Best mattresses for back pain

The Emma Original Pro is our first choice for back pain because its seven-zone spring core held the pelvis level on our test bed, the position that keeps the lower spine neutral. Emma labels it Medium, but we found it firmer and rate it 6 out of 10, inside the medium-firm band the Lancet trial favoured. A UK double costs £799 with a 200-night trial.

For couples who both need support, the Simba Hybrid Pro combines up to 3,800 Aerocoil microsprings with a base of up to 1,000 steel SupportCore springs in a 28cm, medium-firm build. The steel base also firms up the edges, which helps when you sit on the side of the bed before standing with a stiff back. It is the dearest of the top three, at £1,299 for a double.

Readers who want medium-firm support without flagship prices should start with the Emma Original, a 25cm hybrid with five-zone pocket springs that Emma sells as medium firm and we rate 6 out of 10. It ranks above the cheaper Origin Hybrid, which scores 86 overall to its 84, because its support score is higher (86 against 81) and testers with recurring lower back pain reported a clear improvement in our test. A double costs £529, with the same 200-night trial as the Pro.

Side sleepers whose back pain comes with sore hips and shoulders are better served by the Origin Hybrid Pro, a 31cm medium-plush hybrid with up to 5,300 springs in seven zones. It scores higher overall than the Emma Original above it, but Origin sells it as softer than the medium-firm feel the trials favour, so it ranks after the three medium-firm picks. A double costs £599, with a 200-night trial and a 15-year warranty.

The Origin Hybrid is the cheapest way onto a medium-firm, zoned spring mattress in this ranking, a 26cm hybrid with five-zone pocket springs that Origin rates 6 to 7 out of 10 depending on your weight, for £410 in a double. The 200-night trial and 15-year warranty match Origin's dearer models. It sits below the Emma Original despite a higher overall score because its support score is lower (81 against 86).

The TEMPUR PRO SmartCool is the only all-foam mattress in this ranking and the only one sold in four feels, from Soft to Firm, at the same price. That choice matters for back pain, since a lighter side sleeper can take the Soft feel while a back sleeper stays on the Medium Firm build our scores describe, but a double costs £2,299 for 21cm of foam.

A 365-night trial is the Nectar Premier Hybrid's strongest argument if you are unsure a new mattress will help your back, since it covers a full year. Nectar rates the 28cm build 7 out of 10 (medium-firm), with micro-springs over pocket springs and reinforced edges, and a double costs £699.

The Origin LumbarCloud is built around the lower back, with a nine-zone TitanCore spring unit that reinforces the centre third of the mattress under a wool and cashmere pillow top. Origin describes a plush top over a medium-firm core, so the surface is softer than on the picks above it, and a double costs £1,230.

If you know you sleep best on a firm bed, the Silentnight Comfort Breathe 1400 Pocket Ortho is a 28cm, double-sided mattress with 1,400 Mirapocket springs that you flip and rotate to slow sagging. The Lancet trial found firm mattresses did worse than medium-firm ones for chronic low back pain, so we recommend it mainly to heavier back and front sleepers. A double costs £649.

Sleepers over 15 stone who sink through medium-firm mattresses and wake with lower back pain are who the OTTY Extra Firm Hybrid is built for. It is flippable, 9 out of 10 firm on one face and 10 out of 10 on the other, with up to 2,000 encapsulated pocket springs, and a double costs £674.99.