For a long time, it was believed that a very firm mattress was an indicated treatment for back pain. Numerous studies have since contradicted this belief. To avoid or relieve back pain, a mattress must be chosen on a case-by-case basis, and replaced regularly!
Bedding, sleep quality and back pain are intimately linked: an unsuitable mattress can aggravate or even cause back pain.
An Italian systematic review from 2021 shows that the firmness of the mattress plays a role in back pain. Medium-firm mattresses promote comfort, sleep quality, and better spinal alignment1.
In 2003, a Spanish study already made this observation. In their conclusions, the researchers also noted that the firmness of the mattress influences back pain. They observed that people with chronic non-specific low back pain who slept on a mattress of medium firmness had, after 90 days, less pain and less disability than those who used a very firm mattress2.
A "tailor-made" mattress
When you suffer from low back pain and want to renew your mattress, it's difficult to sort it out.
Firm, semi-firm or soft? Spring or foam? Shape memory? What about those presented as "anti-back pain"?
In reality, the choice of a mattress must be made "tailor-made", taking into account several parameters: the weight of the sleeper, his height, but also his sleeping position and the existence or not of a partner sleeping in the same bed.
A good mattress is one that supports the spine in a natural position, offers back support and comfort that will ensure quality sleep. The one on which "we feel good".
Which mattress for back pain? Hard or soft?
It is generally necessary to avoid mattresses that are too firm, as well as those that are too soft, and to favor "semi-firm" ones. If you are overweight, you can also opt for a firmer mattress8. Of course, you will choose the dimensions of the bed according to its size.
Foam mattress or spring for back pain?
A large survey conducted in Finland (10,116 adults), in 2024, analyzed the relationship between mattress type and low back pain upon waking4. It reveals that people sleeping on a Tempur mattress (memory foam) reported significantly less low back pain and more vitality, compared to conventional spring or foam mattresses4. On the other hand, no statistical link has been established between sleeping position and low back pain4.
When choosing a mattress, the main thing is to trust yourself! You will have to try each bed, for a few minutes and varying the positions. To make sure you don't make a mistake, many sellers offer a test of the mattress. This test lasts several weeks or even months.
Finally, a mattress needs to be changed regularly, every 7 to 10 years10 : it has been proven that a new mattress significantly improves the quality of sleep, and thus helps to reduce or avoid back pain5.
A study presented at a conference (ICIBEL 2024) used software measurements to assess spinal alignment on soft, medium, and firm firmness mattresses. The data showed that the medium firmness mattress provided the best alignment, consistently, regardless of the participants' age or BMI. The study highlights the importance of personalizing the choice of mattress according to these criteria.Art. 11
Box spring, pillow and position to limit back pain
The mattress is not everything! The bed base is also important. Of good quality, it will cushion some of the movements and ensure a longer longevity of the mattress.
The choice of pillow for back pain can also make a difference. Just like the mattress, you will have to try it before buying it6. There is no point in having more than one, because you must avoid raising your head too much. In case of neck pain and back pain, it is possible to opt for an ergonomic pillow. These can significantly reduce neck pain-related disability9. Feel free to take a look at our ergonomic pillows.
Finally, certain positions seem to improve better sleep and recovery. This is the case with the position on the back, with the arms at the sides of the body, even if it is not the most common7. It can help relax the back muscles and maintain the curvature of the lower back.
Sleeping on your stomach is not recommended because it leads to a bad position of your spine. If you can't fall asleep otherwise, you can always place a cushion on your lower abdomen, and one for your head.
Caggiari, G., Talesa, G.R., Toro, G. et al. What type of mattress should be chosen to avoid back pain and improve sleep quality? Review of the literature. J Orthop Traumatol22, 51 (2021). https://doi.org/10.1186/s10195-021-00616-5
Ylinen, J., Kautiainen, H., & Multanen, J. (n.d.). Sleeping Position Associated with Well-Being and Mattress Type Linked to Low Back Pain. Journal of Yoga and Physiotherapy. https://doi.org/10.19080/JYP.2024.10.555809
Hu X, Gao Y, Liu K, Xiang L, Luo B, Li L. Surface Electromyographic Responses During Rest on Mattresses with Different Firmness Levels in Adults with Normal BMI. Sensors (Basel). 2024 Dec 25;25(1):14. doi: 10.3390/s25010014. PMID: 39796826; PMCID: PMC11722809.
Fazli F, Farahmand B, Azadinia F, Amiri A. A preliminary study: The effect of ergonomic latex pillow on pain and disability in patients with cervical spondylosis. Med J Islam Repub Iran. 2018 Sep 5;32:81. doi: 10.14196/mjiri.32.81. PMID: 30643756; PMCID: PMC6325275.
Yeoh, P. S. Q., Adib, M. H. M., Usman, J., Razak, N. a. A., & Lai, K. W. (2025b). Spinal alignment analysis for mattress selection across different age groups and BMI categories: a preliminary study. In IFMBE proceedings (pp. 224–231). https://doi.org/10.1007/978-3-031-97374-1_23
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