Updated: June 27, 2019
Choosing a Mattress for Back Pain
If you suffer from back pain and you're looking for the best mattress, you'll have to navigate through a lot of misinformation. You may have heard that if you have back pain, the best mattress is a firm mattress. You may have read about a study out of Spain that found that a mattress with medium firmness improved pain among the 313 study participants. The truth is that there's no one answer for everyone suffering from back pain.
A good general guideline for people with back pain is:
- Side sleepers need a softer mattress.
- People that sleep on their back need a firmer mattress.
- People under 130 lbs tend to need a softer mattress, between 130 and 230 a medium firm mattress, and those over 230 lbs need a firm mattress.
- Stomach sleepers need a firm mattress (though this is the worst position for sleeping and can cause back and neck pain).
Those are general guidelines and it can be different for everybody. The best way to know if you need a softer or firm mattress is to sleep on different mattresses. You can get an idea by laying on a mattress in a store, but it's not the same as spending a whole night on one.
If you're not able to try out different mattresses, the good news is that many mattress companies will give you 30 days to make sure you're happy.
For our top choices, we chose the mattresses that tend to be more in the middle (medium firm) to accommodate most sleepers.
We begin every review with an in-depth research phase on both what your body needs (especially in the case of back-pain sufferers) in a sleep product and what products are available to meet those needs. We draw from extensive first-hand experience with both traditional coil spring mattresses and modern memory foam or gel mattresses. We conduct interviews with doctors and chiropractors to get an idea of what medical professionals are recommending.
The final part of our research phase is establishing a set of criteria we use to evaluate the mattresses on the market. These criteria keep things unbiased and objective when we make a recommendation.
- Price - prices of mattresses have come down dramatically over the years but there is still an incredible variation in price, mostly due to branding and claimed unique benefits.
- Warranty - a solid, long term warranty is normally good evidence of a quality mattress. Companies that offer 5 or even 10-year warranties stand by their products and ready and willing to make sure you are happy throughout the life of the mattress.
- Firmness - While there isn't a specific firmness level that works for everyone, we look for mattresses that match popular sleeping positions and user weights. For example, there are mattresses, especially softer side that isn't great for the vast majority of people. This makes it hard to recommend them for anyone other lightweight sleepers.
- Cooling Ability - most everyone wants a mattress that prevents them from overheating. Nearly all the mattresses available today claim to help with cooling, we'll help you confirm this.
- Durability - It's especially important that your mattress supports you properly right away and throughout the life of the mattress. We look for mattresses that do not deform significantly over time.
- Customer Service - A quality mattress is an investment and if you have an issue its important to a company and customer service team that will help answer your questions, and make sure you're happy with your purchase.
- Length of Home Trial - In addition to a long warranty, a long in-home trial is a great indicator of a mattress company's willingness and confidence to make you happy. In-home trials really take the risk away from you as a consumer.
The great news about our top mattress choices is that the mattress industry is changing, saving consumers lots of money. The old way to buy a mattress: go to a mattress store, lay on several beds, and talk to a salesperson who is fighting for their commission in a very competitive industry. The new way, buying directly from the manufacturer via the internet has eliminated the middle man. When you buy directly from the manufacturer, the price isn't inflated with all of the additional expenses that you have with a brick and mortar store (salesperson commission, rent, heat, electricity, etc.) According to Tuft and Needle, a mattress from a brick and mortar store that costs $3,500 only costs $300 to make! So the principle "you get what you pay for" doesn't apply when you're comparing a mattress from a brick and mortar store and online retailer. Now you can buy a mattress from an online retailer for significantly less and get a much higher quality mattress.
All of our top choices are under $1,000. We didn't include any of the ultra expensive mattresses in this review as they're out of the budget of most shoppers. The mattress industry has changed significantly in the last few years and the good news is that you can save a lot of money by avoiding the middleman, and you can avoid a lot of misinformation. All of our top choices are sold online.
When my wife and I shopped for our new mattress, we went to 8 different retailers and were overwhelmed with information. Some of the things we were told contradicted what other salespeople had told us. One salesman even asked us who we had talked to previously, and started going into detail about what a charlatan one of our previous salesmen was! I guess it shouldn't be a surprise that each salesperson in incentivized to tell you that their product is the best, whether it's best for you or not.
