I don't suffer from any back pain or anything (touch wood), so rating anything as 'Ortho' is beyond me. That said, I've never internally commented on the apparent firmness or softness of the mattress so for me it must be just right and I may benefit from a firmer mattress than usual. I suppose if you needed a really firm mattress, this has 'some' give, so maybe not perfect in that respect, but if the three bears do indeed come home, I will be fast asleep.