Beds and mattresses

If you answer yes to two or more of the following questions, then there is a strong possibility 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. Remember, 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, better still, both legs bent up. Then regular turning through the night to the other side can happen without, in the best case, even disturbing your sleep. Lying on your front all night is bad for your 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 bad.

The best position for the spine is thus one 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 joints are not impacting each other much and that nerves (which exit from between the joints of the spine) are not being squeezed by the joints.

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 hard bed wouldn’t) your unsupported abdomen and lumbar spine sags 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 soggy bed. Your heavier pelvis and shoulders would fall into the bed a lot more than your abdomen and lumbar spine in between. In this case your lumbar spine would be pushed up – exactly 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 them, thus not allowing any curving or twisting to take place.

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

  • Exactly the right amount of give for your shape and bodyweight
  • The ability to alter its shape inch to inch across the bed – because this vastly improves the ability of the bed to be exactly 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 basic 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 on top with various fabrics and materials. High quality mattresses have a lot of top quality springs and very comfortable thick cladding. But even good quality pocket sprung mattresses can need regular turning to avoid warping! Note that modern steel springs are becoming so good, that new quality beds now increasingly offer a no-turn guarantee.

    Open spring mattresses

    Again, as the name implies, these are sprung mattresses where the springs are not enclosed and supported by pockets of material. As a general rule, this type of mattress is not recommended, as a wave like motion goes through successive springs as you lie or move on the mattress.

    Latex mattresses (Dunlopillo)

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

    Synthetic / man-made foam mattresses

    There are lots of these around now 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!

    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 give can be set by spring tension, while infinite degrees of give to your body shape and a high degree of comfort can be got from the use of latex or foam cladding.


    A mattress filled with water sounds weird but works surprisingly well and is not at all risky in terms of leaks. The pressure 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, waterbeds 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).

    Things to think about

    How much to spend? On balance, spend as much as you can afford for a good mattress - circa £500 for a large double mattress at a place like Costco - this should get you pretty much what you want unless you pay full retail price at a regular bed store, when expect to pay more.

    What type of bed? Difficult to say, but with the right one of any type 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 must try a number of different types but as a rule, heavy people with wide 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 allows each single 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 very old days were very saggy and got even worse as they got older.

    Bear in mind that, if anything, we need a slightly softer (but still properly supportive) mattress as we get older.

    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!