Back pain is the leading cause of disability in the UK and affects approximately one in six adults. It's aggravated by our sedentary lifestyles and bad posture, both at our desks and while we sleep. While no mattress will be a magic fix, an unsupportive one can compound the problem.
"Typically inflammatory pain is worse in the morning because as we lie, our heart rate slows down, circulation slows and any inflammation stays pooled in the area. Sleep position is key," says Dave Gibson, osteopath, sleep coach and founder of The Sleep Site.
To avoid back pain you should ideally sleep with your spine in alignment. For back sleepers and front sleepers the main danger is that the spine settles into a U-shape while sleeping. For side sleepers it depends on the pressure points at shoulder, hip and head.
"Lie on your side in bed and get your partner to take a photograph so you can see how your spine lines up," Gibson recommends. "Your pillow needs to be the right height and the mattress needs to be supportive enough so that when you lie down, your spine is in alignment. It can help to put a pillow between your knees. It also helps if the mattress is firm."
Should you sleep on a hard or soft mattress with back pain?
“If you look at all the research that has been done on mattresses and back pain, medium-firm comes out as what you should have,” Gibson says. “Firm, but not rock-hard. Remember, though, there’s no official grading of firmness. What one manufacturer calls firm, another might call medium-firm."
Heavier people generally need firmer support, whereas lighter people can get away with softer mattresses. Whether you sleep alone or with a partner also has a bearing on your choice of mattress. You both want to be able to turn round without disturbing each other or adopting unhealthy sleeping postures.
To find the best mattress for you, Gibson suggests first lying on one in-store. "Although you won’t be able to tell if it will help with your back pain, you will be able to tell if it’s too firm or too soft for your liking, so that can be worth doing as a first step.
"But a better way to spot a good orthopaedic mattress is to see how long a trial the manufacturer will give you. Some do up to a year’s trial. If they can afford to do that, you can be fairly sure it’ll be a good one. Certainly get one with at least 30 day’s free trial, because some of the research has shown that it takes four weeks for people’s back pain to reduce when they switch to a new mattress."
Which type of mattress is best for back pain?
Memory foam or hybrid mattresses contain foam that moulds to your body as you sleep, so are likely to have a slightly softer, more cocoon-like feel. “Memory foam mattresses these days will probably have two or three layers of foam," Gibson says. "At the top will be open-cell foam, which has more breathability. That’s a big advance over older memory foams which held your body temperature."
Traditional pocket-sprung mattresses might offer better weight distribution and feel slightly firmer (although there are sub-categories of firmness). Hybrid mattresses combine a layer (or multiple layers) of memory foam with pocket springs.
Gibson is skeptical of claims to be "contoured", with different support zones for your shoulders and hips, because so much depends on the weight of the sleeper, among other factors. He also believes one of the best things you can do to improve your sleep is to rotate or flip your mattress: "You'll be blown away by how different it feels."
Finally, his biggest piece of advice is the simplest: get a bigger bed. "When you’re sleeping as a couple in a double bed, you’ve each only got the space that a baby in its cot would have. Someone with lower back pain needs to move around. What you need is a superking. Most of the research that you see on sleep quality indicates that the bigger the mattress, the better you sleep."
Which is the best mattress for back pain?
- Best overall – Emma Premium Hybrid
- Best hybrid mattress – Simba Hybrid Pro
- Best memory foam mattress – Nectar Memory Foam
- Best boxed mattress – Eve Premium Hybrid
- Best firm mattress – SilentNight Eco Comfort Miracoil Ortho
The best mattresses for back pain
1. Emma Premium Hybrid Mattress
£1,448 for a king size, Emma
Best overall for back pain
- Type: hybrid
- Depth: 25cm
- Trial: 200 nights
An award-winning foam and pocket-spring hybrid mattress that’s worth considering if you suffer from back pain. It uses the brand’s specially designed “HRX Supreme™ Foam,” which stands for “high resiliency extra foam”, and isn’t just jargon – it’s extra durable and designed with different zones of density to align and support your spine (and so reduce the risk of waking up with a bad back). As per Gibson’s advice, this mattress is described as “medium firm,” but the brand will provide extra layers of memory foam topping to soften it or firm it up should you require.
