Best Mattresses for Back Pain 2020

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In the past, if you had back pain, many doctors and well-meaning friends would direct you toward a firm mattress. Turns out, that advice was wrong. What you really need, according to the current research, is a mattress that feels medium-firm to you.

The key word here is you. Firmness levels are highly subjective. Owner reviews reveal that the same mattress can feel too soft for some people and too hard for others. Discrepancies exist because, besides personal preference, a person’s weight and shape can influence the feel of a mattress. On a soft mattress, my 128-pound body might feel like it’s floating. But for my 230-pound brother, that same mattress might feel overly firm, given that he’d drop immediately into its bottom support layer.

Here’s the rule: When back-pain sufferers lie on a mattress that they determine to be medium-firm, that mattress is the best backache-relieving mattress for them—regardless of how the company labels the mattress or whether that mattress has “support zones,” reinforced layers, or other bells and whistles that cater to a spine-focused audience.

Mattresses labeled medium-firm are a good place to start because they’re likely to support your spine’s natural curves, whether you’re on your back, stomach, or side. Ahmed Radwan, PhD, DPT, co-author of a Sleep Health review paper about mattress design and sleep quality, explained to us in an interview that even though people might prefer a particular position to fall asleep in, they can shift a lot during the night. Thus, “the successful mattress is the one that accommodates many positions and helps you wake up with less pain and tenderness.”

The “medium” part of “medium-firm” not only relieves pressure points (which vary depending on your sleep position, as the pressure-points illustration below shows) but also cushions the heavier parts of the body in a supportive way, without letting them sink into the mattress too far. When you’re sleeping on your back, your shoulders and hips can settle into a medium-firm mattress just enough that the lumbar (lower-back) region is supported and remains concave. When you’re on your stomach, your belly is both cushioned and held up, not caved in and forcing your lower spine into the shape of a hammock. When you’re on your side, there’s enough cushion to support your shoulders, hips, and knees, but not so much that your spine flexes or twists.

A graphic depicting three people sleeping (a back sleeper, side sleeper, and stomach sleeper), with red dots indicating the pressure points for each sleeping position.
Pressure points are the bony or heavier parts of your body that press against the mattress. Adequate cushioning enhances comfort and prevents soreness. llustration: Sarah MacReading

The “firm” part of medium-firm keeps the spine aligned. If you were to take a picture of yourself in each of these three sleep positions (a good thing to do when you’re shopping, as our mattress-buying guide suggests), your spine should appear neutral. You want a straight line from your neck to your lower back to your knees when you’re sleeping on your back or stomach. When you’re sleeping on your side, that straight line should run from the midpoint of your ears to your shoulders and then to your hips. (See the ideal-spine-support illustration below.)

However you like to sleep, bring your pillow when you shop (our pillow guide can help you find the best one for your favorite sleep position). Spend at least 15 minutes on the mattresses you’re interested in and zero in on your spine: It should feel relaxed, not flexed or strained. At the same time, your body should feel cushioned, rather than pressed against the surface of the mattress.

A graphic depicting three people (a back sleeper, side sleeper, and stomach sleeper) with their ideal spine alignment while sleeping.
To avoid aches and pains in the morning, when you’re sleeping, your body should be roughly straight, in “neutral” alignment. llustration: Sarah MacReading

If you already have a medium-firm mattress but are still experiencing back pain, your mattress could be too old. “Whenever patients tell me that their back pain is the worst first thing in the morning, one of the things I always ask is, ‘How old is your mattress?’ They often say, ‘I don’t know, maybe 20?’ or some big number. But we know that mattresses usually don’t last more than 10 years, depending on their materials,” said Marlís González-Fernández, MD, PhD, associate professor of physical medicine and rehabilitation at the Johns Hopkins University School of Medicine.

Research bears out those claims. A study conducted in 2008 asked 33 women and 29 men to record back and shoulder pain for 28 days in their own beds (which were on average 9½ years old) and then in new beds of similar quality. The researchers found that the new mattresses reduced back pain by 62.8% and stiffness by 58.4%. “Over time, the mattress can soften and sag,” said Bert Jacobson, EdD, lead author of the study and a professor of health and human performance at Oklahoma State University in Stillwater. “It becomes less good at aligning your spine.” Even if you start out with a medium-firm mattress, you might not actually be sleeping on one 10 years later.

Of course, we can’t know exactly what medium-firm feels like to you, so in this guide we’ve highlighted the models that we think will feel medium-firm to most people. In the chart below, we’ve arranged our picks and Notable contenders in terms of firmness (in our opinion) relative to one another. If you tend to fall asleep on your side, start by considering the mattresses toward the upper half of the chart. If you find yourself more often than not on your back or stomach, consider the mattresses toward the lower half. In our guide, we start by listing the softer mattresses first and move toward increasingly firmer mattresses toward the end.

An illustration showing the firmness of each mattress tested for this guide.
Illustration: Sarah MacReading

Whatever you decide, take advantage of trial periods and return policies. Ideally you should test out a mattress for at least 60 days, said González-Fernández: “Trying a mattress for a long time is important and can help make sure that a mattress works for a particular person.”

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