All of our top choices have in-home trial periods so if you don't like the mattress, you can return it risk-free.
If you've never shopped online for a mattress, there are pros and cons. The main pro is that you're probably going to save a significant amount of money. The main con is that you can't try out the mattress in a store, you have to try it out in your house. If you choose a mattress that has a 100-night in home trial, you'll have the option of returning it.
Another con of shopping online, if you're a review reader, is that sometimes it can be tricky finding honest reviews. Mattress companies will pay people for positive reviews of their products and negative reviews of competitors. If you read a lot of reviews as we do, sometimes you'll find a high number of reviews of a mattress by people that are making a lot of grammar mistakes; that's a clue that there could be a lot of paid reviews. However, if you go into a store and buy from a salesman, you can't necessarily trust them either! So either way, there can be a little work involved.
One option you have is to check out some of the online mattresses in some high-end retailers like West Elm. You may only find a couple of mattresses that are sold online, and not in all of the West Elm or high-end retailer locations, but it's a possibility that you'll get to check them out without having to order them.
Many mattresses will have a warranty that's 10 years or more in length, but you have to be careful about the "prorated phase," which means that the owner must pay a percentage of the original price to have their mattress replaced or repaired. Make sure you find out how long the non-prorated phase lasts.
Pay attention to indentation depth. Some warranties will use this terminology to differentiate between normal indentations and those that will be covered by the warranties. The range is generally between 1/2"-1.5" Those with back pain will want a warranty that covers at least 1" indentations, and preferably even smaller.
Off-Gassing and VOCs
Offgassing is when a product gives off a chemical smell that comes from the foam, flame retardants, and/or the adhesives. Besides the smell, these volatile organic compounds (VOCs) can include harmful chemicals such as formaldehyde, trichloroethanechlorofluorocarbons, benzene, methylene chloride, toluene, naphthalene, and perfluorocarbons. Some manufacturers claim that exposure to off-gassing isn't harmful, but I personally don't buy it. These manufacturers claim that no studies have shown that memory foam causes cancer. Some people seem to experience issues while others don't; those with asthma or other respiratory issues may want to avoid mattresses that offgas. You will have to decide for yourself whether this is an issue for you.
We know that everyone is different and when it comes to shopping for a mattress this is even more so the case, especially for back pain sufferers. your body, sleep habits, budget, and preferences will make selecting a mattress something that is truly unique to you. Here are the common categories we get asked about:
Tuft & Needle
- Tuft & Needle has received a ton of positive reviews and is one of the cheapest mattresses.
- Sleeps cool
- Medium firmness
- 100-night sleep trial
- 10-year warranty
- Tested and certified by CertiPUR-US, OEKO-TEX, and GREENGUARD Gold
- Made in the USA
Best Value Runner Up
- Our runner up to top choice because of the price, gel-infused foam for cooler sleeping, it's hypo-allergenic, and it's 12" foam layer.
- One of the highest rated mattresses
- Medium firmness
- Sleeps cool
- 12″ of foam and 3 layer gel & foam system
- CertiPUR-US certified
- 10 year warranty
- The Zinus Memory Foam Mattress is one of the most cost effective mattresses out there with nearly all the features we look for at an extremely competitive price.
- Overkill 10 year warranty (don't use your mattress for 10 years)
- Unique use of Green Tea extract to keep the mattress fresh
- Available in 4 different thicknesses
- Medium firmness
Best Budget Runner Up
- If you're on a tight budget the Memory Foam Mattress from AmazonBasics is about as cheap as it gets.
- Designed with a soft to medium firmness for all sleep positions and ideal for lighter weight sleepers
- Available in three different thicknesses
- 1 year limited warranty
- Can take up to three days to fully expand
Best for Multiple Sleep Positions
- The Leesa mattress offers a Universal Adaptive Feel that adapts to all body types and sleeping styles, great for couples with different sleep habits
Notes on our Top Choices
Tuft & Needle
Tuft & Needle is one of the early leaders in the online mattress space. Their main focus for several years has been to create mattresses that have 3 things: pressure relief, support, and cool sleeping.
