How to Buy the Right Mattress: A Chiropractor's Guide
WRITTEN BY DR RUSSELL JENSEN Principal Chiropractor
Southside Spine and Sport, Bicton WA
Practicing Chiropractor since 2015.
Trained in Integrative Diagnosis (USA).
Special interest in nerve entrapment conditions including cluneal nerve pain, sciatica, and piriformis syndrome.
Full profile: southsidespinesport.com.au/meet-our-chiro
You spend roughly a third of your life on your mattress, and it is one of the most impactful purchases you will make. Unlike most things you buy, it affects your body every single day. As a chiropractor, I see the downstream effects of poor sleep surfaces regularly: people who wake stiffer than when they went to bed, whose pain is worst first thing in the morning, or who sleep noticeably better in a hotel than in their own bedroom.
A mattress is rarely the single cause of someone's pain, and no mattress replaces a thorough assessment and treatment by a professional. But it is also not a trivial purchase. It is expensive, and getting it right really matters. The right choice supports good sleep and a comfortable spine. The wrong one will actively work against you over time.
In this guide I will walk you through how to choose well, what some of the research says about firmness, and where to shop locally in Perth's southern suburbs, to help you make the best purchase for you.
Firmer is better?
Most people assume a firmer mattress is better for their back. It is a reasonable assumption, and for a long time it was what most orthopaedic surgeons recommended. A 2003 survey found 76 percent of orthopaedic surgeons were advising firm mattresses to their patients with back pain. The evidence, however, points in a different direction.
A randomised controlled trial published in The Lancet followed 313 people with chronic low back pain over 90 days, comparing firm versus medium-firm mattresses. Neither group knew which type they had received. At the end of the trial, people on medium-firm mattresses were roughly twice as likely to have improved across pain in bed, pain on rising, and disability scores compared to those on firm mattresses.
The takeaway is not "softer is always better." It is that the goal is a neutral spine, not maximum hardness. A mattress that is too firm can create pressure points at the hips and shoulders and leave a gap under the curve of your lower back. One that is too soft lets your hips sink and your spine round. For most people, a medium-firm surface in the middle of the range hits the balance between support and pressure relief.
Subsequent research has reinforced this finding. A 2015 systematic review found medium-firm mattresses were associated with a 48 percent reduction in back pain compared to other firmness levels, and separately found that older mattresses, regardless of firmness, were associated with significantly worse pain. If your mattress is old and you are experiencing morning pain, both factors are worth considering.
My personal experience with morning back pain
For years I dealt with back pain that was at its worst first thing in the morning, mostly in the upper lumbar region. I would wake stiff, unable to bend or lift properly, and it would only settle after sitting up for ten to fifteen minutes.
Over time I noticed a clear pattern: the surface I slept on made a real difference to how bad those mornings were. I am a pretty tall guy, and when I bought what felt like a well-suited medium mattress in the store, it felt perfect there. At home, after a few weeks of sleeping on it, it was a different story. Because of my size and weight, the mattress ended up being less supportive than expected and started to sag sooner than it should have. The morning stiffness came back. When I later invested in a better quality mattress, the difference was significant, and I got many comfortable years out of the right one.
What I see in clinic
This pattern is not unique to me. In having my own back treated and in treating the backs of many patients, three structures come up again and again in relation to this type of morning pain, particularly where an unsupportive mattress or poor sleeping position is a contributing factor.
The psoas, the deep hip flexor running from the lumbar spine to the top of the thigh. It is a common contributor to that stiff, hard-to-straighten feeling in the morning.
The erector spinae at the thoracolumbar junction, the muscles running either side of the spine where the mid-back meets the lower back. This is often exactly where that high lumbar morning ache is felt.
The cluneal nerves, small nerves that cross the rim of the pelvis and one of the most commonly missed sources of lower back and gluteal pain. You can read more on our cluneal nerve pain page.
