Is a firm mattress better for your back?

Getting a good night’s sleep is crucial for both physical and mental health. However, many people struggle with back pain that severely interrupts their sleep quality and daily functioning. One important factor that can contribute to or exacerbate back pain is an unsuitable mattress that fails to properly support the spine.

This raises a critical question for those seeking back pain relief – is a firm mattress inherently better for your back and spinal alignment than a soft mattress?

This comprehensive article examines the evidence around mattress firmness and spinal support in detail. We’ll compare the pros and cons of firm and soft mattresses, analyze what scientific research says about firmness and back pain, and give you expert tips for choosing the ideal mattress firmness for your specific needs and preferences.

What Makes a Mattress Truly Supportive for Spinal Alignment?

Not all mattresses are created equal when it comes to providing optimal support for the spine and reducing back pain. There are several key factors that affect a mattress’ ability to properly align the spine and alleviate pressure:

Conforming to natural spinal curves
  • Contouring to the natural spinal curves: The spine has three distinct curved regions – cervical, thoracic, and lumbar. A high quality supportive mattress accommodates and fills in these curve contours in the neck, mid back, and lower back rather than bending the spine out of its natural aligned position.
  • Cushioning at pressure points: The main pressure points during sleep are the hips and shoulders. A mattress with suitable cushioning in these zones can prevent excess pressure and discomfort at the hips and shoulders which can radiate into back pain.
  • Responsiveness and support: While a mattress should adapt to the body’s natural contours, it also needs to provide adequate pushback support. The mattress should not allow excessive sinking which can strain the back’s muscles and joints.
  • Durability: The level of support and cushioning a mattress provides should not substantially deteriorate within the first several years of use. Loss of support over a short period can lead to back pain from improper spinal alignment.

Mattresses that fail to satisfy the above criteria of contouring, pressure relief, responsiveness and durability often end up overloading the spine’s delicate structures leading to muscle knots, joint irritation, herniated discs and other forms of back pain.

Understanding How Soft and Firm Mattresses Differ in Feel, Contouring and Support

Firmness is a spectrum rather than binary categorization, but mattresses are often characterized as either soft, medium or firm:

mattress firmness scale
  • Firm mattresses are more rigid and resilient, offering less “give” when bearing the sleeper’s weight. They contour minimally to the body and tend to keep the spine in a flatter, straighter alignment.
  • Soft mattresses compress more under the weight of the sleeper’s body, conforming closely and cradling the natural curves at the neck, shoulders and hips. They provide more “give” and adaptability around the body’s contours.

There are varying degrees and nuances of firmness and softness depending on mattress materials and construction:

TypeFirmness RatingFeatures
Extra Firm8-10Extremely rigid, almost no contouring to body, very hard surface
Firm6-8Solid, stable surface; minimal conforming contours
Medium Firm4-6Balances both support and responsiveness with body contouring
Plush3-5Adapts more closely to body contours with slight sinking
Extra Plush1-3Deep compression and cushioning against body shape

In general, back and stomach sleepers usually find better spinal support from a firmer mattress that keeps the back flat and aligned. Side sleepers often prefer a softer surface that cushions pressure points at the shoulders and hips. Combination sleepers who use multiple positions can benefit from a medium firmness level.

Examining the Rationale Behind the Theory That Firm Mattresses Prevent and Alleviate Back Pain

There is a prevalent theory that firmer mattresses provide optimal spinal alignment and support that helps prevent and alleviate chronic back pain. Here is a closer look at the rationale behind this theory:

  • Firm mattresses do not allow the mid-section of the body to “hammock” or sink too deeply into the mattress, which can put excessive arching strain on the back’s muscles and ligaments.
  • Soft mattresses that contour very closely can allow the spine to curve unnaturally into flexion or extension, over-stressing the spinal joints and surrounding tissues.
  • The rigid, inflexible surface of a very firm mattress provides uniform pushback support at all points and keeps the spine properly aligned in a neutral position without sagging.
  • Doctors, chiropractors and physical therapists frequently recommend switching to a firmer mattress for patients suffering from back pain presumably for these reasons.

This is a sensible theory, but conclusive evidence to back up these assumed benefits of firm mattresses for back pain sufferers has been lacking so far.

What Does the Current Research Reveal About Mattress Firmness and Back Pain?