They found that their original mattress was good, but customer happiness plateaued until their chemist developed their Tuft & Needle adaptive foam that has a mix of gel and graphite. It allows for heat to disperse, is a medium firmness which will give a mix of softness and support for most sleepers, and enough give to not disturb your partner.
Their mattress is certified by CertiPUR-US as being free from harmful chemicals and carcinogens, PBDEs, heavy metals, phthalates, and formaldehyde.
The mattress is 10" thick: the top layer is 3" thick, comprised of T & N adaptive foam. The bottom 7" is the support layer. The two layers are glued together by a rubber and water mixture which doesn't come into contact with your skin and is certified by OEKO-TEX to be free from chemical residues, phthalates, and heavy metals.
The mattress also includes a fabric fire barrier that's chemical-free. It goes over the mattress and is made of rayon, polyester, and silica (which doesn't make contact with your skin).
Some people have reported that the mattress was a little firm initially, but after using it for a few weeks it softened up. If after a few weeks it's still not soft enough, you may want to look into a mattress topper. Some reviewers have mentioned that you can call Tuft & Needle and they will send you one for free.
Tuft & Needle has a 100-night sleep trial, a 10-year warranty, and really good customer service. If you have any questions or issues, we have found them to be outstanding and a lot of reviewers report the same experience.
This mattress almost took the top spot. It's one of the highest rated on Amazon for several reasons.
First, users rated it as very comfortable yet supportive, note that it's on the firmer side.
Second, those with allergies, asthma, or other respiratory issues, or those who are very health conscious love that its CertiPUR-US certified, so it's low to no off-gassing from VOCs (volatile organic compounds), and it's resistant to allergens, mold, bacteria, and dust mites.
Third, it sleeps cool. This is probably due to the gel-infused foam in the top 3" of foam, as well as the second layer of foam having 3.5" of open-celled foam which allows air to circulate.
Lastly, and most important for some people, is the price it's the cheapest of all of our top choices.
The best feature of the Leesa is that it sleeps cooler than most mattresses. This is because of the Avena foam top layer that allows air to flow to keep the heat from being trapped under you. It also has a breathable cover.
Their "Universal Adaptive Feel" seems to resonate with side, back, and even stomach sleepers. It strikes a balance between comfort and support.
The Leesa is also a great looking mattress with its grey background and white stripes.
Their 10" mattress is similar in many ways to the Tuft & Needle but has a unique feature: Celliant cover that's supposed to speed up muscle recovery by increasing blood and oxygen into the muscles. This mattress is several hundred dollars more expensive than the Tuft & Needle but may be worth it for more active people.
Their foam is seven times cooler than most memory foam mattresses which can make a huge difference in the quality of your sleep. The top layer of memory foam is infused with graphite gel while the foam is open-cell that allows heated air to disperse.
Similar to the Tuft & Needle, their foam is Certi-PUR certified to have low VOC (volatile organic compounds) emissions, so they're free of heavy metals, phthalates, formaldehyde, and ozone depleters. They're both sourced and made in the USA.
Bear has a fraction of the reviews of Tuft & Needle, and they have a great average score, but if you read through the negative reviews you will see a wide range of complaints. "It's so soft I feel like I sink in and I can't get out," followed by "this thing is a brick." The Bear mattress doesn't have a 100-night trial like Tuft & Needle, so if you purchase it and find it too hard, you'll need to purchase a mattress topper to soften it up. If it's too hard, you'll have to put a board under the mattress to give it more support. We think this mattress is a great option for athletic people, but if you'd feel more confident with an in-home trial, as you can't try this out in stores, you'll want to look at our other top choices.
Mattress Material Types
Memory foam has air pockets inside and when you lay on it, it compresses the air pockets so there's no air circulation to disperse the heat. Higher body temperature isn't recommended for high-quality sleep. If you have or plan on buying a memory foam mattress, you may want to buy a mattress topper that has a cooling effect or purchase a mattress that has a cooling feature.
Inner Coil Spring
Spring mattresses are cheaper than memory foam, less durable, transfer motion to another person on the bed, and for 2 out of the 2 different types of coil mattresses, aren't recommended for people suffering from back pain.
