What Type of Mattress Should Be Chosen to Avoid Back Pain and Improve Sleep Quality? Review of the Literature
Study by G. Caggiari, G. R. Talesa, G. Toro, E. Jannelli, G. Monteleone and L. Puddu (orthopaedic departments at six Italian universities and hospitals)
Systematic Review · Journal of Orthopaedics and Traumatology (Vol. 22, Issue 1, Article 51) · DOI: 10.1186/s10195-021-00616-5
Key Takeaway
A Review of 39 Articles Leans Toward Medium-Firm Mattresses for Back Pain
What was tested: Italian orthopaedic researchers searched medical databases for studies from 2000 to 2019 on mattresses, sleep quality and low back pain in adults. 39 articles met their criteria (Caggiari et al., 2021).
What the numbers showed: The review does not combine the studies into one number. The authors conclude that a medium-firm mattress promotes comfort, sleep quality and spinal alignment, and offers more advantages to people with non-specific low back pain.
What this means for you: The evidence leans toward medium-firm if you have back pain. The authors warn that the studies differed a lot and often did not define the type of back pain well.
Key Numbers
How the Study Was Done
The authors searched databases including PubMed, the Cochrane Library, Web of Science, Scopus and Google Scholar for English-language studies of adults published from 2000 to 2019. The first search found 323 possibly relevant papers. After removing duplicates and papers outside the topic, 39 articles were analysed, with the selection shown in a standard PRISMA flow chart (Caggiari et al., 2021).
They grouped the mattresses in those studies using the European Committee for Standardization classes: soft, medium-firm, extra-firm, or customised. Each study was also rated for its level of evidence. The included studies range from randomised trials, such as the Kovacs 2003 trial, to smaller non-randomised and design studies.
What the Review Compared
Medium-Firm Mattresses
The authors conclude these offer more advantages for non-specific low back pain, improving sleep quality and lowering the risk of back pain.
Other Firmness Classes
Soft, extra-firm and customised mattresses were also covered. The review found the studies too varied to pool into one result.
What the Study Found
The authors conclude that, based on the published studies, medium-firm mattresses offer more advantages to people with non-specific low back pain, and that they improve sleep quality and reduce the risk of developing low back pain. Beds with active control, which adjust their support during the night, improved spinal alignment and sleep quality in the studies that tested them (Caggiari et al., 2021).
The review also reports on temperature: a mattress with a high heat capacity, which soaks up more body heat, was linked to more deep sleep and better sleep continuity in the study that tested it.
The review does not give a single combined figure for pain, pressure or spinal alignment. An earlier version of this page gave a pooled pressure figure and a combined number of people that we could not find in the paper, so both have been removed. The authors state that the work received no grant funding.
How to Apply This Study When Choosing a Mattress
What it tells you: If you have back pain with no clear cause, medium-firm is a reasonable place to start.
Brands label firmness in their own way, so treat labels as a rough guide. Use the sleep trial and return window to judge how your back feels.
Study Scope and Limitations
The 39 articles differed in what they measured, and the people in them varied a lot in health and body type. The type of back pain was often poorly defined. The review covers studies up to 2019 and does not test any brand sold today.
Primary Citation
Caggiari, G., Talesa, G. R., Toro, G., Jannelli, E., Monteleone, G., & Puddu, L. (2021). What type of mattress should be chosen to avoid back pain and improve sleep quality? Review of the literature. Journal of Orthopaedics and Traumatology, 22(1), 51. https://doi.org/10.1186/s10195-021-00616-5