British backs are in crisis. Almost a million people in the UK are too sick to work because of back and neck problems, according to official figures, while the charity Versus Arthritis says 5.8 million experience “severe” back pain each year. The causes of back problems are complex, and treatments often fail to bring relief, especially where the pain is chronic and debilitating.

Long-term back pain is unlikely to be cured by upgrading your mattress, and a doctor or physiotherapist should be your first port of call if pain is affecting your quality of life. But studies suggest that switching to the best mattress for your body type and sleeping position can genuinely help. I’m lucky to not experience chronic pain, but in years of testing mattresses, I’ve often suffered temporary backache after sleeping on a surface that doesn’t suit me. Switching to a more appropriate mattress has often brought real relief, along with a better night’s sleep.

Here, I’ll help you choose the ideal mattress for your back, whether you already experience pain or want to avoid it. To support this, I’ve talked to experts, including an osteopath and sleep scientist, and scrutinised the often-used “orthopaedic” label.

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Are firm orthopaedic mattresses best for a bad back?

Not necessarily. Firmer doesn’t always mean better, and the term “orthopaedic mattress” is little more than marketing spin. Orthopaedic surgeons have fixed all manner of musculoskeletal maladies since the 18th century, but in the context of selling beds, the word “orthopaedic” has no medical authority.

“The term was made up by mattress manufacturers,” says Hannah Shore, head of sleep science at Mattress Online. “It was made to sound medical, because at the time, doctors were telling people a firm mattress was best for a bad back. More recent research has proved this to be wrong, though.”

The notion that your back requires a bed only marginally softer than the kitchen floor has been discredited since at least 2003, when the Lancet reported that medium-firm mattresses had better outcomes for patients experiencing back pain. “Medium-firm mattresses consistently come out on top in research into back pain,” says osteopath and sports coach Ian Greaves of Southampton Physio. “Comfort matters as much as support, and medium-firm beds strike a better balance than firm or soft types. This helps to improve sleep as well as reduce pain.”

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Keep your spine in line

The key to keeping your back healthy and pain-free is “spinal neutrality”, in the words of medical researchers. Also called spinal alignment, this refers to the way your spine relaxes in a straight-ish line when you’re lying on a mattress that’s neither too firm nor too soft. It’s not just about your backbone, either: your head, neck and knees should all fall into line, neither dipping down nor sticking up. Without this alignment, you could experience back, neck and shoulder pain.

Your back muscles can’t fully relax on a mattress that’s too firm or too soft, and you’ll quickly feel the effects, says Shore. “If your spine isn’t aligned when you sleep, you’re engaging muscles at a time when they should be relaxing and recovering from the day. The aches you feel from the occasional night of poor support are your muscles holding you in that position when they should be resting.”

In the long term, back pain can also result from your spine failing to rehydrate at night. “Throughout the day your spine compresses,” says Shore. “This is completely normal, and it’s caused by pressure squashing each disc between the vertebrae.” At night, these discs reabsorb fluid and decompress, she explains – but only if you’re lying comfortably. “If the spine is twisted due to lack of support, chances are discs are still being compressed.”

You may not feel the effects of compressed discs for years, says Shore. “Over a night or two of your spine being curved into non-neutral positions, you may feel a few aches and pains, but over a prolonged period, this can turn into serious back pain that affects you during the day.”

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How to choose the best mattress for back pain

The surest route to spinal neutrality while you sleep is to choose a mattress that’s neither too firm nor too soft for you. Bed firmness isn’t a one-size-fits-all matter, so don’t just go for a mattress that’s labelled “orthopaedic”. Instead, find one with the ideal balance of cushioning and support for your body size and sleeping position.

As a rule of thumb, the bigger you are, the firmer your mattress will need to be to offer enough support for your spine. Side sleepers need a bit more cushioning to accommodate their hips, knees and shoulders, while people who mostly sleep on their back or front need a little more firmness.

“If you’re a petite person, with small hips and narrow shoulders, an extra-firm orthopaedic mattress is probably the last thing you need,” says Shore, who won the British Sleep Society’s Green Ribbon prize for her research into body size and mattress firmness. “Your body wouldn’t be heavy enough to let the surface contour to your shape, and that’ll alter your spinal alignment. Find the firmness that suits your shape rather than because it sounds medically right.”

The only way to know for sure is to sleep on a mattress for a few months, which is why many mattress manufacturers now offer lengthy trial periods. But you can also get a good idea of what you need in a showroom, or indeed on your own bed, by lying down (ideally on your side) on a mattress and asking someone to take a photo of you from the back. You should be able to draw a relatively straight line down your backbone, starting at your head via the cervical vertebrae of your neck, all the way to your knees and ankles. If this imaginary line dips at your hips and shoulders, the mattress is too soft for you. If the line curves up at those points, it’s too firm. Both are recipes for back pain.

I’m a small side sleeper, so medium-firm works well for me and my back. I found my sweet spot with the medium-firm Otty Original Hybrid, which offered just enough cushioning to let my spine relax. The Origin Hybrid Pro is also described as medium-firm, but has different levels of support in different “zones”: firmer areas that give stronger support for your back, and softer areas to accommodate pressure points such as your hips and shoulders. This didn’t quite work for my diminutive body, which suffered lower back pain after a few nights on the mattress’s firm surface. The zoning system may, however, be ideal for you if you’re a more standard size than my 5ft frame. Its firm surface may also provide the extra support you need if you sleep on your back.

