Tight top mattresses come in a range of firmness levels. A medium-firm tight top mattress is more rigid than a regular medium-firm mattress. This is due partly to the thinner top that comes with a tight top mattress. A medium-firm mattress is best for larger back sleepers or those who suffer from back pain. For more contouring, consider going with a plush tight top mattress or a mattress with a memory foam comfort layer.