Which is the Best Mattress for Low Back Pain?

“Buy our newly developed Orthopedic Mattress and End your Back Pain”.

You can hear this widely used phrase when you visit a mattress showroom. Even such ads
appear in Television and newspapers nowadays. People are willing to spend good money on
buying an expensive mattress that is presumably beneficial to their back pain. Humans have
been using the mattress for the past many centuries. The mattress was not considered a
part of back pain treatment in those times. But in the last five years, extensive deliberations
have been going on about good mattresses for back pain. If we needed a back-friendly
mattress, I wonder how humans survived thousands of years without these Orthopedic
Someone who does not have neck or back pain does not care about the type of mattress he
is using. He will be happy to sleep on any mattress. In other words, if your back is normal
and healthy, the mattress does not matter.
But only the people suffering from aches and pains lament about their mattresses and
pillows. They will have problems sleeping on a hotel mattress which is usually very soft and
saggy. Have you heard of people with acute back pain who prefer sleeping on the floor or
dislike soft mattresses? These folks research to find the best mattress for their back pain.
They want to derive some positive benefits (if any!) from sleeping on a good mattress. Since
we spend one-fourth of our life on our mattresses, such mattresses should be in good shape
to support our body and spine.
Many patients asked me to suggest the right mattress for their back and neck pain. With 20-
plus years of treating back pain patients, I learned how our back functions and how it will be
affected by day-to-day stress. So, I am writing this blog to clarify the mattress aspect of back
pain. Though there is no perfect mattress that cures one’s back pain, a few
recommendations can be made to help these patients a bit.
So, this blog’s objective is to explain to the reader how to choose an optimal mattress.

Before that, let me ask this question.

Can a bad mattress independently cause back pain?

Well, the answer is NO and YES.

NO– Mattress alone can’t be the independent cause of back pain. However, if you are young,
have a moving-around job, and sit less, you will have no issues using a soft mattress or any
The risk factor is decided by what you do for the rest of the day. For example, if you sit all
day long, your spine is slouched too much throughout the day. So, if the mattress is soft, it
will accentuate the slouch when sleeping on a soft bed. Such people will find a soft mattress
painful to sleep on.

Does a bad mattress influence your back pain, or can it worsen it?

YES- Since you spend 6-7 hours every night on the bed, and if you use that bed for 5 to 6
years, it creates a cumulative effect. So, a bad mattress can increase the risk of back pain in
an already vulnerable back. If you sit for 10 hours every day and, one fine morning, you
bend forward to pick up a towel from the floor, you suddenly get back catch or get an
intense spasm. Here it is not the towel which caused the back spasm but the cumulative
effects of sitting. The towel is just a trigger. Triggers are only Triggers, not the cause.
Low back pain itself is a symptom, not a diagnosis. Therefore, anyone claiming to help or
cure low back pain must first establish a diagnosis so the treatment can go in the right
direction. But in this blog, I discuss only mechanical back pain, which constitutes 90% of all
back pain worldwide. Mechanical back pain means your daily movements, postures, life
habits, exercise, and recreational habits all contribute to or cause mechanical (Physical)
stress on your spine. This mechanical stress you knowingly or unknowingly acquire and
accumulate over a period. Structurally, the disc and the nerves are involved in causing pain
in most mechanical back pain.
So, before you choose a mattress, choose the right Physiotherapist or Doctor who can
diagnose the cause of your back pain.
If your back pain is mechanical, choosing an optimal mattress will give you some potential
advantages. We can identify your pain pattern and suggest a mattress that best suits your
body type and problem nature.

Two main factors will help you decide what type of mattress you need.

  1. Pain Nature 2. Body Type

Pain Nature of your BACK:

If you wake up with a stiff spine and your back feels stooped forward (like old people) in the
morning for first few minutes, then your problem is that you are flexion intolerant (forward
bending type). You will get your problem worsened if you continue using a soft mattress.
Even the so-called memory foam is bad for you. Memory foam means the bed takes your
body shape when you sleep on it. In such a memory foam mattress, as you sleep on your
back, the middle of your body, which is heavier than the rest, will sink down. This soft
mattress would cause further forward bending stress on the spine. So, it will cause more
morning pain and stiffness when you wake up. Most females would avoid sleeping on their
backs because of this reason. They will always be uncomfortable sleeping on their back.
So, people who are flexion intolerant would need a firm mattress, which is made up of
cotton or coir mattress. Since cotton mattress usage is not in vogue in urban areas, a coir
mattress is the better choice. It must have a double-layer coir with a foam topping. When
you vertically poke your index finger on the bed, the finger should not sink more than 2
inches. If it does sink more, it is categorized as a soft mattress, which is not ideal for your

Body Type of your BACK:

There are three types of the lower back.
• Excessive Curvature Back (Lordotic Back)
• Flat Back (Kyphotic Back)
• Normal Back (Normal Curvature)
Back pain can occur in all the above three types of back.
However, back pain risk is higher for the flat-back people
than the other two groups. A flat back essentially has low
curvature, so they would benefit from sleeping on the
hard coir mattress (pic above), so their back won’t slouch further. People with an excessive
arch will feel their lower back is unsupported when they sleep on their back(supine) on a
hard mattress. So, such people need a bit of foam or a soft mattress, but not too soft. A
little cushion under their buttock will move the lower back down to the bed so that the back
will contact the mattress. Otherwise, these people may keep a small towel rolled or a
bedsheet folded under the curve of the back to feel supported under their back.

People with normal alignment back (normal lordosis) shall use a firm coir mattress. But they
must experiment with a mattress for two or three nights to find the best one. But
unfortunately, the mattress shop owner won’t allow that facility. If they experiment with
sleeping on the floor (free of cost), they can know whether they need a hard mattress.
When we talk about a hard mattress, it is not rock hard. It is still a soft one but does not sink
too much. We guide that it should sink not more than 2 inches when you firmly poke your
fingers vertically on the bed’s surface.

Does the mattress have Validity?

The most mattress will have a life span of 8 to 10 years. Of course, it also depends on the

Factors that reduce the life of the mattress:

• Too heavy or Obese people using the mattress.
• Too many children were playing and jumping on the mattress.
• Poor quality mattress.
• Using a mattress to work, watch TV, socialize or for anything other than sleep.
• Extreme weather conditions, water leak on the bed etc.
All the above factors will affect the sturdiness of the mattress.

Inspect your mattress once every year. Look for a dent in the middle or uneven surfaces.

When do you need to Change the Mattress?

• Every morning, you feel like you have a stiff back and do not sleep properly, which
does not happen when you sleep on a different mattress.
• A visible dent in the middle of the mattress. More observed when someone lay on
the mattress.
• If the mattress is older than 12 years and you have been getting morning back.

Reversing the side of the mattress can do the trick for some time. But some
mattresses are not double-sided.

Does Sleeping Position Matter?

Yes. Avoiding the fetal position is important. Whichever high-quality mattress you use, if you
sleep in the fetal position, the good effects of the mattress will be nullified. Sleeping in a
fetal position is analogous to forward bending. However conscious you are at night, correct
your position and keep your knees and hips aligned with your body. Or better sleep on your
back. I have done a YouTube video on “Best Sleeping Postures for Backpain”. You can view
that by clicking the link here https://www.youtube.com/watch?v=YaYWX6K4vAk.

The best mattress in the world is MOTHER EARTH.

Sleep anywhere and anytime, and you should wake up energetic and fresh. To sleep, you
don’t need to have a nice mattress. You must have a healthy Back and Neck.
Good Luck

Dr Rajkannan. P, PT,

Director- APTER Institute

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