What mattress firmness is best for people with low back pain?

Published 1:30 am Friday, September 26, 2025

Last month, I came across a post in a Facebook community group that asked members to share health questions they were interested in learning more about. While all were great questions and likely pertained to most people in the group, one in particular caught my eye.

“What mattress firmness is the best for people with low back pain?”

This is a frequently asked question, and one that has a fair amount of research surrounding it. It’s also an interesting question that is more nuanced, as low back pain is a symptom rather than a diagnosis. There are many reasons why our backs hurt; therefore, one-size-fits-all questions can be difficult to answer.

Nonetheless, if I were to do my best to answer this individual’s question from a 30,000-foot view, I would reference a couple of research articles.

The first is a large study published in 2003 in The Lancet, one of the most respected and influential medical journals in the world. This study consisted of 313 adults with chronic low back pain who experienced back pain when lying in bed and rising from bed. These individuals were randomized into two groups: a firm mattress group and a medium-firm mattress group. After 90 days, individuals using medium-firm mattresses reported less pain when lying in bed, rising from bed, and experienced less disability compared to those using a firm mattress.

This conclusion was supported by another study on mattress firmness, published in 2009 in the Journal of Chiropractic Medicine. This paper included 59 participants, whose own mattresses were compared to a medium-firm mattress. Everyone in this study used their own mattress for 28 days, followed by a medium-firm mattress for 28 days. The results showed that sleeping on a medium-firm mattress reduced back pain and improved sleep quality compared with participants’ own mattresses.

Based on the information from these studies, it would appear that a medium-firm mattress would be a good choice for many people with low back pain. This makes sense, as mattresses should provide the right amount of support as well as accommodation for your spine.

And while this information is helpful for individuals who experience low back pain when trying to sleep, there are other aspects of self-care that may be even more important than proper mattress selection. For example, what you do in the hours preceding bed can have a significant impact on back pain when trying to sleep. If you sit and watch television or do another seated activity in the hours before bed, paying attention to your posture is absolutely critical. Many people with low back pain are sensitive to poor sitting posture, which often makes their backs more vulnerable at night. Therefore, if you are going to sit for any length of time prior to bed, ensuring upright posture is likely more critical than mattress firmness in promoting back health.

Dr. Jordan Duncan is from Kitsap County and writes a monthly health column for Kitsap News Group. He is the owner of Silverdale Sport & Spine.