Several studies have tried to determine whether mattress firmness has a measurable impact on back pain symptoms:

  • A study in 313 people with long term back pain found no significant difference in pain levels, disability or quality of life between those using medium-firm and firm mattresses over a 3 month period.
  • However, a smaller 2015 study found significant improvement in morning back pain and stiffness for a group of ROTC candidates switching from a soft mattress to a medium-firm mattress over 4 weeks.
  • A Spanish study exposed people with chronic back pain to mattresses with hard, medium-hard and medium surface firmness. They reported lower back pain sensitivity on the hard mattress surface than the medium-hard surface.
  • But another study comparing soft, medium and hard mattresses found no differences between groups in morning back pain and stiffness over a 6 month test.

The evidence overall seems mixed, suggesting individual physical characteristics and preferences play a major role in ideal mattress firmness. Specific body weight distribution, sleep position tendencies, injury history, and sensitivities may influence whether a firm or soft mattress provides more back pain relief for any given sleeper. More high-quality research is still needed to draw definitive conclusions.

Expert Tips on Choosing the Most Suitable Mattress Firmness for Your Back

Since research results are still inconclusive, here are some expert tips for choosing a mattress firmness that properly supports your back and sleeping style:

  • Carefully consider your regular sleep position(s): Back and stomach sleepers generally need firmer mattresses to keep the spine neutrally aligned. Strict side sleepers usually prefer softer mattresses to reduce pressure point discomfort at the shoulders and hips. Combination sleepers can benefit from a medium firmness level to accommodate shifting positions.
  • Think about your body frame and weight: Heavier individuals exert more pressure and require thicker comfort layers for support, indicating a firmer mattress. Lighter people require less support material so can find greater comfort on a softer mattress surface.
  • Factor in any existing orthopedic pain issues: Those already dealing with chronic back pain may gravitate towards a softer mattress for additional pressure relief and cushioning, but too soft can also allow poor spinal alignment resulting in pain. A firmer mattress can provide better support, but may not accommodate pre-existing sensitivities.
  • Don’t overlook personal comfort preferences: Getting a restful night’s sleep requires finding a mattress you inherently find comfortable and can fully relax into. Make sure to test different firmness levels to determine which feel best matches your individual preferences to ensure satisfaction.
  • Examine materials, quality and design: Superior materials like natural latex or high-density memory foam provide durable support and cushioning across a range of firmness levels. Quality mattress construction also determines performance – more doesn’t always mean better.
  • Consider using a mattress topper: Adding a thin comfort topper layer lets you modify the firmness of your existing mattress to finetune its support and feel.
  • Look into dual-firmness mattresses: Models with dual-sided firmness allow you to flip the mattress for a softer or firmer sleeping surface to match your needs.

Finding the sweet spot between comfort and support is the key to sleeping without back pain and waking up pain-free. Take time to test different mattresses with varying firmness during your search to determine the ideal fit. A high quality mattress well suited to your body and sleeping style can be a worthwhile investment in spinal health and restful sleep.

Warning Signs Your Mattress Is Exacerbating Back Pain and Needs Replacement

If you are waking up with chronic back pain and soreness every morning, your mattress may be to blame. Here are some telltale signs that your bed is no longer properly supporting your back and needs to be replaced:

Person sitting with back pain on bed due to mattress
  • You feel stiffness and numbness or tingling in your back when you get up in the morning that eases shortly after getting out of bed.
  • You frequently toss and turn at night trying to find a comfortable position, but still wake up with pain.
  • Your mattress sags or shows lasting body impressions where you normally sleep.
  • You sleep better and wake up with fewer aches and pains when sleeping in a hotel, guest room or other bed than your own bed.
  • Your mattress is over 7 years old. The materials and support break down over time.
  • Your back pain is worse at night or in the morning when lying down vs later in the day after being upright.
  • You feel like you sink too far into the mattress, throwing your spine out of alignment.
  • You feel additional pressure points on your hips and shoulders that radiate pain.

If you are experiencing any of these issues, it’s likely that your mattress lacks adequate support and needs to be replaced.Switching to a new mattress that better supports your back and sleeping style may significantly relieve back pain and stiffness.

When shopping for a replacement mattress, be sure to:

  • Lie down on mattresses for an extended period to assess comfort and support. Don’t just sit on the edge.
  • Carefully consider whether you need a firmer or softer mattress based on your sleep position, body type, and preferences.
  • Choose higher quality materials like natural latex and high-density foams which provide more durable support.
  • Avoid ultrasoft mattresses that lack adequate support unless recommended by a doctor.
  • Consider a medium firm or adjustable air bed if you and a partner have differing needs.

