Choosing a new mattress that is comfortable, supportive, and high quality is important to help people with low back pain get a sound night's sleep. And marketing messages, promotions and special features can make shopping for the right mattress a challenge.

By understanding the physical composition of a mattress and being prepared to ask questions about the interior of a mattress, individuals can accurately evaluate and compare mattresses. Some mattress stores will offer cutaway views of the interior; this is a good aid in understanding and gauging mattress quality.

See Mattress Guidelines for Sleep Comfort

Key Components of a Good Mattress

The following physical components are the important features of most high quality mattresses.

Mattress springs and coils provide back support

The wire in the coils comes in different thicknesses, where a lower gauge number denotes thicker, stiffer wire and a firmer mattress. A higher concentration of steel coils may indicate a higher quality mattress, but this does not mean that the highest number is best: patients should use their own judgment regarding which mattress is best suited to provide support and help alleviate their low back pain.

See Mattresses and Sleep Positions for Each Back Pain Diagnosis


Mattress padding provides comfort

In addition to the spring coils in a mattress, the padding on top of the mattress can indicate quality. Mattress padding is usually made of materials such as polyurethane foam, puffed-up polyester or cotton batting. Extensive mattress padding is often more expensive, but many people find it more comfortable and worth the extra cost.

See Pillow Support and Comfort

Middle padding in a mattress

This type of mattress padding is just below the quilted top layer and is usually made with foam. When looking at a cross-section of the mattress, softer foams feel almost moist to the touch while firmer foams won’t spring back as quickly. The next layer of mattress padding is made of cotton batting that may vary in thickness across different mattresses and even within one mattress. This causes the mattress to feel firmer in some areas rather than others, such as increased firmness in the middle of the mattress.

Insulation mattress padding

This padding lies on top of the coil springs so that they cannot be felt from the top of the mattress, and it also protects the coils from damaging the top layers of the mattress.

Mattress ticking and quilting

The outer layer of a mattress consists of ticking, which is usually a polyester or cotton-polyester blend in a good quality mattress. The mattress quilting attaches the ticking to the top layers of padding. It is a good idea to examine the quality of stitching on the mattress quilting, looking for consistent, unbroken stitches.

See Selecting the Best Mattress

Mattress foundations

The mattress foundation or box spring adds another level of support to the mattress. Foundations usually consist of a wooden or metal frame with springs. A plain wooden frame may make mattresses feel harder than a frame with springs. A wood mattress foundation should only be purchased if the wood has no cracks and is straight. The Better Sleep Council recommends that purchasing a foundation and mattress as a set helps preserve the mattress.


Foam mattresses

As an alternative to traditional mattresses, some types of mattresses are constructed entirely or mostly from memory foam or latex foam. They can be purchased in different densities. Some foam mattresses are made of multiple layers of foam adhered together while others have a foam core in the center. Foam mattresses come in various degrees of firmness to give people greater selection for back support and comfort. Choosing between a foam mattress and a traditional mattress is based on personal preference.

Asking questions, requesting written product information and examining each mattress thoroughly will help patients become more educated consumers. By following the practical guidelines for selecting a new mattress, patients will be well equipped to find the best mattress for sleep comfort, back support and reducing low back pain.

Dr. J. Talbot Sellers is a physiatrist specializing in the diagnosis, treatment, and management of spine pain at NeuroSpine Center of Wisconsin. He has decades of experience using physical therapy, rehabilitation, and injections to treat painful musculoskeletal conditions.