Choosing the Correct Bed Firmness

Is a firmer Bed better for your back?  A research study tackled the problem…

Conventional wisdom had been that firmer mattresses were better for bad backs.  A team of physicians in Spain were interested in whether this was so.  To answer the question, they enrolled 313 adults with chronic low back pain into a clinical study.  All the patients had pain when lying in bed at home.  Patients were randomly assigned into one of two groups.  All patients in the study had their mattresses substituted for new spring mattresses of the same size.  Patients in the first group had their mattresses replaced with firm mattresses, and patients in the second group had their mattresses replaced with medium-firm mattresses.  The physicians determined the firmness of the mattresses by using the European Committee for Standardization scale that goes from 1 (firmest) to 10 (softest). 

Patients were assessed at baseline and at 90 days for pain and disability.  Interestingly, both groups of patients experienced an improvement in pain and disability after 90 days of sleeping on their new mattresses.  Patients given the firm mattresses had 70% improvement in pain.  Patients given the medium-firm mattress had 80% improvement in pain.  In addition, patients given the firm mattress had a 30% improvement in disability, versus 50% improvement in disability for patients given the medium-firm mattresses. 

What conclusions can we draw from this study?  The only information given about the mattress was the degree of firmness.  Firm was compared with moderate-firm and the results indicated that in patients with chronic low back pain, moderate-firm mattresses are superior for alleviating symptoms.  What we don’t know, is whether moderate mattresses are better, worse, or the same as moderate-firm mattresses.  And we are likewise unsure about moderate-soft and soft mattresses.  It is also not clear if we can generalize from patients with chronic low back pain to the public at large.  Do people with chronic back pain have different characteristics in their backs that predispose them to responding better to a moderate-firm as opposed to a firm mattress?  Would an asymptomatic person be better off on a firm mattress?  While we can’t draw any firm (pardon the word-choice) conclusions, it does seem reasonable that people without back pain would also respond best to a moderate-firm as opposed to a firm mattress.  It is reasonable that a patient with chronic low back pain has a sensitized back.  So whereas the benefits of a moderate-firm mattress may not be as immediately apparent in a non-sensitized back, over time it does seem that the public at large without chronic low back pain would do best on a moderate-firm mattress.

It’s too soft…it’s too hard…..which one is just right?

Goldilocks was right.  You want a mattress that is not too hard and not too soft.  Think of the forces at work on your body when you’re sleeping in bed.  Gravity is pushing you down and the only force preventing you from falling to the ground is your mattress.  If you’re lying on your side, this means that your hips and shoulders are being pushed into your mattress. If your mattress were a sheet of iron, it would not compress at all and your hips and shoulders would be subjected to the brunt of the force and would probably start to hurt.  Additionally, since your shoulders and hips would not mold at all to the mattress, there would be nothing directly supporting your midsection and it would sag down toward the ground, exerting a burden of force on your lumbar spine.  If you were lying on your back on the same sheet of iron, as your lumbar spine curves forward, it would not be supported by the iron and would again be subjected to excessive force.  If you are a stomach sleeper and are on the sheet of iron, your neck will be pushed into the iron but because of its natural curvature, it will not be supported and will undergo undo force.  Of course, no one chooses to sleep on a sheet of hard iron…but the same principles apply when you sleep on a mattress that is too firm. 

Suppose you were to sleep on an extremely soft bed.  If you were lying on your side, the pressure points of contact on your shoulders and hips wouldn’t become bruised, but as the gravity pushed down on you from above, your body wouldn’t have support from below and the points on your spine that are less supported would sag, pulling the spine out of alignment and stressing the other portions of your spine in turn putting excessive stresses on the muscles, ligaments, and small joints of the spine.  The same biomechanical chain of events would happen if you were lying on your stomach or back. 

The ideal mix is to find a mattress that conforms to your pressure points, while simultaneously offers firmness and resiliency to provide sufficient support to the natural curves of your spine.  Some mattresses accomplish this by providing greater support in different parts of the bed where most people have the curves in their spine.  Other mattresses are created with foam materials treated with chemicals to make them conform to pressure points and resiliency to support the natural spinal curvatures.  In the end, the best way to know which bed offers you the right support in the right places is to take the Goldilocks test…try it out for yourself.  But unlike Goldilocks in the story, most people require at least a few weeks to a month to tell if a mattress is right for them.  For this reason, it is a good idea to get a mattress with a 100% guarantee and easy return policy. is a proud member of these and other organizations