The Best Mattresses for Back Pain (2024)

In the past, if you had back pain, many doctors and well-meaning friends probably directed you toward a firm mattress. As it turns out, that advice was wrong. What you really need, according to the peer-reviewed research, is a mattress that feels medium-firm to you.

The key word here is you. Firmness levels are highly subjective. Owner reviews reveal that the same mattress can feel too soft for some people and too hard for others. Apart from personal preference, such discrepancies exist because a person’s weight and shape can influence the feel of a mattress. On a soft mattress, for example, a 130-pound body might feel like it’s floating. But for someone over 200 pounds, that same mattress could feel overly firm, given that they would sink immediately to its bottom support layer.

Here’s the rule: When back-pain sufferers lie on a mattress they determine to be medium-firm, that mattress is the best backache-relieving mattress for them—regardless of how the company labels it or whether the mattress has “support zones,” reinforced layers, or any other bells and whistles that cater to a spine-focused buyer.

Mattresses labeled medium-firm are a good place to start because they’re likely to support your spine’s natural curves whether you sleep on your back, stomach, or side. Ahmed Radwan, PhD, DPT, co-author of a Sleep Health: Journal of the National Sleep Foundation review paper about mattress design and sleep quality, explained to us in an interview that although people might prefer to fall asleep in a particular position, they can shift a lot during the night. Thus, “the successful mattress is the one that accommodates many positions and helps you wake up with less pain and tenderness.”

The “medium” part of “medium-firm” not only relieves pressure points (which vary depending on your sleep position, as illustrated below) but also cushions the heavier parts of your body in a supportive way without letting them sink too far into the mattress. When you’re sleeping on your back, your shoulders and hips can settle into a medium-firm mattress just enough that your lumbar (lower-back) region is supported and remains concave. When you’re on your stomach, your belly is both cushioned and held up, rather than caved in and forcing your lower spine into the shape of a hammock. When you’re on your side, the mattress offers enough cushion to support your shoulders, hips, and knees, but not so much that your spine flexes or twists.

The “firm” part of medium-firm helps keep the spine aligned. If you were to take a picture of yourself in each of these three sleep positions (a good thing to do when you’re shopping in person, as we suggest in our guide about how to choose a mattress), your body should be roughly straight, in neutral alignment. This means back- and stomach-sleepers should be able to draw a line from the neck to the lumbar (lower spine) region to the knees, while side-sleepers should be able to draw a line along the midpoints of the ears, shoulders, and hips. (See the illustration of ideal spine support below.)

If the mattresses you’re interested in are available in a store, and you can shop in person (we have guidance for what to do if you can’t), bring your favorite pillow and try the mattress out before you buy. (Our bed-pillow guide can help you find the best one for your preferred sleep position.) Spend at least 15 minutes lying on the beds and zero in on your spine: Does it feel relaxed, rather than flexed or strained? At the same time, does your body feel cushioned, as opposed to pressed against the surface of the mattress?

If you already have a medium-firm mattress but are still experiencing back pain, your mattress could be too old. “Whenever patients tell me that their back pain is the worst first thing in the morning, one of the things I always ask is, ‘How old is your mattress?’ They often say, ‘I don’t know, maybe 20?’ or some big number. But we know that mattresses usually don’t last more than 10 years, depending on their materials,” said Marlís González-Fernández, MD, PhD, associate professor of physical medicine and rehabilitation at the Johns Hopkins University School of Medicine.

Research bears out those claims. A study published in 2008 asked 33 women and 29 men to record back and shoulder pain for 28 days, first in their own beds (which were, on average, nine and a half years old) and then in new beds of similar quality. The researchers found that the new mattresses reduced back pain by 62.8% and stiffness by 58.4%. “Over time, the mattress can soften and sag,” said Bert Jacobson, EdD, the study’s lead author and a professor of health and human performance at Oklahoma State University. “It becomes less good at aligning your spine.” Even if you start out with a medium-firm mattress, you might not actually be sleeping on one 10 years later.

