What's the Best Orthopedic Mattress for Back Pain? Soft or Firm?

Updated 2026: If you’re suffering from a bad back, you’ll know all too well just how much of a nightmare getting a good night’s sleep can be. Recent statistics have shown that around 10% of people suffer from severe back pain in the UK, which can affect their sleep. This guide will help you pick a mattress that can help you get a decent night’s sleep if you suffer from back pain.

What does the research actually say?

A landmark randomised controlled trial published in The Lancet followed 313 people with chronic low back pain over 90 days. The findings were clear:

Those who slept on a medium-firm mattress reported significantly less pain and disability than those on a firm mattress.

The study concluded that the long-standing advice to sleep on a hard surface is not supported by clinical evidence. Read the Lancet study here.

Jump To:

1. Are firm mattresses good for bad backs?
2. What does the science say about mattresses and back pain?
3. What is an orthopaedic mattress?
4. Different types of back pain and what they mean for your mattress choice
5. How do you know if your mattress is causing your back pain?
6. What is the best mattress for a bad back?
7. Our recommended mattresses for back pain
8. How to match bodyweight and height in a mattress
9. Is a memory foam mattress good for a bad back?
10. Is a latex mattress suitable for a bad back?
11. Can a mattress topper help with back pain?
12. Chiropractors’ advice when choosing a mattress
13. Zip and link mattresses for bad backs
14. When should you replace your mattress?
15. Is your mattress suitable for your sleeping position?
16. Check your sleep hygiene
17. Get additional medical help
18. Frequently asked questions

Are firm mattresses good for bad backs?

One statement that seems to haunt us is, “My chiropractor told me to look for an orthopaedic or firm mattress to help my bad back“. We have investigated this to find out why certain Chiropractors recommend firm beds. The response has been that firmness is thought to help support the body.

This is where the confusion starts; firmness and support are two different things when choosing a mattress.

Firmer mattresses are not necessarily better for a bad back.

The British Sleep Council has also confirmed this, being quoted as saying, “Any reference to beds being orthopaedic – or similar medical-sounding terms – does not automatically mean that the bed has been professionally assessed or recommended – it is a term loosely used by manufacturers to refer to extra firm models in their range”.

This brings us to the most important thing to know when choosing a mattress for a bad back. Spring tension.

What does the science say about mattresses and back pain?

The research into mattresses and back pain is more robust than most people realise, and the conclusions consistently challenge the idea that firm equals better. Understanding what the studies actually show is the single most useful thing you can do before spending money on a new mattress.

The most frequently cited study on this topic was published in The Lancet in 2003. Spanish rheumatologist Dr Francisco Kovacs led a study involving 313 adults with chronic non-specific low back pain, tracking them over 90 days. Participants were randomly assigned to either a firm mattress or a medium-firm mattress. The results were straightforward: those on the medium-firm mattress reported meaningfully better outcomes for both in-bed pain and daytime pain-related disability. You can read the full Lancet study here.

A second study, published in Applied Ergonomics in 2008 by Jacobson, Wallace, and Gemmell, examined 59 healthy adults over a 28-day period. Participants who switched to a medium-firm mattress reported reductions in back and shoulder discomfort and spinal stiffness upon waking, alongside improvements in sleep quality. The researchers concluded that mattress selection is a clinically meaningful variable in back pain management.

A 2021 systematic review of the literature published via PubMed, covering multiple studies on mattress type and sleep quality, found that medium-firm pocket sprung and latex mattresses consistently produced the best outcomes for people with musculoskeletal complaints. The review also noted that very firm mattresses tend to create pressure points at the shoulders and hips, which can increase muscle tension and worsen pain. Read the systematic review here.

The NHS notes that the vast majority of back pain cases — around 90% — are classed as non-specific, meaning there is no single identifiable structural cause. The NHS back pain guidance recommends staying as active as possible and acknowledges that the sleep environment plays a role in symptom management. A mattress that holds your spine in a neutral, well-supported position throughout the night is the practical goal — and that almost always means medium-firm with the correct spring tension for your bodyweight, not an orthopaedic slab.

Notably, none of this research endorses any particular brand or mattress type by name. The consistent finding is that medium-firm, correctly weight-matched support is what makes the difference — not a marketing label, a spring count, or a price point. That is exactly the basis on which we build every mattress in our range.

Choose the correct spring tension if you have a bad back

Choosing the correct spring tension for your body weight is essential. All quality mattresses should provide adequate support for your weight and height. Where most people fail when choosing a mattress for backache is that they fail to pick the right spring tension for their body weight.

Most retailers give a ‘firmness’ rating, but no spring tension.

Let’s explain why firmness and support are two separate choices:

• Firmness is the perceived tension or comfort of the mattress as experienced by the sleeper, provided by the upholstery, not the springs.
• Support is determined by your weight, since most mattresses are sprung unless you’re looking at a solid-core latex or foam mattress. The spring units will have a weight range which they have been designed and manufactured to accommodate.

Any half-decent mattress manufacturer or retailer should be able to tell you exactly what weight range their particular spring tensions are suited for. Unfortunately, they probably won’t have a clue and will just ask you to lie on it, maybe telling you that it’s ‘individual preference’.