When these structures are involved, treating them directly tends to provide real and sustained relief. It is important to be clear though: when the underlying issue is the mattress itself, treatment is a management solution, not a cure for a poorly matched or worn-out sleep surface. For many people who are not in a position to replace their mattress straight away, treating these structures can be an effective way to manage symptoms in the meantime.
Three things that actually determine your ideal mattress
There is no single best mattress, only the right one for you. Three factors do most of the work in narrowing it down.
1. Your sleep position
How you spend most of the night is the biggest single clue.
Side sleepers, the most common group, need pressure relief at the hips and shoulders, since that is where weight concentrates on your side. A slightly softer surface, often around a 4 to 6 out of 10, with a conforming comfort layer lets the shoulder and hip settle in so the spine stays level, while still needing enough support underneath to stop the hips dropping too far.
Back sleepers do well with a bit more firmness and good support through the middle of the body, so the hips do not dip and the natural curve of the lower back is maintained. Somewhere around a 6 to 8 out of 10 tends to suit, with just enough cushioning on top for comfort.
Stomach sleepers need the most support of all. This position tends to push the lower back into extension, so a firmer surface that keeps the hips lifted and the spine flatter is important. A softer mattress here usually makes things worse. As an aside, stomach sleeping is the position most likely to aggravate the neck and lower back, so if that is you and you have ongoing pain, it is worth a conversation.
Combination sleepers who move through positions during the night usually do best with a versatile medium feel that does not punish any one position.
2. Your body weight
Weight changes how a given mattress feels and how far you sink into it.
Lighter people, very roughly under about 60 kg, often find firm mattresses feel too hard because they do not sink in enough to benefit from the comfort layer. A softer surface tends to suit. Average weight ranges tend to have the easiest time, since most mattresses are designed with the middle of the range in mind, and a medium feel works well. Heavier people generally need a firmer and more supportive mattress, because softer surfaces let the body sink too far and lose spinal alignment. Quality of the support core matters more at higher body weights.
3. The features that solve specific problems
Modern mattresses come with a range of features, built in or as upgrades. The ones worth knowing about:
Cooling technology, if you sleep hot. Cushioning foams can trap heat, so breathable designs and cooling layers help.
Motion isolation, if you share the bed. This stops you feeling every movement when your partner shifts or gets up.
Edge support, also useful for couples, since it increases the usable surface of the bed and makes getting in and out easier.
Zoned support, where the mattress is firmer through the lumbar region and softer at the shoulders, which can help maintain spinal alignment.
The three main types of mattress
Foam
Built from layers of foam, usually softer conforming foam on top and firmer high-density foam underneath for support. Foam excels at pressure relief and motion isolation, which makes it popular with side sleepers and couples. The trade-off is that foam can sleep warm and some people find it lacks the responsive feel of springs.
Innerspring
The traditional coil mattress, with a system of springs and a thinner cushioning layer on top. Innerspring beds are supportive and breathable, so they sleep cooler, but they often offer less pressure relief and less motion isolation than other types.
Hybrid
A combination: foam comfort layers over a coil support core. Hybrids aim for the best of both, the pressure relief of foam with the support and airflow of coils. For many people, particularly average weight sleepers and those who want a balanced feel, a hybrid is a versatile choice.
How to actually shop for one
A few practical points that make a real difference:
Lie on it properly, in your normal sleep position, for several minutes. A ten second sit on the edge tells you almost nothing. If you sleep on your side, lie on your side. If you share a bed, shop together.
Use the trial period. Most mattresses take a couple of weeks of real sleeping to fairly judge, because your body needs time to adjust. A good retailer will offer a comfort trial or sleep guarantee, so ask about it before you buy.
Do not over-index on the price tag alone. A more expensive mattress is not automatically better for your body. Match the mattress to your position, weight, and comfort, then consider value within that.
Replace it when it is past its best. Most mattresses are worth reviewing around the 7 to 10 year mark. Sagging, waking stiff, or sleeping better elsewhere are all signs.
