Firm mattresses aren't always best for back pain — here's why, say experts

A woman in a brown t-shirt massages her painful lower back in bed
(Image credit: Getty)

If you suffer from back pain like I do, you've probably had at least one person suggest that you sleep on a firm mattress. But are hard beds good for your back? While there are some benefits to sleeping on a firmer surface, it may not be the right choice, depending on your situation.

Finding the best mattress for your needs is more nuanced than you may realize. Beyond price and brand recognition, you also have to consider your sleep style, weight, and build. If back pain is a constant, you'll need to hone in on a mattress that can keep you comfortable and pain-free – but that doesn't necessarily mean you need to seek the best firm mattresses.

Our guide to the best mattresses for back pain features a broad range of firmness levels, proving that you don't need to sleep on a rock-solid slab to find relief. Still, I wanted to dive deeper into the topic so I consulted with a trio of experts for their thoughts on hard mattresses for back pain. Here's what they told me.

Meet our experts

Dr. Mark Aloia
Mark Aloia, Ph.D.

Dr. Mark Aloia is the Head of Sleep and Behavioral Sciences at Sleep Number. A prominent sleep researcher who serves on the editorial board of several scientific journals, Aloia also works with NFL teams to help individual players leverage their sleep data for optimal performance and recovery.

Chris Tomshack
Chris Tomshack, D.C.

Dr. Chris Tomshack is the CEO of HealthSource Chiropractic, a national chain of chiropractic clinics. Prior to HealthSource's inception in 2006, Tomshack founded what eventually became the largest chiropractic clinic in Ohio. 

Dr. Ben Carvasso
Ben Carvosso, D.C.

Dr. Ben Carvosso is the principal chiropractor at Mornington Peninsula Chiropractic Centre. He's also a nutritionist and owner of MP Nutrition, with a specialized focus on men's health.

Why do people think firm beds are best for back pain?

"The idea that a hard mattress is good for back pain is a concept that has been reinforced over time by medical advice and cultural practices. We can tell by looking at spinal alignment that a firmer bed can help in that area," explains Aloia. However, every sleeper has a different interpretation of "firm" and improper alignment is not the only cause of back pain.

Tomshack offers a different perspective: "Developing aches and pains is a common health consequence of sleeping on an old bed. People tend to keep their mattresses longer than they should, and as a result, they may feel sore or stiff when they wake up multiple times a week." (Make sure you know the signs it's time to buy a new mattress.)

"People assume that purchasing a firmer mattress can solve their pain issues, but in reality, they need to replace their old mattress with a new one that aligns with their body type and sleep preferences," says Tomshack. Alternatively, if your mattress is in otherwise fine shape, adding a mattress topper is a quick and relatively cheap fix that can alter the feel of your bed for the better.

A man sits up in bed at night, holding one hand to his lower back because he's experiencing back pain

(Image credit: Getty)

Who shouldn't sleep on a firm mattress for back pain?

A firm mattress isn't a one-size-fits-all solution to back pain – and again, everyone's idea of firmness is subjective. Here are some situations in which a hard bed isn't ideal for back pain:

❌ Sleepers weighing under 130lbs: Carvosso says, "Lightweight sleepers benefit from the added give in a medium firm mattress, which will support their body. Although firm mattresses typically offer more support, lightweight sleepers will gain little support as there simply isn’t enough give."

Side or combi sleepers: Side sleepers with back pain can potentially introduce new aches in their hips or shoulders by sleeping on a firm mattress. Tomshack says a medium-firm mattress will be "cushiony enough under hips and shoulders for side sleepers" to prevent pressure build-up. (Browse our list of the best mattresses for side sleepers.) Meanwhile, combination sleepers will fare best with a medium-firm mattress for ease of movement and support for various sleep positions.

Sleepers with wide hips: According to Carvosso, sleepers with wide hips will feel more supported with a medium-firm mattress versus a firm mattress as it'll help you maintain alignment without creating discomfort in your hip pointers (in addition to your existing back pain).

Sleepers with a herniated disc: Firm mattresses won't give you the relief you need if you're dealing with a herniated disc. Opt for a medium-firm memory foam or latex mattress that'll offer support while alleviating pressure in the affected area.

Who should sleep on a firm mattress for back pain?

On the flip side, some types of sleepers can benefit from a firmer mattress to relieve their back pain: 

✅ Sleepers who weigh over 230lbs: Carvosso says heavyweight sleepers should choose a firm mattress because anything too soft could lead to them feeling "stuck" in bed, resulting in increased back and joint pain. Check out our guide to the best mattresses for heavy people to discover top-rated options for larger bodies.

✅ Stomach sleepers: Stomach sleeping isn't usually recommended for those with back pain, but if you can't help but fall into this position, skew firm. "Those who prefer to sleep on their stomachs will benefit from a firm mattress since it allows their body to have good alignment while sleeping in a prone position," says Tomshack. Learn more about our best mattresses for stomach sleepers.

Sleepers with lower back or neck pain: Aloia recommends a firm mattress for sleepers with sciatica, a condition that affects the lower back, hips, and legs. In this case, a harder surface can "best support the lumbar area without shifting unwanted pressure to the hips and shoulders." Meanwhile, Aloia adds that a firm bed can minimize strain on the neck since it'll prevent the chest from sinking in.

Man lying on a firm mattress for back pain in a mattress showroom

(Image credit: Getty)

Are firm beds good for back sleepers with back pain?

For light to average-weight back sleepers, Tomshack recommends a medium-firm mattress as it'll provide "the right amount of cushioning and support to get a good night's sleep." However, heavier back sleepers and those who don't want too much sinkage will be comfortable on a firm bed.

As our experts stress, firmness and comfort are subjective. We certainly agree, and so do online sleep companies – which offer mattress trials so you can take the time to properly test your new bed before making a full commitment to it.

Firm mattresses for back pain: The bottom line

"The spine is responsible for more movement in the body than you may realize. It connects with all your major muscles, meaning chronic back pain can quickly impact your daily life and sleep quality," warns Tomshack. Constant aches can cause you to wake up during the night, which can have a negative ripple effect on your mental health and general well-being.

Thus, the best mattress for back pain is the one that allows you to sleep uninterrupted and wake up in the morning without severe discomfort. This doesn't have to be an ultra-firm mattress, although for some people that'll end up being the best solution. Factoring in your weight, build, and comfort preferences will make finding the right bed to ease your back pain a lot easier.

However, Aloia is quick to note: "Back pain is highly variable, and it is difficult to recommend a more or less firm mattress." For personalized treatment for your condition, speak to your healthcare provider.

Alison Barretta
Freelance reviewer and writer

Freelance writer and editor Alison is an expert mattress tester for Tom's Guide, and hails from Philadelphia, USA. Alison has reviewed a wide range of mattresses, pillows and other sleep accessories for Tom's Guide, putting the latest hybrid, memory foam and cooling mattresses from Casper, Nectar, Awara, Brooklinen and other leading brands through their paces. Alison has been sharing buying advice and retail news for over a decade. When she isn't reviewing mattresses, other home products or hunting for great deals to save you money, Alison can be found teaching/training in martial arts, fawning over skincare, and indulging in her quarantine-borne hobby: cooking.