SynthesisJournal of orthopaedics and traumatology : official journal of the Italian Society of Orthopaedics and Traumatology2026
Mattress impact on lifestyle and back pain: a 25-year orthopedic literature review guideline.
Synthesis in Journal of orthopaedics and traumatology : official journal of the Italian Society of Orthopaedics and Traumatology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Authors and funding
11 authors.
Funding
Abstract
backgroundSleep quality is influenced by several modifiable environmental factors, including the sleep surface. Low back pain, morning stiffness, shoulder discomfort, and muscle tightness on awakening may indicate inadequate bedding support. This systematic review evaluated whether mattress characteristics influence spinal alignment, sleep quality, and low back pain.
methodsA systematic literature search and qualitative synthesis were conducted for studies published from 1999 to 2023. PubMed, Cochrane Library, Web of Science, Scopus, EMBASE, PsycINFO, ScienceDirect, and Google Scholar were searched using terms related to mattress ergonomics, pain, vertebral-column alignment, sleep, and quality of life. Eligible studies evaluated adult or young-adult populations and reported outcomes related to low back pain, spinal alignment, pressure distribution, sleep comfort, or sleep quality. Methodological quality and risk of bias were appraised using literature evaluation and grading of evidence (LEGEND) and Critical Appraisal Skills Programme (CASP) tools.
resultsA total of 47 studies were included. The evidence most consistently favored medium-firm mattresses over very firm or very soft surfaces. Medium-firm support was associated with better pressure distribution, improved sleep quality, reduced morning stiffness, and low back pain intensity. Zonal support, air-adjustable systems, customized designs, and thermal microclimate optimization showed potential benefits, but heterogeneity in materials, outcome measures, follow-up duration, and participant characteristics precluded meta-analysis.
conclusionsMedium-firm mattresses represent the most defensible general recommendation for adults with nonspecific low back pain or morning stiffness. Mattress selection should also consider body habitus, age, sex-related anthropometry, preferred sleep position, and thermal comfort. Smart and adaptive mattress systems are promising but require larger, methodologically rigorous clinical trials before routine recommendation. LEVEL OF EVIDENCE: Level III according to the Oxford 2011 Levels of Evidence. REVIEW REGISTRATION: Not registered.
trial registrationNot applicable.
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