Five layers of alternating high-tech memory foam and pocket springs combine for a springy – yet supremely supportive – feel, so it's no wonder Emma won a wide array of consumer awards for comfort. Emma offers a lengthy 200 night trial and a ten year guarantee.
2. The Simba Hybrid Pro Mattress
£989.40 for a king size, Simba
Best hybrid mattress for back pain
- Type: hybrid
- Depth: 28cm
- Trial: one year
It’s no secret that the Telegraph Recommended team are big fans of Simba, and the sleep tech brand is featured in tried-and-tested guides to the best pillows and duvets as well as mattresses. This mattress is expensive, that’s for sure, but it’s the product of an almost-obsessive attention to detail, and is a worthy investment if you want a truly outstanding hybrid mattress.
The first layer is natural wool, which is naturally hypoallergenic and temperature-regulating, so the Simba Hybrid Pro is a better choice for hot sleepers than a traditional memory foam mattress. Then there’s a layer of Simba’s open-cell memory foam, a double layer of pocket springs, two more layers of foam and a base. It’s a thick, luxurious-feeling mattress that provides unparalleled support without compromising on comfort. It comes with a one year risk free trial period.
3. Nectar Memory Foam Mattress
£521.95 for a king size, Nectar Sleep
Best memory foam mattress for back pain
- Type: memory foam
- Depth: 25cm
- Trial: one year
The Nectar mattress is billed as a medium-firm mattress – although it’s slightly firmer than competitors – that’s made from three layers of different types of memory foam. This is crucial, as a top temperature-regulating layer keeps you cool at night and provides that soft, cushioned feeling, while the lower, sturdier layer is responsible for supporting your spine and relieving pressure beneath your hips and shoulders as you sleep. The bottom layer is a ‘zoned’ base foam.
Thanks to the slightly firmer than usual memory foam, this mattress minimises motion transfer very effectively – so, if you’re a light sleeper with a partner who tosses and turns, you won’t be disturbed. It comes with a one year trial period and a lifetime warranty.
4. Eve Sleep Premium Hybrid Mattress
£592 for a king size, Eve
Best boxed mattress for back pain
- Type: hybrid
- Depth: 28cm
- Trial: one year
Another hybrid mattress worth considering is the Premium Hybrid from Eve. As with other bed-in-a-box brands, Eve mattresses come compressed and rolled up into a single box, so you don’t need to worry about trying to squeeze a mattress through a too-small doorway. It’s a thick, comfortable mattress made from five layers of engineered memory foam paired with 1,400 pocket springs.
A marshmallow-soft top layer of “floatfoam” gives the sinking feeling memory foam is famed for, followed by two layers of firmer cooling memory foam, followed by full-size pocket springs and more foam. It’s also dubbed a ‘medium-firm’ mattress, but the plush top layer means it skews a little on the softer side – perfect if you want a snuggly surface without compromising on support to help minimise back pain. It gets extra points for the fact that the quilted cover is removable and machine-washable.
5. SilentNight Eco Comfort Miracoil Ortho Mattress
£449 for a king size, Silentnight
Best firm mattress for back pain
- Type: pocket-sprung
- Depth: 24cm
- Trial: 60 days
Bouncy, springy and supportive – but definitely not soft. If you don’t find a medium-firm mattress offers enough support, this extra firm pocket-sprung mattress is the one you should try for pressure-relieving support. It’s filled with zoned Miracoil springs specially designed to support spinal alignment, and they minimise movement so you don’t disturb your partner (or vice versa).
It’s also significantly cheaper than the mattresses above. However, there is one downside – Silentnight only offer a 60 day trial period, and within that period, if you’re unhappy with your mattress, you can exchange it but not get a refund.