Of course, we can’t know exactly what medium-firm feels like to you, so in this guide we’ve highlighted the models that we expect will feel medium-firm to most people. Whatever you decide, make sure to take advantage of trial periods and return policies. Ideally, you should test out a mattress for at least 60 days, said González-Fernández (our picks offer at least 100-day trials): “Trying a mattress for a long time is important and can help make sure that a mattress works for a particular person.”

It’s really hard to tell whether a specific mattress is right for you without lying on it first. Firmness, pressure relief, and support are all highly subjective factors, which is why we’ve always advised trying out a mattress in person prior to purchasing. But we also know that can be easier said than done. So in lieu of our usual try-before-you-buy advice, we recommend that you look for a generous return policy on any mattress you’re thinking of buying sight unseen.

With respect to trial periods and return policies, here are your best options of all the mattresses in this guide:

Who it’s for: The Saatva Classic in Luxury Firm caters to back-pain sufferers who prefer a traditional innerspring mattress with a just-cushy-enough top. It’s likely to feel comfortable regardless of your preferred sleep position.

How it feels: After sleeping on the Saatva Classic for a number of months, it softened slightly from a stiff medium-firm to a plusher medium-firm.

Why it’s great: The Saatva Classic is one of the least expensive innerspring mattresses we’ve tested, yet it feels sturdy and supportive. A layer of memory foam and a polyfoam and cotton-quilted Euro top (a pillowy layer of cushion sewn underneath the mattress cover) create a down-pillow-like surface that cushioned my sore shoulder muscles without being suffocatingly fluffy. In the top, more than 800 individually pocketed 14.5-gauge coils and a touch of memory foam conform to your curves, while sturdier coils at the base prevent your spine from caving in. “It’s almost like you feel lifted,” said one Wirecutter staffer who tried it. People who have owned the Saatva for a few months to a couple of years tend to be quite vocal about how comfortable they find it (though comfort is highly subjective, of course).

Flaws but not dealbreakers: The 416 support coils in the bottom half of the Saatva Classic are sturdy, but they number only about half those in the pricier WinkBed (Luxury Firm), another innerspring we’ve liked in the past. They’re not individually wrapped, either, which can lead to motion transfer. For that reason, we think the Saatva works best if you sleep alone or don’t wake easily when your partner rolls over. (If you need more motion isolation, consider the Charles P. Rogers Estate SE. The Estate SE is a good option if you prefer a firmer feel, though it cushions with intrinsically less-fluffy latex compared with the Saatva.)

The Saatva Classic in Luxury Firm is likely to work well for back-pain sufferers who sleep in all positions, but some side-sleepers have told us it feels too firm (the mattress also comes in Plush Soft and Firm models). Body impressions are a risk with the Saatva Classic (as they are with all thick Euro-top mattresses); rotate your mattress religiously at least every six months and sleep in the middle whenever you can. You can try the Luxury Firm for 365 nights and return it for a full refund, but if you do return it, you have to pay a $100 transportation fee. (Read more about the Saatva Classic in our innerspring-mattress guide.)

Who it’s for: The Leesa Sapira Hybrid is likely to appeal to back-pain sufferers of all sleep positions who want a foamy feel with a pinch of springiness. The foam’s density suggests it will hold up well for people who weigh more than 200 pounds.

How it feels: The bounce from the coils seems to mellow out the feel, making this hybrid just a touch softer than a typical medium-firm.

Why it’s great: The foam-innerspring feel of the Leesa Sapira Hybrid is more balanced than that of the Tempur-Adapt, our other hybrid pick in this guide, whose memory foam takes over the entire experience of the mattress. In the Leesa Sapira Hybrid, the 4-pounds-per-cubic-foot memory-foam layer and 1,000-plus individually pocketed coils support your spine and conform to (and cushion) your curves. It’s “sturdy but not rigid,” said one of our back-and-side-sleeping testers. You can sit on the edges without sliding off, too. Unlike the Saatva Classic, Leesa mattresses are available at partner retailers, so you may be able to try the Leesa Sapira Hybrid in person before you buy it. Within the 100-night trial period, you can return it for a full refund if you don’t like it, though you’re required to sleep on it for at least 30 days first.

