Having a mattress that is considered too old, too hard, or too soft, is commonly view as a contributor to developing low back pain. Since lower back symptoms (e.g. pain, stiffness) commonly present first thing in the morning for many people, it is easy to see how one might think their symptoms are related to something in their sleeping environment.
A large array of companies promote special mattresses for low back pain and many people struggling with low back pain flock to buy them. But what is the evidence for the role of mattresses in low back pain?
It may surprise you to learn that there is no study available assessing the relationship between mattresses and the development or maintenance of low back pain. So, we are unable to say with any confidence if mattresses have any role in low back pain.
One trial published in The Lancet examined the effect of different types of mattresses on treating chronic low back pain. In the trial, people either received a firm mattress or a medium-firm mattress. At 90 days, patients with medium-firm mattresses had better outcomes for pain in bed, pain on rising, daytime pain and disability than did patients with firm mattresses.
Overall, while there are several claims made about the role of mattresses in low back pain, the evidence is very limited to support their role in the development of low back pain.
One trial found that people with chronic low back pain benefit more from a medium firm mattress compared to a firm mattress, so if choosing a mattress maybe a medium-firm (not too hard, not too soft) one would be worth considering.
But, since the overall evidence is not convincing for mattresses, the best advice would be
1. Pick a mattress you personally find comfortable
2. Be wary of advertisements for expensive mattresses promising to cure low back pain. Most of these mattresses have never been tested scientifically.
3. Look at other factors – beyond your mattress – that may be impacting your sleep (e.g. caffeine, lack of routine, stress, etc). Poor sleep can contribute to low back pain and is always worth addressing as part of your treatment plan.
Refs: Kovacs FM et al. Effect of firmness of mattress on chronic non-specific low-back pain: a randomised, double-blind, controlled, multicentre trial. The Lancet. 2003 Nov 15;362(9396):1599-604.
Kelly GA et al. The association between chronic low back pain and sleep: a systematic review. The Clinical journal of pain. 2011 Feb 1;27(2):169-81.