Best Mattresses for Back Pain

“Unless you sleep on your stomach, choose a feel from the middle of the firmness scale with firmer support under the hips, and buy from a seller that takes the mattress back if your back disagrees.”

Medium-firm suits most backs, firm suits fewer than you think

The old idea that a bad back needs a rock-hard bed does not hold up. In a 2003 Lancet trial of 313 adults with chronic low back pain (Kovacs and colleagues), people given a medium-firm mattress reported less pain in bed and less disability after 90 days than people given a firm one. That medium-firm mattress rated 5.6 on a European scale that runs from 1, the firmest, to 10, the softest, so it sat close to the middle, while the firm one rated 2.3. US product pages usually run their scales the other way, with 10 as the firmest, and most label medium-firm as 6 or 7 out of 10.

Firm still has a place. If you sleep on your stomach or are a heavier sleeper, a softer bed lets the hips sink and the lower back arch, and a firmer surface keeps you level.

Match the bed to how you sleep

• Back sleepers do best with extra support under the lower back, plus a pillow or rolled towel under the knees.
• Side sleepers need a softer top layer so the shoulder and hip can settle in while the waist stays supported. Medium is usually the right feel, with a pillow between the legs.
• Stomach sleepers need a firm surface.
• Combination sleepers do better on a responsive hybrid than on slow-recovering foam.
• Heavier sleepers should pick the firmer version of a model and look for a coil core with reinforced edges.

Both pillow tips, under the knees on your back and between the legs on your side, come from the MedlinePlus guidance on low back pain.

Hybrid, innerspring or foam

Material matters for what it does to firmness and support. Most picks in this ranking are hybrids or innersprings, which can zone their coils firmer under the hips and make turning over easy; the wider field is ranked in our hybrid mattress comparison. All-foam beds isolate motion and relieve pressure well. Foam that is too soft or worn is a common reason memory foam gets blamed for back pain.

Let the trial decide

Give your back a month or more to judge a new mattress. Most picks here let you return the mattress within a year, yet the terms are not all equal. Some brands charge a return or pickup fee, and Brooklyn Bedding takes a mattress back only after 30 nights, so read the cons on each card before you order. For the whole market, start with our best mattresses ranking.

The ranked picks side by side