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by Dr. David Borenstein, Medically Reviewed by Dr. C.H. Weaver M.D. 4/2022

I am frequently asked the question, “Which bed should I get to relieve my back pain?” I tried to answer the question in my book, Heal Your Back: Your Complete Prescription for Preventing, Treating, and Eliminating Back Pain. My suggestion at the time after looking at what was available in the literature and my own personal experience was a moderate firmness mattress with a pillow top cushion.

More recently, a similar question was asked by Caggiari and fellow authors – What type of mattress should be chosen to avoid back pain and improve sleep quality? The authors realized that correct mattress firmness may have an impact on surface sensitivity and alignment of the spine that will decrease the risk for LBP.

They reviewed available literature from 2000 to 2019 and examined 323 potential studies. They found 39 articles worthy of inclusion. Caggiari et al. analyzed mattress firmness according to the European Committee for Standardization as soft, medium-firm, extra-firm, or customized to avoid decubitus ulcers. In a study of individuals who slept on spring mattresses, who were switched to medium firmness mattresses for 28 days versus a control group, the medium firmness group had less back pain progressively improving from week one to four. In another study of 313 adults with chronic low back pain, patients who slept on moderate firmness mattresses had higher level of improvement in terms of pain and disability.

Another form of moderate firmness was generated by overlay systems on top of a mattress. Air pillows or cushion tops could modify firmness. Studies demonstrated benefit in pain relief and sleep quality with overall systems. Also of interest was sleep quality related to body temperature. High-thermal capacity mattresses caused a reduction in temperature of proximal skin on the back and core body temperature and an increase in sleep continuity.

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The authors explain why mattress firmness influenced back pain. Too firm mattresses do not let the shoulders sink, leading to a lack of support for the neck and shoulders and increasing the lumbar lordosis. Too soft a mattress allows the hips and shoulders to sink too much causing spinal column malalignment.

So over time, additional evidence to support my Heal Your Back recommendation came to pass. My other recommendation is to test drive your selection. Rest on your selection for at least 20 to 30 minutes before making up your mind. If you start to hurt at 10 minutes, another few additional hours will not make it better.


  1. Caggiari G et al. What type of mattress should be chosen to avoid back pain and improve sleep quality? Review of the literature. J Orthop Trauma (2021) 22:51