Back Pain

Updated 04 June 2015

Position is key when sex causes back pain

A new report suggests that alternatives to the traditional missionary-style position can help men who suffer from lower back pain.


Guided by movements of couples engaged in sexual intercourse, a new report suggests that alternatives to the traditional missionary-style position can help men who have lower back pain.

Setting guidelines

The findings report that side-by-side intercourse, known as "spooning" and thought by some to be a cure-all, isn't recommended for everyone.

Back pain during sex is a major issue for many people and there's been little, if any, research into the best positions, the Canadian study authors pointed out.

"Up until now, clinicians have only had opinions to go on. Our objective was to set guidelines," said the study's lead author, Stuart McGill, director of the Spine Biomechanics Laboratory at the University of Waterloo in Ontario.

Read: Preventing pain during sex

The good news is that most men with back pain can avoid triggering their pain during sex, he added.

At least one back pain expert, however, dismissed the findings, because the researchers only looked at healthy couples having intercourse. The methodology specifically excluded participants with back pain or those who had back surgery, according to the study, which was published September 11 in the journal Spine.

Spinal movements and sex positions

For their study, the researchers used a "motion-capture" system to track the spinal movements of 10 men, average age 29, as they had intercourse with their female partner in five variations of three coital positions: facing each other, sideways, and from the back.

After analysing the results, the researchers then made recommendations about sexual positions for men with back pain.

The study authors suggested that men who get back pain from flexing their spines forward should avoid the side-by-side position, use the back position and also use their hips, not their spine. For men who feel back pain when they extend their spines, it would be exactly the opposite: avoid the back position, use the side position. And men who feel back pain from simple movement of their spine should focus on using their hips, the study suggested.

Read: When sex is a pain

McGill, who wrote the paper with graduate student Natalie Sidorkewicz, said he hoped this study and future research would produce a kind of atlas of the best and worst sexual positions for men and women with various types of body issues, even hip and knee replacements. A report about women with back pain will be released later, the study noted.

Not everyone agrees with findings

Back pain experts not involved in the study had differing reactions to the report.

"Sadly, we know far too little about back pain and sex," said Dr. Eeric Truumees, an orthopaedic surgeon in Austin, Texas, who's familiar with the study findings. "In many of my patients with acute muscular low back pain, sex actually helps. Patients with severe disc or arthritis conditions, however, may find certain positions painful. And for those with chronic spine conditions, altered sleep patterns and medication side effects also alter sex drive and performance."

However, he added, the Canadian study is based on an understanding of the mechanics of back pain that's not universally accepted.

Read: Are you too tight for sex?

In the big picture, Truumees said, "truthfully, we don't know what causes a great deal of both acute and chronic low back pain."

Chris Maher, director of the musculoskeletal division at Sydney Medical School at the University of Sydney in Australia, dismissed the study outright.

It "tells us nothing about back pain and sex because it excluded people who had a history of back pain," he said. "I think people should ignore this paper. People would be better off being guided by common sense, their own experiences and raising the issue with their partner."

What should back patients do?

Truumees recommended "openness and a sense of humour".

With an exception for some patients, like those with spine fractures or recent surgeries, he added, sex won't cause any spine damage for the vast majority of those with chronic low back pain. "So a little experimentation might go a long way," Truumees said. "Talking to your partner about your pain; trying new positions, and making adjustments to positions previously used is recommended."

Read: Managing back pain

Better overall fitness helps, as can stretching, a hot tub and anti-inflammatory medications before sex, he added.

And, Truumees noted, "open communication with your partner is key, but ongoing difficulties should be discussed with your physician."

Read more:
Paracetamol may not ease back pain
Bed rest can cause back pain
Yoga for back health

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Susan qualified as a Physiotherapist in 1990, and completed her master’s degree in Physiotherapy in 2013 at the University of Pretoria. She has a special interest in human biomechanics, as well as the interaction between domestic and work-related ergonomics.

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