Best for side sleepers

Otty Original Hybrid, double

£674.99 at Otty

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Best for back sleepers

Origin Hybrid Pro, double

£618 at Origin

It’s also worth mentioning that softer memory-foam mattresses do work well for some pain sufferers. The marshmallowy sensation of the all-foam Tempur Pro Plus SmartCool left me craving more support, but some people love it for pain management. Its powerful pressure relief – essentially, the way it cradles you as though you’re floating in a cloud – can be gamechanging if you’ve struggled to get comfortable in bed after an injury.

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Best for pressure relief

Tempur Pro Plus SmartCool, double

£2,099.99 at Bensons for Beds £2,399 at Tempur

Don’t forget about the surface your mattress is on. A sprung-slatted base has much more give than a divan base, and will make a mattress feel softer as a result. If you have a slatted bed and your mattress feels too soft for your back, try it on the floor to see if you find it more comfortable. If you do, it may be time to upgrade to a more solid bed base.

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Firmness isn’t everything

A bad back will keep you awake, and being awake too much will give you a bad back. The most excruciating backache I’ve ever experienced was at a music festival, after a couple of nights awake, clenched against the cold in my tent. The camp bed didn’t cause my back pain; the lack of sleep did.

The “bidirectional” vicious circle of back pain and poor sleep has been studied many times. Results consistently suggest that anything you can do to sleep better – including choosing a good mattress – will also help prevent and soothe a sore back, not least by giving your muscles a proper chance to relax.

Other mattress attributes such as breathability, motion isolation and edge support are also vital for sleep quality. If you overheat or experience night sweats, look for a pocket-sprung mattress that contains natural fibres, such as the Millbrook Wool Luxury 4000. If you like the feel of foam but worry that it might trap heat, consider a specially designed cooling mattress, such as the Panda Hybrid Bamboo. The Panda and its similarly heat-dissipating mattress topper performed brilliantly in my heat-retention tests, and the topper helped me sleep surprisingly well during summer’s heatwaves.

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Best pocket sprung

Millbrook Wool Luxury 4000, double

£754.95 at Mattress Online £754.98 at B&Q

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Best for cooling

Panda Hybrid Bamboo, double

£799 at Panda

“Motion isolation” is a mattress’s ability to absorb the tossing and turning of your sleep partner, whether it’s your spouse or your dog. Bouncy springs can amplify a partner’s fidgeting, while foam is great for absorbing it and letting you sleep in peace if separate beds aren’t an option. The memory foam beneath the sleeping surface of the Simba Hybrid Pro excels at this.

Alternatively, you could split your bed in two. “‘Zip and link’ beds have separate mattresses that can be linked together,” says Rachel Marshall, brand manager at Bensons for Beds. “These can be ideal if you want to share your bed with your partner but you each have different mattress needs, as you can choose different firmness levels, too.” Sealy’s Redcliffe Backcare mattress, for instance, is available with one side firm and the other medium. Like most zip and link mattresses, it comes only in super-king size, so your bed and room will need to be suitably spacious.

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Best for motion isolation

Simba Hybrid Pro, double

£1,199 at Simba

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Zip and link

Sealy Redcliffe Backcare Zip and Link, super king

£849.99 at Bensons for Beds

Getting in and out of bed can be uncomfortable if you experience back pain, especially if the edges of your mattress aren’t supportive enough. A strong mattress perimeter, such as the reinforced edge of the Millbrook Wool and the Origin Hybrid Pro (both above), provides a stable frame that can help prevent putting strain on your back. Strong edges also support your spine consistently if you move around in your sleep, and help prevent the mattress from sagging.

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Don’t throw out your mattress (yet)

If you’ve done the spinal alignment test on your own mattress and found it’s too firm for your poor back, don’t throw it out. Provided the mattress is in generally good condition and not lumpy, you can strap a mattress topper on it to add a comfort layer that cushions your pressure points and lets your back muscles relax while you sleep.

I found the Simba Hybrid Topper particularly good for this. Attached to a firm Sealy mattress, it added just enough cushioning to help my pressure points sink in and allow my spine to align.

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Best topper

Simba Hybrid topper, double

£349 at Simba

A mattress that’s too soft for an aligned spine, however, will need to go to the spare room or charity shop, because it’s doing your back no good at all. If it’s too far gone to be slept on by anyone, take advantage of mattress companies’ recycling schemes. The best of the bunch is run by Panda, which will carefully recycle your saggy mattress for free if you buy a new one.

Read more of the Filter’s expert mattress tests:
• The best mattresses in 2025, tested
• Is the Simba Hybrid Pro mattress worth the hype? I slept on it for three months to find out
• How to choose a mattress: the features worth paying for – and the ones that aren’t

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Jane Hoskyn is a features journalist and WFH pioneer with three decades of experience in rearranging bookshelves and “testing” coffee machines while deadlines loom. Her work has made her a low-key expert in all manner of consumables, from sports watches to solar panels. She would always rather be in the woods