Beds and mattresses

If you answer yes to two or more of the following questions, then it is quite likely that your bed is contributing to your spinal pain or stiffness.

  • Do you wake up in the morning with a stiff, achy low back noticeable before you even get out of bed?
  • Do you generally go to bed at night with your low back feeling ‘ok’?
  • Are you generally better with your back in the afternoon and evening?
  • Is your bed older than 10 years?
  • Do you feel your bed is particularly soft or hard?
  • When you spend some time in another bed (for example, a holiday) does your back feel better in the morning?
  • Have you just bought a new bed and mattress that is quite a bit firmer than the old one?

The human spine – it’s joints, discs, ligaments, muscles and nerves – does not really like being still for any length of time. If you think about it, when you are in bed you are spending a considerable period of time not moving except to occasionally turn over. You spend up to a third of your life on a mattress.

Perhaps not this one!
Perhaps not this one!

The ideal sleeping position is lying on your side with one or both legs bent up. Then regular turning through the night to the other side happens without, in the best case, disturbing your sleep. Lying on your front all night (‘prone’ lying) is quite demanding for the low back, although younger spines may well be able to cope with it – while lying on your back with your legs straight out can be nearly as challenging.

The best position for your back is where the spine from the sacrum (the bone between your upper buttocks) to the top of the neck is basically straight with no curves or twists, and with an overall slight forward curve as if you were bending forward slightly. This ensures that there is no undue loading on muscles or ligaments, that spinal joints are not impacting each other too much or squeezing the nerves that exit the spine.

Imagine you are lying on a hard floor on your side. Your pelvis and shoulders are wider than your abdomen (or they should be). Because the floor won’t ‘give’ to your shoulders and pelvis (just like a very hard bed wouldn’t) your unsupported abdomen and lumbar spine will sag down in between the shoulders and pelvis, creating a series of curves and twisting forces between the vertebrae of the low back.

Imagine the other way round – that you are laying on your side on a really saggy bed. Your heavier pelvis and shoulders would fall into the bed a lot more than your abdomen and lumbar spine. In this case, your lumbar spine would be pushed up – precisely the opposite of the hard surface but causing much the same problems.

It’s easy to see then that the ideal bed is one where the amount of give for the pelvis and shoulders is ‘just enough’ so that the spine remains suspended and straight between the two, preventing undue curving or twisting.

Then we can see that the ideal bed (actually, the mattress) has the following characteristics;

  • Nearly the right amount of giving for your shape and bodyweight
  • The ability to alter its shape across the bed – because this vastly improves the ability of the bed to be right for your particular shape and bodyweight
  • A durable structure that won’t warp after prolonged use
  • A very high feeling of comfort – this is partly a function of the first two points but is also very much affected by the choice of cladding used by the manufacturers (regular foam, memory foam, latex etc.)

    It’s important to understand the differences between the various types of beds and how manufacturers have tried to achieve all the points made above.

    Pocket spring mattresses

    These, as the name implies, have individual springs that are enclosed and separated from each other in a lattice type of arrangement, then cladded with various fabrics and materials. High-quality mattresses have a lot of top quality springs and very comfortable thick topping. But even these can need regular turning to avoid warping. Note that modern steel springs are often of such quality that new beds increasingly offer a no-turn guarantee.

    Open spring mattresses

    Again, as the name implies, these are sprung mattresses where the springs are not enclosed. As a general rule, this type of mattress is not recommended, as a wave-like motion goes through successive springs as you move on it.

    Latex mattresses (Dunlopillo)

    Made from rubber tree sap, this material is both expensive and heavy. It has been going for years and is quite effective at meeting the requirements noted above. Unlike with springs, where spring resistance can be altered to provide varying degrees of giving in the mattress, this is harder to do with latex.

    Synthetic/man-made foam mattresses

    There are lots of these around and most claim to be space age, long lasting ‘memory’ foam types of products. The points made about latex apply here. They work very well but are not cheap. Now they patents have expired there is a lot more competition and prices have come down. Because they are visco-elastic in nature, they trap heat.

    Combination approaches

    Some manufacturers are looking to combine the ‘best of both’ via pocket springs allied with latex or foam cladding. This can work exceptionally well in the best examples as basic degrees of giving can be set by the spring tension then optimised by the use of latex or foam cladding.


    A mattress filled with water sounds weird but works surprisingly well and will not leak. The volume of the water can be precisely altered to suit the individual and of course water provides an infinitely conforming surface for your bumps and lumps. Contrary to what many think, they are not too heavy for the bedroom floor.

    The bed base

    The bed that the mattress rests on is either a rigid, or slatted, or a sprung base. Generally, the higher the quality of mattress, the more likely the bed is to have an open sprung base (a pocket sprung base is not really necessary when the mattress is up to it).

    Things to think about

    • How much to spend? On balance, as much as you can afford for a good one – circa £500 for a large double mattress at a place like Costco – this should get you pretty much what you want
    • What type of bed? Difficult to say, but with the right one of any kind you should get an excellent sleep as far as spine comfort is concerned.
    • How big? A matter of personal preference
    • What ‘grade’ of mattress (hard, medium or soft are the usual choices) should you get? You should try some different grades but as a rule, heavy people with broad shoulders and pelvises will need a softer mattress and vice versa.
    • Should a large bed be a complete mattress or two ‘singles’ zipped together? Two singles allow each one to be a different grade if required, but two mattresses zipped together may be useful even if you go for the same grade on both sides.
    • When you lie on a bed, test it by lying on both sides and not just on your front or back. Don’t just think about whether it feels comfortable, but get someone to see whether your spine is broadly straight between your pelvis and neck when you are lying on your side (they should be standing behind you).
    • Ask about the turning schedule and whether one is required to maintain the guarantee. If you need to turn every month or so, then it implies something negative about the durability of the mattress, or that it’s old stock.
    • Don’t be misled by the term ‘orthopaedic’. It is not the case that a hard bed is better than a soft bed. The term orthopaedic is really a marketing gimmick that was based on the fact that beds in the old days were very saggy and got even worse as they aged.
    • Bear in mind that, if anything, we need a slightly softer (but still properly supportive) mattress as we age.
    • If you have bought a new bed/mattress and are suspicious that it may be too hard for you then don’t despair. There are a variety of overlay solutions that usually can inexpensively solve the problem.
    • Finally, look out for beds that have a ‘no turn’ guarantee. What this means is that the manufacturer has been able to source steel springs of such quality that they are sure they will never deform. Getting such a bed will be well worth the time and effort saving in turning mattresses, and the eventual sagging that is bound to happen in the long run!