Is There Sex After Low Back Pain?

Jenni Laidman

Disclosures

August 26, 2015

In This Article

Five Coital Positions Biomechanically Evaluated

Readings were taken for five positions.[3,4] One was side-lying, the standard position that had been recommended to patients with LBP. Two positions featured the woman in the quadruped position ("doggy style"). In one of these positions, the woman supported her upper body with her elbows; in the other, she used her hands.

Finally, two versions featured the missionary position. In one, the man supported his upper body on his hands while the woman was minimally flexed at the knees and hips; in the other, the man supported himself on his elbows while the woman was more flexed at the hips and knees. In both missionary positions, the woman kept her feet on the mattress.

Which position is most easily tolerated depends on whether a patient has pain with flexion (bending forward or sitting) or pain with extension (leaning backward), Sidorkewicz explained.

"Our findings and initial recommendations contradict the most frequently advised coital position for both male and female patients with LBP: the side-lying position," the authors wrote.[3] "This may be due to conflicting biomechanical rationales influencing the development of recommendations."

Sidorkewicz noted that Clinical Biomechanics of the Spine (Lippincott, 1990), a well-regarded textbook, advised that side-lying is the best basic position for either partner with LBP. The authors proposed that flexing at the hips and knees relaxes the psoas muscle and sciatic nerve, straightening the spine and reducing disc bulge. But, Sidorkewicz and McGill write, "current research on intervertebral disc mechanics, commonly used tests for sciatic nerve tension in the clinical setting, and our results [for side-lying] have shown the contrary."[3]

Best Coital Positions for Men and Women With LBP

For men with flexion-intolerant back pain, Sidorkewicz and McGill reported in Spine that the quadruped position in which the woman supports herself on her elbows was the least likely to lead to pain.[3] The missionary position in which the man supports himself on his hands was the next least likely to be painful, they found. This was followed by the quadruped position in which the woman supports herself on her hands, and then the missionary position in which the man supports himself on his elbows. The side-lying position was most likely to produce pain for men with flexion-intolerant LBP.

"If a man gets increased LBP when he flexes his spine (eg, bending down to touch his toes or sitting for long periods), then he should avoid positions where his spine tends to use more flexion (spooning) and try positions where his spine uses more extension (ie, doggy-style)," Sidorkewicz explained in an email to Medscape.

"Men use a lot of spine flexion (ie, bending forward movement) in the spooning position and use a lot of spine extension (ie, bending-backward movement) in the doggy-style position," she added. The recommendation is reversed for men whose back pain is triggered by extending their spine—that is, when bending backward or lying on their stomach, she wrote.

Sidorkewicz and McGill's study in the European Spine Journal focused on LBP in women.[4] It found that women use more spine flexion in the missionary positions and more spine extension in the quadruped positions.

The best-tolerated position for women with flexion-intolerant LBP, Sidorkewicz and McGill found, was the quadruped position in which the woman supports herself on her hands—followed, in descending order, by the side-lying position, the quadruped position in which the woman supports herself on her elbows, and missionary position in which the man supports his upper body with his hands and the woman's hips and knees are minimally flexed.[4]

For women whose back pain is extension-intolerant, the rankings would run in reverse, with the missionary positon in which the man is supporting his upper body with his elbows and the woman is flexed at the hips and knees least likely to provoke pain, and the woman in the quadruped position supporting her upper body with her hands and the man kneeling behind her as most likely to cause pain.[4]

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