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.

Is Your Bed Causing Your Back Pain?

You have seen the ads for sleep number beds, promising that you will sleep better. But how do you know when to replace your present mattress? There is actually not one right answer, but here are some guidelines that may help to determine if your bed is causing or aggravating your back pain.

1. What is the present age/condition of your mattress set? If it is over 10 years old, likely you may need to replace it soon. If it is 2-4 years old, it is probably still in good condition. Of course this depends on the quality of the mattress, how much it has been used, and if it has been rotated/flipped regularly. If you bought it firm, does it still feel firm? Does your medium or soft mattress feel too soft?

2. What position is your spine in when you lie down on your bed? How far do you sink into the mattress? Can you get your back into its straight alignment in your sleep position of choice or is bent/twisted in one direction? A bed that is too soft makes it more difficult to sleep with a neutral back posture because the middle of your body will sink down more than your upper body and legs (especially if you lie on your side or tummy).

3. Do you sleep better on the couch, the recliner, the floor or another bed? That is a sure sign that you should find a different mattress. Traditionally, individuals with back pain prefer a firm mattress and have increased pain if they sleep too long (>7-8 hours).

4. Do you have more back pain when you first wake up than the rest of the day? There may be an easy solution, such as modifying your sleep position, changing your mattress or using additional pillows (body pillow or adding a pillow between your legs for improved spine alignment). The best way to achieve proper sleeping posture is to lie on your side with a pillow between your knees and to keep your back in a straight position (not rounded up into fetal position). Lying flat on your back is also appropriate for most individuals, as the spine is kept in a straight position (you may also put a pillow under your knees for more comfort). Sleeping on your tummy is not usually recommended.

Your sleeping posture is more important than you may realize because it places your spine in a potentially bad position for so many hours every night. So the next time you are mattress shopping, I recommend spending some nights sleeping on various types of beds, whether at hotels or friends' guest rooms. That way you don't spend the money on a mattress that you end up hating for the next 10 years.

Finally, if you have increased back pain during the night that is not present during the day and worsens every night (wakes you up), please consult your physician immediately, as this can be a sign of a more serious problem.