Flaws but not dealbreakers: In our tests, this mattress produced slightly more motion transfer than the Tempur-Adapt but less than the Saatva Classic. This means you may feel your sleep partner’s movements in the night. Some of our testers who had spent years sleeping on innerspring mattresses described their experience on the Leesa Sapira Hybrid as “feeling stuck”; if that sensation sounds off-putting to you, we recommend trying the Saatva Classic or the Charles P. Rogers Estate SE instead. Several readers have also commented that the Leesa Sapira Hybrid felt too stiff for side-sleeping; this is not a super-soft mattress, but it represents a good compromise for people who require sturdy spinal support. (Read more about the Leesa Sapira Hybrid in our hybrid-mattress guide.)

Who it’s for: The flippable, all-latex Zenhaven mattress is likely to suit back-pain sufferers who want curve-conforming cushioning without the slow sink of memory foam. It should work best for people who sleep on their back or stomach, as well as those who change positions often (aka rotators). It should be durable for people of all weights, too, including those who weigh more than 200 pounds.

How it feels: The Zenhaven has two sides. The Luxury Plush side is on the softer end of the medium-firm spectrum, while the Gentle Firm side provides a slightly firmer sensation (about 20% firmer, according to the company, which sounds about right to us).

Why it’s great: Latex (which is made from the milky sap of a rubber tree) is inherently durable and supportive. It also has an elastic resilience, which makes it easier for back-pain sufferers to move around.

The Zenhaven uses Dunlop latex in the foam layers. Compared to pricier Talalay latex (which tends to be more supple and consistent-feeling), Dunlop latex mattresses often feel hard and weirdly elastic. The Zenhaven is one of the Dunlop latex mattresses we’ve tried that avoids this; its latex layers feel soft and cushiony, and nearly indistinguishable from those made from Talalay latex. (The company told us it uses softer variations of the Dunlop foam and blended a range of layers.)

If you’re considering the Zenhaven, try it before buying it, if possible; you’ll find it at the Saatva Company’s showrooms.

Flippable mattresses give you a choice of firmness levels. And if you’re not picky about the feel, you can still flip the mattress periodically to increase its longevity. Back-pain sufferers—who, of course, should not be lifting a 125-pound queen mattress—will probably be relieved to know that if they change their mind about the side they want to sleep on, the company will send movers for a “one-time courtesy flip.”

Flaws but not dealbreakers: Although the Zenhaven is more pliable than cheaper latex offerings, latex isn’t an inherently cuddly material. The Saatva Classic and the Charles P. Rogers Estate SE both offer more of a pillowy feel without making it difficult for back-pain sufferers to move around at night. Because of the mattress’s weight, you need either a platform (not slatted) frame or a box spring. The company offers a 365-day trial period, within which time you can return the Zenhaven if you don’t like it, but you need to pay a $100 transportation fee.(Read more about the Zenhaven in our guide to Saatva mattresses.)

Who it’s for: The Novaform ComfortGrande is an appealing option for back-pain sufferers who like a good deal (who doesn’t?) and a loose memory-foam hug. This mattress should work well for side-sleepers who prefer a firmer mattress, as well as back- and stomach-sleepers who want a cuddly surface.

How it feels: The Novaform ComfortGrande is available in one firmness level, medium-firm, which is an accurate description, according to our testers.

Why it’s great: The Costco-exclusive Novaform ComfortGrande costs around $600 online and $500 in-store (a 5% fee applies to non-Costco members). Yet it offers much sturdier support than most cheap mattresses—and even some pricier ones.