Investing in a supportive new mattress tailored your needs can greatly improve sleep quality and reduce chronic back pain over your old, worn out mattress. Give your back the rest it deserves.

Guide to Finding the Best Mattress for Your Back and Sleep Style

Finding the ideal mattress is key to reducing back pain and waking up feeling rejuvenated. Here is a step-by-step guide to choosing the best new mattress for your back and sleep style:

Step 1 – Evaluate your current mattress

  • How old is your current mattress? Mattresses wear down over 5-7 years.
  • Do you wake up with back pain and soreness? Sign of poor support.
  • Does your mattress sag or have impressions? Indicator it needs replacement.

Step 2 – Determine your optimal firmness level

  • Firmer if you primarily sleep on back/stomach.
  • Softer if you primarily sleep on your side.
  • Medium firmness if you change positions.

Step 3 – Consider your body type

  • Firmer if you are heavy/overweight. Less sink, more support needed.
  • Softer if you are petite. Less support material required.

Step 4 – Try different firmness levels in person

  • Lie on mattresses for 10-15 minutes to assess comfort/support.
  • Rank firmness feel from too soft/too firm to “just right”.

Step 5 – Compare mattress types

  • Memory foam conforms closely to the body.
  • Latex is responsive but provides more buoyancy.
  • Innerspring is traditional; many firmness options.
  • Hybrid combines foam and coils.

Step 6 – Examine materials and quality

  • Higher density foams and natural latex are highest quality.
  • More coils or thicker coils increase support and durability.

Step 7 – Consider customization options

  • Mattress toppers allow adjusting softness/firmness.
  • Adjustable air beds let you customize each side.

Step 8 – Don’t forget a supportive foundation

  • Platform bed or adjustable base is optimal.
  • Slatted base or box spring works for most mattress types.

Step 9 – Make the investment in your back health

  • Higher quality mattresses improve sleep and last longer.
  • Consider it a long-term investment in better rest.

Taking the time find your ideal new mattress pays off through years of reduced back pain and restful deep sleep. Don’t settle – finding the right match for your body and sleep style should be the priority.

Firm vs. Soft Mattress: Which One Should You Choose For Your Back?

The optimal mattress firmness is highly individual, but here are some general guidelines for choosing between a firmer or softer mattress depending on your needs:

Discover the advantages of firm vs soft mattress in this informative Infograph.

Firm Mattress Benefits

Good for:

  • Back and stomach sleepers – keeps spine aligned
  • People with chronic back pain – less “hammocking” effect
  • Heavier individuals – need added support
  • Those who prefer floating feel – less sinkage


  • Prevents midsection from sinking which strains back
  • Provides even support for proper spinal alignment
  • Less contouring can improve back pain for some

Potential Drawbacks of Extra Firm Mattresses

  • Can create pressure points at shoulders and hips
  • Not enough give for side sleepers
  • Some find overly rigid feel uncomfortable

Soft Mattress Benefits

Good for:

  • Side sleepers – cushions shoulders and hips
  • Those with sensitivity to pressure points
  • People with some types of back pain – curves around body
  • Individuals who prefer “sleeping in” feel


  • Accommodates shoulders and hips to reduce strain
  • Contours closely to spine’s natural curves
  • Provides pressure relief

Potential Drawbacks of Extra Soft Mattresses

  • Insufficient support – midsection can sink, straining back
  • Spine not kept in neutral alignment
  • May wear down and lose support faster

In general, medium to medium-firm mattresses provide the best compromise for support and contouring for the majority of sleepers. But individual factors make finding the ideal firmness a personal decision. Thoroughly test out different mattress firmness levels during your search to make the optimal choice for your back and body.

Moumita Ghosh

Moumita Ghosh

Moumita Ghosh is an experienced Sleep Health Educator and lead editor at From testing bedding to authoring guides on sleep hygiene, her aim is to assist readers in achieving restful sleep. She also stars in educational videos on our YouTube channel. Moumita graduated from King's College London with a degree in health science and a focus on sleep medicine. She has invested over a decade honing her expertise to measure and evaluate how products impact sleep quality. As an oft-cited authority on sleep products, Moumita steers millions of consumers toward personalized recommendations for everything from pillows to mattresses. Previously, she directed search and social media strategy for premier lifestyle brands at Harrods. In her free time, she enjoys outdoor activities, exploring new cafes, cuddling her furry friends, and of course - catching some quality shut-eye.

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