If you have ongoing back or neck pain, it is worth getting the underlying problem assessed rather than assuming a new mattress alone will solve it. A mattress can support recovery, but it works best alongside addressing the actual source of the pain. If morning stiffness or pain is part of your picture, that is something we can help you get to the bottom of.
Where to buy a mattress in Perth's southern suburbs
There are several good options close to the clinic in Perth's southern suburbs. We have no commercial arrangement with any of these. They are simply established local stores where you can test beds in person, which is the most important part of buying a mattress.
The Back and Neck Bed Shop, Booragoon. A specialist store focused on support-oriented mattresses and pillows. A sensible first stop if back or neck comfort is your main concern or if your needs are more specific.
Forty Winks Melville and Forty Winks O'Connor. Long-established with a broad range across price points. Good if you want to make a relatively quick, well-informed decision with plenty of options in one place.
Bedshed Melville and Bedshed O'Connor. Another well-regarded local option with a wide selection and knowledgeable staff.
Snooze O'Connor. Good range of brands and bases. Worth visiting alongside the other O'Connor stores since several are clustered together, making it easy to compare a few in one trip.
And if you are willing to drive a little further, my personal recommendation is The Bedroom Gallery. I worked nearby for years and have bought my last few mattresses there. I keep going back because the owner, Morten, took the time to understand what I needed, which in my experience is not always a given in mattress retail.
Frequently asked questions
What mattress firmness is best for back pain?
For most people with general lower back pain, a medium-firm mattress, roughly 5 to 7 on a 10-point scale, has the strongest research support. A 2003 trial in The Lancet found people with chronic low back pain on a medium-firm mattress were about twice as likely to improve as those on a firm one. The right firmness still varies with your body weight, sleep position, and comfort.
Is a firm mattress better for your back?
Not necessarily. The idea that the firmest mattress is best is not well supported. Too firm can create pressure points and leave a gap under the lower back; too soft lets the hips sink and the spine round. A medium-firm surface that keeps the spine neutral is a better target than maximum firmness for most people.
What mattress is best for side sleepers?
Side sleepers usually do well on a slightly softer surface, often around 4 to 6 out of 10, that relieves pressure at the hips and shoulders while still supporting the spine. A conforming comfort layer over a supportive core lets the shoulder and hip sink in enough to keep the spine level.
How often should you replace your mattress?
Most mattresses are worth reviewing around the 7 to 10 year mark, though condition matters more than age. Sagging, waking with stiffness that eases through the day, or sleeping better in other beds are all signs it may be time.
Can a mattress cause back pain?
A mattress that no longer supports a neutral spine can contribute to stiffness and discomfort, especially pain that is worse in the morning and eases once you are moving. It is rarely the sole cause, but it is one of the more easily addressed factors.
Ready to Book?
If you have had persistent headaches that have not responded to standard treatment, and you have not had your suboccipital muscles properly assessed, it is worth finding out whether this is what you are dealing with.
A good mattress supports healthy sleep and a comfortable spine, but if you are waking in pain or stiff most mornings, the mattress is usually only part of the story. If that sounds familiar, we are happy to assess what is going on and help you address the underlying cause.
or send us a message if you would like to ask a question first. We are based in Bicton and see patients from across Perth's southern suburbs.
Or call us on 08 6317 9897 if you would prefer to talk first.
References
Kovacs FM, et al. "Effect of firmness of mattress on chronic non-specific low-back pain: randomised, double-blind, controlled, multicentre trial." The Lancet, 2003;362:1599-1604. View at PubMed: pubmed.ncbi.nlm.nih.gov/14630439
Radwan A, et al. "Effect of different mattress designs on promoting sleep quality, pain reduction, and spinal alignment in adults with or without back pain." Sleep Medicine, 2015. View at ScienceDirect: sciencedirect.com/science/article/abs/pii/S2352721815001400
Written by Dr Russell Jensen, Principal Chiropractor (AHPRA: CHI0001927257), Southside Spine and Sport. Published June 2026.
This article is for general information only and does not constitute medical advice. Always consult a qualified health professional for diagnosis and treatment.
