Is A Firmer Mattress Better For My Back?

Is A Firmer Mattress Better For My Back?

For years, many people with back pain have been advised to sleep on a firm mattress. But a new study shows that might just add to the nightmare of their morning-after misery. 

Researchers in Spain say that people who sleep on a medium-firm mattress were twice as likely to report improvements in lower back pain compared to those sleep on more firm bedding. They reach this conclusion after replacing bedding of 313 patients with a history of back pain with new "firm" or "medium-firm" mattresses. The patients didn't know which mattress type they received.

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 This study, published in the upcoming issue of the Lancet, is among the first to test the popular belief -- at least among some orthopedic doctors -- that the firmer a mattress is, the better it is at preventing or relieving lower back pain.

 While there's little hard scientific data to support that firm mattresses are better -- only a handful of studies have been conducted -- the Spanish researchers say that about three in four orthopedic doctors recommend firm mattresses to their patients.

 In fact, a survey of Atlanta-area orthopedic surgeons indicates that two in three said they recommend a firm mattress to their patients, and most believed that a mattress' firmness had a definite role in managing back pain. This finding, by Emory University orthopedist Howard I. Levy, MD, was presented at the 1996 annual meeting of the American Association of Orthopedic Surgeons.

 But chiropractors have long argued that firm mattresses are not the best choice, says George McClelland, DC, spokesman for the American Chiropractic Association.

 "Traditionally, what we have recommended is that a moderately-firm works best, or when using a firm mattress, you should add a 1½- to 2-inch thick padding on top of it," he tells WebMD. "It's wonderful to be validated by some form of research."

 McClelland says that this extra padding -- or using a medium-firm mattress without the extra padding -- better adapts to the natural curvatures in the spine. This padding is available at most stores that sell mattresses or bedding supplies.

"The spine is not a straight line, and padding or a moderately firm mattress 'gives' better to the concavities and convexities of the spine," he says. "A younger spine may tolerate a firm mattress perfectly well. But as we get middle years any beyond, when back pain is more prevalent, we find that more equalized support seems to be better."

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 The researchers, led by Francisco Kovacs, PhD, who operates an independent medical research company in Palma de Mallorca, Spain, say that a medium-firm mattress leads to better "pressure distribution" when lying in bed, resulting in less pain while lying or after getting up.  But McClelland and others say you also shouldn't use a soft mattress, because it doesn't provide enough support. From my own perspective, if a mattress is soft or too hard, it's not comfortable," says orthopaedic surgeon Dana C. Mears, MD, PhD, of the University of Pittsburgh Medical Center. "Something in the middle works best for me -- a medium-firm mattress. If a mattress is too firm, you might as well be sleeping on the floor."


 When buying a mattress, McClelland advises against relying on store ratings as an accurate guideline. "These numbers are all over the place," he says. "Individual companies use different rating systems, so you don't really know what you're getting." In fact, in the U.S., firm mattresses typically have a higher rating number; in Europe, a lower number goes to firmer mattresses.

 His advice: "When testing for a mattress, don't push on it or bounce up and down, as many people do. What's better is to lie on it for 10 minutes or so -- on your back, on your side, every way. It shouldn't be too hard. If it is, get some padding to place on top of the mattress."