The density of the memory foam, which cradles loosely and feels cushy, is somewhere in the range of 3 to 3.5 pounds per cubic foot (the company wouldn’t reveal the exact specifications), and the polyfoam’s density is a sturdy 1.8 to 2 pounds per cubic foot. These values, while suggesting good durability for people who weigh less than 200 pounds, make the Novaform more likely to sag for people who weigh more. (If that’s you, choosing a denser option—such as the hybrid Leesa Sapira Hybrid, which has a more resilient feel, or the springier, latexZenhaven—can lower your chances of making body impressions.)

Thanks to Costco’s generous return policy, you can return the Novaform ComfortGrande for any reason, at any time, for a full refund and free mattress pickup.

Flaws but not dealbreakers: The memory-foam density in the ComfortGrande is less than 4 pounds per cubic foot, which is what experts consider suitable for people over 200 pounds. We’ve noticed over the years that some owners complain in their reviews that this mattress takes a long time to puff up to its full height—or it doesn’t reach its full 14 inches at all. Costco’s customer service has been consistently good, and getting a replacement mattress shouldn’t be a problem, if you encounter this issue. (Read more about the Novaform ComfortGrande in our foam-mattress guide.)

Who it’s for: The Charles P. Rogers Estate SE is likely to satisfy back-pain sufferers who prefer extra-sturdy coil support with a plush—but not billowy—sleeping surface. The firmer side of this two-piece, flippable mattress works well for those who tend to drift off on their back or stomach; the softer side accommodates those who also roll onto their side on occasion. We expect it to be durable for most people, including those who weigh more than 200 pounds.

How it feels: This two-sided mattress feels medium-firm on one side and slightly firmer on the other.

Why it’s great: The Charles P. Rogers Estate SE delivers on the sturdy support that back-pain sufferers typically seek out, without feeling like a kitchen countertop. The key: 1,221 pocketed, house-made coils in the base, reinforced with two layers of rugged Dunlop latex, as well as a 2-inch layer of softer Talalay latex and two layers of fiber padding zipped together into a quilted cotton cover. You can use the bottom portion right-side up for a medium-firm feel or turn it upside down for a slightly firmer surface. (This flippability factor is helpful for those who aren’t sure of their firmness preferences or who want to prolong the life of their mattress, assuming they’re not particular about the feel.) The Estate SE gets its strong edge support from stronger (thicker) coils around the perimeter, as opposed to a foam encasem*nt or coils that either have more turns or are more tightly packed (which is often the case in other innerspring mattresses). The slight springiness of Talalay latex also makes shifting positions easy. Latex is intrinsically more durable than memory foam or regular polyurethane foam, so we expect this bed to hold up well (for people of any weight) through its 20-year warranty. This mattress offers a 100-day trial, so you can return it for a refund (minus a $200 “recycling fee” and any delivery fees, if you selected that instead of free FedEx delivery).

Flaws but not dealbreakers: There are only three showrooms (in New York, New Jersey, and Pennsylvania) where you can try the Charles P. Rogers Estate SE before you purchase it. FedEx will ship the mattress for free, but each box weighs roughly 45 to 150 pounds (depending on mattress size), so you may need help setting up the bed. If you live within 100 miles of Charles P. Rogers’s East Rutherford, New Jersey, factory, the company will deliver your mattress unboxed, generally for no extra charge. Because of the mattress’s weight, it needs either a platform (not slatted) frame or a box spring. In-home setup costs $200. (Read more about the Charles P. Rogers Estate SE in our innerspring-mattress guide.)

Who it’s for: The Tempur-Adapt (Medium Hybrid) may appeal to back-pain sufferers who like a supportive mattress with the slow, pronounced, hugging sensation of memory foam. It should work well regardless of your preferred sleep position, and we expect it to hold up over the long term for people of all weights, including those who weigh more than 200 pounds.

How it feels: The coil-on-foam construction makes this mattress feel medium-firm to almost firm. But because the foam is so contouring, it’s not stiff.