A spring unit must be designed with load-bearing capacity in mind; this is fundamental to the laws of physics. If not, the manufacturers are just guessing, and given the multi-million-pound bed industry, there’s no way spring manufacturers are going to risk a guess at a specification.

A good example of spring tolerances is our Artisan range, which comes in 3 spring tensions, making split tensions and zip-and-link mattresses truly bespoke. Below is the table showing the weight tolerances of these springs. There is some give-and-take needed, especially when you’re on the cusp, such as 10-stone or 16-stone sleepers. This is where our team’s expert advice can really help you make an informed decision.

What is an orthopaedic mattress?

An orthopaedic mattress is simply a term the industry came up with years ago to refer to a super-firm spring tension or support unit in a mattress.

An orthopaedic mattress is any spring unit that uses a 1.94mm 12-gauge spring. This is the firmest gauge wire you can use in a conventional mattress spring. They are uber-firm, very unforgiving, and, in our experience, will suit only a tiny fraction of the bed-buying public.

The issue with orthopaedic mattresses is that they have come to be known as mattresses for bad backs. These orthopaedic models are usually far from suitable for people with a backache.

Why are orthopaedic mattresses unsuitable for most people?

They are unsuitable because, unless you’re weighing in at the 18-stone-plus bracket, the springs will have zero function. They will struggle to compress or offer any give to most sleepers. It’s the equivalent of sleeping on a table for most. You will effectively be making your back conform to the mattress rather than the mattress conforming to your most comfortable natural spine position.

Unless you really like an extra firm sleeping surface with no give, we advise avoiding orthopaedic mattresses if you have a bad back.

Different types of back pain — and what they mean for your mattress choice

Back pain is not one single problem. The location and nature of your discomfort can point towards very different mattress requirements, and treating a herniated disc the same way as general lumbar tension is a common mistake. Getting the right match starts with understanding what type of back issue you are actually dealing with.

We always recommend speaking with your GP or a physiotherapist before making a major mattress decision, particularly where there is a specific diagnosed condition. What we can offer below is the practical mattress perspective based on 25 years of working with customers who have each of these conditions.

Lower back pain (lumbar)

Lower back pain — whether from muscle tension, lumbar ligament strain, or general wear — is by far the most common type we hear about. The lumbar region needs to be gently supported in its natural inward curve (lordosis) rather than pushed flat by a too-firm surface or allowed to sag by a too-soft one. A medium-firm pocket-sprung mattress with adequate comfort layers is typically the most effective choice here, as the springs provide weight-appropriate support while the upholstery fills the natural gap at the lower back.

If your lower back pain is worse first thing in the morning and eases as the day progresses, this is a strong signal that your mattress is either too firm (which creates pressure at the hips) or too soft (which allows your spine to sag overnight). Our Artisan Naturals and Origins 1500 are frequently chosen by customers with lumbar issues, available in multiple spring tensions to match your bodyweight precisely.

Upper back pain (thoracic)

Upper back and thoracic pain often relates to shoulder and neck alignment rather than the mattress support layer itself. Side sleepers with upper back pain, in particular, need a softer comfort layer at the shoulder so the joint can sink slightly, keeping the spine straight rather than creating a lateral curve towards the shoulder. Stomach sleepers with upper back issues should really consider changing position if possible — sleeping on your front puts the cervical spine into rotation for hours at a time, which rarely helps thoracic problems.

Our Artisan Naturals, with its generous natural Wool and Cotton comfort layers, tends to perform very well for customers with upper back and shoulder tension.

Sciatica

Sciatica — pain that radiates from the lower back down through the buttock and leg along the sciatic nerve — is particularly sensitive to hip position during sleep. The key priority for sciatic pain is avoiding pressure on the hip and piriformis area, which means side sleepers will usually benefit from a softer comfort layer at the hip, while back sleepers need a mattress that maintains the lumbar curve without tilting the hips.

Many of our customers with sciatica tell us that sleeping on their non-affected side with a pillow between the knees provides the most relief — a simple adjustment that takes pressure off the sacroiliac joint and reduces sciatic nerve compression. A mattress that is too firm compounds this by creating an unrelenting pressure point at the hip. If your sciatica is undiagnosed, please do consult your GP or a physiotherapist. The NHS has helpful guidance on sciatica here.

Herniated or slipped disc

A herniated disc occurs when the soft inner material of a spinal disc pushes through the tougher outer layer, often pressing on nearby nerves. It is most common in the lumbar region. People with a herniated disc typically need a mattress that keeps the spine in neutral alignment without any sagging, which makes medium-firm pocket sprung the common recommendation. Very soft mattresses are generally ill-suited here, as they allow excessive spinal flexion overnight, which can aggravate the affected disc.

It is worth noting that Spine-Health expert guidance published by Spine-Health consistently recommends medium-firm support for disc-related lower back conditions, with particular emphasis on maintaining the natural lumbar curve and avoiding mattresses that sink in the middle.

