Nearly everyone will experience low-back pain at some point during his or her lifetime. Low-back pain most often occurs in people between the ages of 30 and 50. It can interfere with work, routine tasks, and recreational activities. Some people experience acute low-back pain, which is resolved within a few days or weeks. But others experience chronic low-back pain, which can persist for months or years. Many times, the cause of chronic low-back pain is difficult to determine.

Although there is a widespread belief that firm mattresses are beneficial for low-back pain, there is a lack of evidence supporting this recommendation. One survey found that over three quarters of orthopaedic surgeons recommend a firm mattress to their patients who suffer from low-back pain.

A new study in the November 15, 2003 issue of The Lancet compared the effects of medium-firm mattresses to firm mattresses in people who suffered from chronic low-back pain. The researchers found that, compared with people sleeping on firm mattresses, the people sleeping on medium-firm mattresses were approximately twice as likely to experience improvements in their back pain.

About the Study

This study included 313 people who had low-back pain for three months or more. In order to qualify for the study, the participants couldn’t have back pain caused by an inflammatory disease, cancer, fibromyalgia , pregnancy, major injury, or other systemic condition. Also the participants had to sleep in their own bed virtually every night of the week, and could not take 24-hour anti-inflammatory medications or pain medications that would affect their back pain upon rising out of bed.

Half of the participants received a medium firm mattress (firmness score 5-6, on a scale of 1-10, with 10 being the softest) and the other half received a firm mattress (firmness score 2-3). Neither the participants nor the researchers were aware of which mattress each participant received.

Before the study began and 90 days after the receiving the mattresses, the participants completed a questionnaire to assess the intensity of their low-back pain in bed and on rising, and the degree of pain-related disability.

The researchers compared improvements in low-back pain between participants who received the medium-firm versus firm mattresses.

The Findings

Three months of sleeping on the new mattresses improved low-back pain while lying in bed and on rising in both the medium-firm and the firm mattress groups.

When the researchers adjusted for baseline pain ratings and perceived firmness of the new mattress (both of which affected the final pain ratings), they found that medium-firm mattresses were associated with significantly more improvements in pain than firm mattresses. Specifically, the medium-firm mattress group was 2.4 times as likely to have improvement of pain while lying in bed, 1.9 times as likely to have improvement of pain on rising, and 2.1 times as likely to have improvement of pain-related disability.

These findings are compelling, but they do have certain limitations. The participants in this study had chronic low-back pain with no known cause; it is not clear whether these findings apply to people with acute low-back pain or low-back pain caused by disease or injury. Also, the mattresses used in this study were spring mattresses; it is possible other types of mattresses may produce different results.

How Does This Affect You?

These findings suggest that the widespread belief that firm mattresses are the best choice for people with low-back pain may be unfounded. This was the first randomized controlled trial to test the recommendation that people with low-back pain sleep on a firm mattress.

This study suggests that the effects of a mattress on low-back pain may extend beyond the time when you are lying in bed or just rising, as evidenced by the improvement in pain-related disability. Since you spend about a third of your life lying down on a mattress, it makes since that the type of mattress you have could affect your lower back.

In addition mattress choice, the National Institute of Neurological Disorders and Stroke recommends the following strategies to protect your back:

  • Always stretch before exercising.
  • Don’t slouch while standing or sitting.
  • Make sure your work surface is at a comfortable height for you.
  • Wear comfortable, low-heeled shoes.
  • Sleep on your side.
  • Don’t try to lift objects too heavy for you.
  • Lift with your knees, pulling your stomach in, and keep your head down in line with your straight back.
  • Prevent excessive weight, especially around the waistline.
  • If your smoke, quit (smoking reduces blood flow to the lower spine, causing spinal discs to degenerate).

While all of these recommendations sound reasonable, and probably make sense, we will have and see which will ultimately be supported by future research.