Why it’s great: The Tempur-Adapt (Medium Hybrid) offers arguably more pressure relief than the other mattresses in this guide.

Tempur-Pedic’s unique memory-foam layer (4.5 pounds per cubic foot) is also the densest—and probably the most durable—of all the mattresses we recommend for back pain. That layer, topped with a proprietary, polyfoam-like material (2.5 pounds per cubic foot, which is a good density for polyfoam), creates the overall sensation of a gradual, measured cushioning (as opposed to instantaneous). The material’s density makes the mattress less prone to body impressions and sagging, too. More than 1,100 pocketed coils contribute additional support and conformity, though only a bit of resilience.

We also like that this mattress is available to try in Tempur-Pedic showrooms and many department and furniture stores nationwide.

Flaws but not dealbreakers: Our testers either loved or hated this mattress–and many hate it. Some found the slow sink to be wonderfully “transportive,” while others described it in more terrifying terms (“like quicksand”). If you have aches and pains, the pronounced memory-foam sink of the Tempur-Adapt may make shifting positions difficult; instead, consider the Leesa Sapira Hybrid, which is made with almost-as-dense memory foam but has a more dominant hybrid feel and more resilience. You can return the Medium Hybrid within the 90-day tryout period for a refund, but if you do so, you have to pay the shipping costs, which can be well over $100. That’s why we recommend browsing in-store whenever possible. But be aware that if you buy the mattress from a department store rather than from the company’s site or showroom, you’re subject to that seller’s return policy, which may or may not be as generous as Tempur-Pedic’s.

Mattresses can collect a lot of unwanted nastiness, including dust mites, dead skin, and liquids (everything from water droplets to sweat and pee). Your mattress is susceptible to stains and odors that may drive you to trash it before its expected shelf life is up. According to our guide on how to clean your mattress, a mattress encasem*nt will keep the worst of the unpleasantness out, and it will make routine cleaning as simple as throwing the encasem*nt in the wash once or twice a year. We recommend the Protect-A-Bed AllerZip Smooth Mattress Encasem*nt, which has super-strong seams and a zipper that won’t easily open. A mattress encasem*nt can also make it easier to inspect your mattress for bed bugs. (If this is a problem you’re dealing with, or something you’re worried about, check out our advice on how to get rid of bed bugs.)

If you don’t have a mattress encasem*nt, vacuum your mattress once a month using a full-size vacuum cleaner with powerful suction to draw out trapped dust and grime from every crevice. For bigger accidents and spills on a bare mattress, spray equal parts warm water and white vinegar onto the stain and dab it until the stain disappears. Then, sprinkle baking soda onto the affected area to absorb the wetness, wait a few hours until it’s dry, and vacuum it up. Dry your mattress completely before dressing and sleeping on it again—dampness invites mildew, and no amount of vacuuming can fix that problem.

1. Kaliq Chang, MD, interventional pain-management specialist, Atlantic Spine Center, email interview, March 29, 2019

2. Matthew Connolly, executive vice president, Bedding Industries of America, New Brunswick, New Jersey, in-person interview, October 25, 2018

3. Buddy Delaney, co-owner, Best Mattress, Columbia, South Carolina, phone interview, March 6, 2019

4. Marlís González-Fernández, MD, PhD, associate professor of physical medicine and rehabilitation, Johns Hopkins University School of Medicine, phone interview, June 21, 2019

5. Raymond Hah, MD, assistant professor of clinical orthopaedic surgery at Keck School of Medicine of USC and physician at USC Spine Center, phone interview, June 5, 2019

6. Bert Jacobson, EdD, professor of health and human performance, Oklahoma State University in Stillwater, phone interview, June 17, 2019

7. Ahmed Radwan, PhD, DPT, associate professor of physical therapy, Utica College, phone interview, March 8, 2019

8. Santhosh Thomas, DO, medical director, Center for Spine Health, Cleveland Clinic, phone interview, November 19, 2018