There are 4 types of innerspring mattresses, which are the traditional mattress that has been around for a long time: continuous coils, Bonnell coils, offset coils, and pocket coils. The first two aren't recommended for people with back pain. Offset coils make mattresses very firm, so they could work for back pain sufferers that sleep on their back. Pocket coils, the most expensive type inside of innerspring mattresses, are not as expensive as memory foam and are the only type that offers the support that someone with back pain would need.
The two benefits of coil mattresses are that they're less expensive and they don't sleep hot.
Gel mattresses first hit the market in 2011 via Serta's iComfort gel memory foam mattress. They're supposed to be cooler than memory foam and offer the same support. They are incorporated into mattresses as a layer on top or beneath the top layer, it can be included as beads inside of the foam, or it's poured into the foam as the foam sets. You'll normally see gel incorporated into memory foam mattresses, but you'll see them in innerspring mattresses and mattress toppers as well.
As far as them being cooler, there hasn't been extensive testing, but they seem to be slightly cooler. The liquid in the gel seems to take longer to heat up, but it eventually does heat up. I did own a Tempur-Pedic for 10 years and it would warm up after a while. I bought a memory foam top to make it softer, and that got very hot after a few hours and was definitely hurting the quality of my sleep. My current mattress has a 1" memory gel top layer with memory foam underneath. It still gets warm, so I bought a cooling mattress topper and that keeps it cool.
According to Best Mattress Brand, foam manufacturer Cargill did a study and found that plant-based memory foams sleep 25% cooler than gel memory foam. Amerisleep, one of our top choices, uses plant-based memory foam that has a more open structure allowing heat to disperse. The plant-based memory foams also produce far less VOCs (volatile organic compounds), which can cause health issues.
Latex mattresses are similar to memory foam, although these mattresses are not temperature activated. They are also more resilient, thus having better "spring back", so the sleeper can avoid the feeling of being stuck in quicksand that some who sleep on memory foam complain of.
Sleeping on your back generally keeps your spine in a neutral position, though it's better when you put a pillow under your knees, which keeps your knees in a better position (just like when you get a massage or acupuncture appointment). It can be problematic for those suffering from sleep apnea as the tongue tends to slide back and block your breathing pathway. This position can also make snoring more intense.
Sleeping on your side is the second best position, and it's better for those who snore and those with sleep apnea. To minimize pressure on your hips and torso, it's best to keep a pillow between your knees and one in front of your chest to drape your arm over.
Sleeping in the fetal position is better than sleeping on your stomach, but can cause issues if you're too balled up as you're restricting your breathing and your spine is not in a neutral position, which can put pressure on the vertebrae.
The reality is most people don't stay in one position all night. They're going to shift which makes it difficult to keep your pillows in the right position (under or between your knees, and/or in front of your chest).
Stomach Sleeping and How to Stop
This is the worst position for sleeping for your spine. It takes you out of alignment more than sleeping on your side or back, and it puts a lot of pressure on your neck. If you do sleep on your stomach, you can put a pillow under your stomach which will keep your spine in a more neutral position.
Well before I talked to any good chiropractors about my back pain, I learned that sleeping on my stomach was a huge mistake! When I did it, I would wake up with incredible tightness in my lower back and it would take me a few hours to be able to move without pain. To stop myself from sleeping on my stomach, I got in the habit of tucking a pillow in right at my stomach, often folded in half, so it would make it almost impossible to go onto my stomach. If I tried to turn over on my stomach while I was asleep, the pillow would keep me from turning all the way over. After a few months, the habit stuck and I never slept on my stomach again.
Changing Your Mattress Firmness
If a new mattress isn't in your budget, buying a mattress topper can make your bed softer or firmer. Note that if you purchase a piece of foam that you slip under your bedspread, the foam will compress and become dense. There's no room for air to circulate and let the heat from your body to disperse, and you get hot. Being hot will reduce the quality of sleep for most people. It's, therefore, a good idea to shop for cooling pads and toppers to make your bed softer.
Different Firmness Needs for Spouses
If your partner or spouse has different firmness requirements than you there are a few different options:
- Try a mattress that is designed specifically for different positions and sleep weights, like the Leesa.
