Mattress Firmness for Lower Back Pain If you wake up with sore or aching lower back muscles, your mattress may be the first suspect you accuse. After all, if you spend more than a third of your life asleep, your mattress must play some role in how your body feels. But if your mattress is causing your lower back pain, what is the solution? Do you need a firm mattress or a soft one? Not so fast. Mattress firmness is not one-size-fits-all, nor does a single mattress type work fo