
Takes the arch out of your lower back when you lie face up.
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Lower back ache when sleeping on your back

Lying flat on your back with straight legs makes the lower spine arch away from the mattress. A bolster under the knees bends them slightly, which lets the lower back settle flat and takes pressure off the lumbar discs.
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On your side with a pillow between your knees, or on your back with a pillow under your knees. Both keep the spine in a neutral line and take pressure off the lower back.
Yes, for many people, as long as a pillow under the knees keeps the lower spine from arching. Without that support, back sleeping can strain the lumbar area.
Research has found medium-firm mattresses often relieve back pain better than very firm ones. Too soft lets the hips sink and twist the spine.