- Considering investing in a Sleep Number bed or similar that allows you to adjust each side individually.
- Add a mattress topper to make one side more firm or softer as needed.
- To make one side more firm, try putting a piece of plywood between the mattress and the box spring for additional support.
- Order two different twin mattresses of different firmness levels and slide them next together.
Sleep researchers have found that you cool down when you sleep, and if your core temperature doesn't drop, the quality of your sleep suffers. The issue with many types of foams is that they compress when you lay on them, and there's nowhere for the heat to escape. So when you first lay down on one of these mattresses, you won't feel hot, but after a few hours, you may wake up hot.
Choosing a Mattress Size
Many people don't realize how much more comfortable they could be with a larger mattress. Below we list the sizes of the common and a few uncommon mattresses:
- Crib: 27" x 52"; once your child reaches 35" in height it's a good idea to upgrade the mattress size to a twin or larger.
- Twin: 38" x 75"; these mattresses are sometimes referred to as a "single" and are great as a space-saver in a small room but may not be comfortable for many adults.
- Twin XL: 38" x 80"; this mattress is the 5" longer than a standard twin and will give taller sleepers more room.
- Full: 53" x 75"; also referred to as a "double," these mattresses are a tight fit for two and are a tight fit for taller sleepers.
- Queen: 60" x 80"; the most popular mattress size because they give many couples the space to sleep comfortably while not taking up too much bedroom space.
- King: 72" x 84"; this bed is the widest of the most popular mattresses.
- California King: 72" x 84"; this size is 4" longer but 4" narrower than a regular king. These are great for taller people. But if one of the sleepers shifts and moves a lot, the king will give more space as it's wider.
- Emperor or Wyoming King: 84" x 84".
- Caeser: 96" x 87".
- Alaska King: 108" x 108".
When to Change Your Mattress and Box Spring
The Better Sleep Council recommends replacing your mattress every 7-10 years, but you have to pay attention to how you feel when you wake up and the quality of your sleep. There are of course many things that can cause back pain, but an old mattress or a mattress that isn't right for you is a very common contributor to back pain.
The general rule is every 8-10 years. Some signs that you need to replace it are squeaking or sagging in the center. You can remove the dust cover and look inside. If you see worn or broken wood slats or coils, then you know it's time. Though box springs tend to last longer than mattresses, some people replace their box spring whenever they replace their mattress.
Mattress Care Tips
You spend a third of your life sleeping, so it makes sense to put extra time, energy, and money into something that has such a big influence on your back pain and overall health.
- You may have heard that you should flip your mattress every 6 months, but some mattresses are only designed to be used with one side up. You can, however, rotate your mattress to slow down sagging.
- Don't let kids play on your bed. Though it's fun for them, it will reduce the life of your mattress and your bed frame!
- Use a high-quality bed frame. If your frame is bowing in the center, it reduces the life of your mattress as well as change the position you sleep in.
- Get a high-quality mattress cover that's washable and that will protect you from allergens and dust mites.
- Read the care guide for your mattress and follow any recommendations for taking care of your mattress and extending its life.
When you get rid of your old mattress, don't give it away. If it was one of the contributors to your back pain, you don't want anyone else to have the same issue.
My Personal Story
I used to wake up every morning with a tight lower back, and I needed to stretch my hamstrings until my back loosened up. I just assumed it was something I was always going to have to deal with. I spent a week at the Westin Bonaventure in downtown Los Angeles, and I noticed after a few days that my back wasn't tight any of the mornings when I woke up. The reason why - the Westin's "Heavenly Bed," which is very soft.
When I got home I ordered a 3" mattress topper. I immediately felt better and had no tightness when I got up. My wife said that her hips and shoulder felt better.
When we moved we decided to buy a new mattress. We went to 6 different mattress stores and decided to buy one at Relax the Back. The salesman asked if we needed a soft or hard mattress, and we responded very soft. He told us that the mattress that we wanted had 3 levels of softness, and he strongly recommended 2nd softest. He finally convinced us to not get the softest, and we listened.
When we got the new mattress, we both were waking up with a little pain and decided to return the mattress for the softest version. It turned out that the salesman ordered us the firmest mattress! Once we got the softest mattress, we had no pain.