Arthritis and joint pain

Osteoarthritis in the spine and joints introduces a different set of needs. The priority here is pressure relief alongside support — a mattress that is too firm creates sustained pressure on already-inflamed joints, while one that is too soft fails to maintain alignment. Natural Latex is a genuinely excellent choice for arthritis sufferers because of its progressive compression properties: it yields gently under pressure without fully bottoming out, providing that combination of cushioning and support that foam and springs alone often struggle to replicate.

Our Artisan Latex (king size from £2,250) combines a pocket sprung core with a natural Latex comfort layer and is particularly well regarded by customers managing joint conditions and inflammatory pain.

Fibromyalgia

Fibromyalgia brings widespread musculoskeletal pain and heightened sensitivity to pressure across the body. People with fibromyalgia often find firm surfaces almost intolerable, as the increased sensory sensitivity means even normal contact points feel painful. A medium to medium-soft comfort layer with a high natural fibre content tends to be the most effective approach, providing gentle contouring without the heat retention that synthetic foam layers typically bring — fibromyalgia and overheating in bed are an unfortunately common combination.

We have a dedicated guide to mattresses for fibromyalgia if this is your primary concern.

How do you know if your mattress is causing your back pain?

This is one of the most common questions we are asked, and it is a genuinely useful one. Back pain has many causes, but if the pattern of your discomfort follows your sleep rather than your daytime activities, your mattress is the first place to look. Here are the clearest signs that your current mattress is the culprit.

Your back is worse first thing in the morning. If you wake with stiffness, aching, or pain that noticeably improves within 20 to 30 minutes of getting up and moving around, this is one of the most reliable indicators that your sleeping surface is the issue. Daytime back pain that is not related to how you slept is more likely to be postural or activity-related.

You sleep better elsewhere. If you notice that nights in a hotel, at a relative’s house, or on a different surface result in less morning pain, the evidence is fairly compelling that your own mattress is contributing to the problem.

Your mattress is over eight years old. The internal spring structure and comfort layers of a mattress degrade significantly over time, even if the surface looks intact. An older mattress may no longer provide the support it originally offered, leading to gradual increases in back and joint discomfort that are easy to attribute to other causes.

You can see or feel visible sagging or body impressions. Even relatively modest dips in a mattress’s surface can cause the spine to remain curved for hours each night. Settlement and body impressions are a natural part of mattress wear, but when they become pronounced, they signal that the mattress can no longer support you properly.

You find yourself adjusting position repeatedly through the night. If you are frequently waking to change position because you cannot get comfortable, your mattress is likely creating pressure points that your body is instinctively trying to escape. This broken sleep pattern makes pain worse by depriving your muscles of the overnight recovery they need.

Your mattress is the wrong tension for your bodyweight. A spring tension that does not match your weight will either hold you on the surface, like on a table, or allow you to sink through it. Both scenarios lead to the spine being held in an unsupported position and will produce exactly the kind of morning stiffness and aching that gets blamed on simply having a bad back. Our expert team is available on 0161 437 4419 to help you work out the right specification.

What if you like a firm mattress?

People who love a firm mattress can achieve the same feeling but with much better, body-specific support, by allowing the upholstery layers to provide the firm feel and not a super rigid spring mechanism.

We list our ranges based on the feel of the upholstery layer, not just the spring unit, which shows you that you can get that firm feel without crippling your back or settling for a useless, heavy-gauge support unit.

Our Origins Reflex and Artisan Bespoke are excellent examples of a firmer feel in the upholstery layer, whilst featuring spring units forgiving enough to accommodate your weight properly.

Cage sprung orthopaedic mattresses

One thing to bear in mind is that many orthopaedic mattresses are made with the dreaded cage-sprung or open-coil spring system.

Avoiding cage-sprung mattresses is essential if you have a bad back.

We have written scathing reviews of these monsters here on the site. You should definitely be asking what type of spring unit you’re looking at if you are adamant that an orthopaedic mattress is the one for you. A number of them are made from cage-sprung support units as they are cheap, easy to make, and can utilise very thick wires with much less precision and skill than a pocket spring unit can.

What is the best mattress for a bad back?

If you have a bad back and are struggling to sleep, it is usually because your mattress is aggravating your back issues — it’s not suitable. The best mattress you can choose if you have a bad back is one that can be customised to your body weight and sleeping requirements. This means a pocket-sprung and upholstered mattress. These types of mattresses have the most variables, so you have a far better choice when finding a truly suitable mattress for your particular bad back.

If you have a bad back, the best mattress is one that has the following properties:

1. The correct spring tension/gauge for your body weight
2. Enough comfort layers to allow some sink in the top layer
3. A pocket spring unit that can individually contour to you
4. Limited transference (movement) when your partner or you move, to limit disturbance
5. A natural fibre mattress that is breathable to avoid overheating
6. A two-sided mattress model so you can turn it and even out settlement (avoiding dips)

Our recommended mattresses for back pain

Every mattress we make is available in the correct spring tension for your bodyweight, which is the starting point for all back pain recommendations. The table below shows our most-recommended models for people with back issues, with honest assessments of what each one is best suited for. All prices shown are king size from our November 2025 price list.