Mattresses for Bad Backs - Firm or Soft?

Matress Firmness
Is your mattress firm or soft?. Soren Hald Collection: Stone

If you're one of the over 70 million Americans who deals with pain, a lot may be stacked against you at bed time. And, as someone with chronic neck or back pain, you likely know first-hand how pain can limit things like the number of hours of sleep you get per night, how restful the sleep you do get is, how well you function during your waking hours, and how satisfying, overall, your sleep is to you.

Perhaps worst of all is the nasty habit chronic pain has of curtailing your ability to fall asleep.

One of the biggest obstacles to sound sleep for people with neck or back pain is using the wrong mattress. The key to mitigation is to match the degree of mattress firmness (or lack of,) to your back’s uniquely individual needs for support and comfort — which is often a very individual and personalized choice.

When you think about it, shopping for a mattress could even be considered a component of your pain management plan. But’s a process, and to truly successful as mattress shopping, you need to allot ample time. I personally start way in advance (like a year or two), so that I can, with minimal stress and disruption to my usual routine, fully evaluate the brands and models that are on the market, especially in terms of how each interacts with my spine.

Of the numerous considerations that come with mattress shopping, the question people most frequently want to know is: How hard, or soft, should it be?

I asked Dr. Michael Perry, M. D., Medical Director of the Laser Spine Institute in Tampa, FL, for his recommendations. He advises staying away from either extreme (of hardness or softness) when selecting a mattress, stating that studies generally find a medium-firm mattress does the trick for most types of back problems.

Perry's clinical experience bears out these results, as well, he informs me.

There's nothing like a good dose of facts, so here's a quick run down on mattress firmness research as it relates to back pain.

Temporary Back Pain from Foam Mattresses Survey

One hundred Indian medical residents who slept on foam mattresses were surveyed about the effects on their spines. The mattresses in question were 10 centimeters in thickness — the kind one might find in a youth hostel. The residents experienced temporary backaches from the mattresses, but not the type that is also accompanied by nerve symptoms such as sciatica, radiculopathy, or parasthesia (pins and needles.)

The sleep-induced pain was relieved for most of the residents (61%) once they returned to their own beds, and it came back when they once again slept on the foam.

Soft, Medium or Hard? A Randomized Controlled Trial that Evaluated All Three Mattress Firmness Levels

In an effort to confirm whether hard mattresses have a positive effect on chronic low back pain (as is commonly believed), 3 groups of study participants slept, for 1 month, on 3 different mattress firmness.

The “soft” mattress group slept on a water bed (an Akva). Another group slept on a Tempurpedic mattress, which is known for its ability to conform to your body shape, while at the same time providing support.

 And the “hard” mattress group slept on a futon.

Overall, the researchers found, participants favored the water bed and foam (Tempurpedic) mattresses the most for pain, ability to function and number of hours of sleep per night. That said, the difference in scores between these 2 types of mattresses and the hard mattress was small.

When asked, Perry said that a Tempurpedic with a dial-in firmness feature would be his top choice. The reason, he explains, is that if you need more support, you can get it simply by adjusting the dial.

“The beauty of Tempurpedic is that you can get support where you need it.

You can also get softness where you need it,” he adds.

He adds that a dial-in water bed also has advantages. More water equals more firmness, he tells me.

“Just remember not to dial in so much water that your mattress bursts,” he quips.

On the flip side (though more seriously), Perry says that if you don’t dial in enough water, your water bed mattress may surround and enclose your body, which can decrease the quality of your sleep.

In fact, he adds, “some of my patients report they feel smothered in a water bed when they don't dial in enough water firmness. "

This is because your lungs have less room to expand when you "sink" down into your mattress.  Of course, the cure is to firm it up by in dialing more water.

After that, you're ready to realize — in terms of restful repose — the benefits of having invested your time and attention into proper mattress selection and set up.


Bergholdt K, Fabricius RN, Bendix T.  Better backs by better beds? Back Research Center, Part of Clinical Locomotion Science, Backcenter Funen, Ringe, Denmark.  Spine (Phila Pa 1976).  2008 Apr 1;33(7):703-8.  http://www. ncbi. nlm. nih. gov/pubmed/14630439

Kelly GA, Blake C, Power CK, O'keeffe D, Fullen BM.  The association between chronic low back pain and sleep: a systematic review.  Clin J Pain.  2011 Feb;27(2):169-81.  doi: 10. 1097/AJP. 0b013e3181f3bdd5.

Kovacs FM, Abraira V, Peña A, Martín-Rodríguez JG, Sánchez-Vera M, Ferrer E, Ruano D, Guillén P, Gestoso M, Muriel A, Zamora J, Gil del Real MT, Mufraggi N.  Effect of firmness of mattress on chronic non-specific low-back pain: randomised, double-blind, controlled, multicentre trial.  Lancet.  Nov.  2003.  http://www. ncbi. nlm. nih. gov/pubmed/14630439

Koul PA, Bhat MH, Lone AA, Koul AN, Wahid A.  The foam mattress-back syndrome.  J Assoc Physicians India.  2000 Sep;48(9):901-2.

Perry, M.  MD.  Telephone Interview.  March 11, 2013.