so, if you’re a light sleeper with a partner who tosses and turns, you won’t be disturbed. It comes with a one year trial period and a lifetime warranty. 

4. Eve Sleep Premium Hybrid Mattress

£592 for a king size, Eve

Best boxed mattress for back pain

Key features 

  • Type: hybrid
  • Depth: 28cm
  • Trial: one year

Another hybrid mattress worth considering is the Premium Hybrid from Eve. As with other bed-in-a-box brands, Eve mattresses come compressed and rolled up into a single box, so you don’t need to worry about trying to squeeze a mattress through a too-small doorway. It’s a thick, comfortable mattress made from five layers of engineered memory foam paired with 1,400 pocket springs. 

A marshmallow-soft top layer of “floatfoam” gives the sinking feeling memory foam is famed for, followed by two layers of firmer cooling memory foam, followed by full-size pocket springs and more foam. It’s also dubbed a ‘medium-firm’ mattress, but the plush top layer means it skews a little on the softer side – perfect if you want a snuggly surface without compromising on support to help minimise back pain. It gets extra points for the fact that the quilted cover is removable and machine-washable. 

5. SilentNight Eco Comfort Miracoil Ortho Mattress

£449 for a king size, Silentnight

Best firm mattress for back pain

Key features 

  • Type: pocket-sprung
  • Depth: 24cm
  • Trial: 60 days

Bouncy, springy and supportive – but definitely not soft. If you don’t find a medium-firm mattress offers enough support, this extra firm pocket-sprung mattress is the one you should try for pressure-relieving support. It’s filled with zoned Miracoil springs specially designed to support spinal alignment, and they minimise movement so you don’t disturb your partner (or vice versa). 

It’s also significantly cheaper than the mattresses above. However, there is one downside – Silentnight only offer a 60 day trial period, and within that period, if you’re unhappy with your mattress, you can exchange it but not get a refund.

View the latest Simba Sleep and Silentnight deals

What mattress firmness is best for your back?

Medium-firm mattresses, which have a rating of 7 to 8, are typically recommended for lower back pain.

Is it better to sleep on a firm mattress for back pain?

If you carry weight, sleep on your back, or sleep on your stomach, a firm mattress may help alleviate lower back pain by distributing your body weight more evenly across the mattress. This way, your back isn't curving as much while you sleep.

Is a firm mattress better for your back side sleepers?

Back and stomach sleepers tend to prefer firmer mattresses, while side sleepers prefer a softer feel.

Which mattress is best for sleeping and back pain?

Best Orthopaedic Mattress for Back Pain - Summary.
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Best Mattress for Back Pain – Sunday Ortho Latex Mattress..
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