In a recent nationwide survey on back pain, most survey participants reported using a firm mattress with a 2 cm plywood bed board between it and the box spring. But many of those who expressed the most enthusiasm about their sleeping arrangements suggest omitting the box spring and putting an extra-firm mattress on a platform bed.
If you have the option, don't use a brand-name mattress. Instead, have a foam-rubber company make you a, 15 cm (6 inch) thick, extra-firm mattress. It's less expensive than purportedly corrective mattresses and at least as firm and comfortable.
Futon mattresses on platforms are the next choice of US survey participants. But if your hips, buttocks or thighs are painful, you will probably find the futon too thin and hard, and the cause of unwelcome pressure.
If your bed is too hard (as may be the case with some 'orthopedic beds'), try placing a duvet between the under-sheet and the mattress. This gives a softer surface, especially for a more petite sleeper. Remember that what feels firm to someone of 50 kg (8 stone) is very different to what feels firm to someone of 115 kg (18 stone).
Of the 15 US survey participants who turned hopefully to water beds, 8 switched back to firm mattresses and bed boards, complaining that the bed couldn't be made hard enough to suit them. They also said that the water produced a 'rolling action' that made it difficult for them to control their movements and positions. (However, this has become less of a problem with more recent advances in water-bed technology.)
The other 7 were happy with their water beds so long as the mattresses were kept 'filled to the top' and 'firm'. They said the water enabled the spine to align more comfortably, and that the floating sensation eased the pressure on the spine and muscles. You can also regulate the temperature of water beds, which can be an advantage for treating chronic low back pain.
Some back sufferers give up mattresses altogether and take to the floor when their back pain flares up. But lying on the floor is not recommended for incapacitating pain and muscle spasm, primarily because getting up from and down to the floor may add to your pain. Also, if your low back pain is accompanied by pain and spasming in the hips arid upper legs, even a carpeted floor can put too much pressure on inflamed and sensitive areas, causing more pain and spasm.
If, however, you find yourself stuck between a hard floor and a sagging mattress, take the floor until you can make other arrangements.
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