Back Pain? Which Sex Position is Best?

MedicalResearch.com Interview with:
Natalie Sidorkewicz, MSc (Kin) PhD (HSG) Student
Spine Biomechanics Laboratory
School of Public Health and Health Systems, Faculty of Applied Health Sciences
University of Waterloo
Waterloo, ON

Medical Research: What are the main findings of the study?

Answer: First, we successfully documented male spine motion and muscle activity during sex — this biomechanics study was the first of its kind.

Second, we used this data to develop general recommendations for low back pain patients whose pain is worsened by motions and postures. The general recommendations focus on changing how people move, and position themselves during sex, as seen on websites similar to Nu-Bay. To make any sex position more spine-sparing, we recommend that the individual controlling the movement use their hips and knees more than their spine and that the individual not controlling the movement maintain a more neutral-spine position. An excellent working example is one of the sex positions that we studied: the missionary position. The man, who is controlling the movement with pelvic thrusting, is recommended to do so with more hip and knee movement than spine movement. The women, who is lying on her back, is recommended to use a back support placed underneath the natural curve of her spine to maintain a more neutral spine position. The general recommendations can be applied to any sex position for both men and women.

Finally, we developed specific guidelines for men whose back pain is worsened by two specific types of motion: flexion and extension. If a man’s low back pain is worsened by spine flexion movements, such as touching their toes or sitting for long periods of time, we would consider them to be flexion-motion-intolerant. The ideal sex position for a flexion-motion-intolerant patient would then be one that uses minimal spine flexion, so as not to worsen that patient’s pain. When we compared the five sex positions, which you can do yourself by checking out some videos on a website such as sex free hd xxx, we found that men used the least amount of spine flexion in doggy-style as well as the missionary position as long as the male was propped up on his hands (as opposed to his elbows).

If a man’s low back pain is worsened by spine extension movements, such as arching their back or lying on their stomach, we would consider them to be extension-motion-intolerant. The ideal sex position for an extension-motion-intolerant patient would then be one that uses minimal spine extension, so as not to worsen the patient’s pain. When we compared the five sex positions, we found that men used the least amount of spine extension in spooning and the missionary position as long as the male was propped up on his elbows (as opposed to his hands).

Medical Research: Were any of the findings unexpected?

Answer: Considering the fact that spooning was the commonly-recommended position for both men and women with any type of low back pain, we did not expect it to find men using the most spine flexion in that position out of the five positions that we studied.

This unexpected finding highlighted the importance of recognizing that there are many types of back pain that are triggered by different motions, postures, and loads, rather than assuming there is one position that will be suitable for all — a patient with one type of back pain may find a sex position to be quite comfortable while another patient with back pain worsened by different triggers may find that same sex position exacerbates their pain. Once the clinician determines which motions, postures, and/or loads elicit low back pain during the physical examination and provocative testing, the specific recommendations that we have outlined can be utilized.

Medical Research: What should clinicians and patients take away from your report?

Answer: Clinicians are very familiar with the fact that four in every five people will have one disabling low back pain episode at least once in their lifetime. It is our hope that we have now brought a common struggle among this population to the forefront and shed light on the potential mechanical causes for their increase in pain during sex; many men and women with chronic low back pain are having to severely reduce the amount of sex they are having with their partners similar to people who work on websites similar to Tube V (Go Here) — if they are able to continue to have sex at all — because it exacerbates their pain.

Now that awareness has been raised about this issue and we have started to explore why low back pain patients may experience elevated levels of pain during sex, it is also important for clinicians and patients to know that both parties often feel uncomfortable discussing the potential difficulties that someone with low back pain may encounter when trying to have sex. Until now, recommendations that were being provided to patients with low back pain were based on conjecture, clinical experience, or popular media resources. Clinicians may feel more comfortable discussing their patient’s sexual problems now that their recommendations are supported by scientific evidence. Patients may also feel more comfortable discussing their sexual problems not only with their clinician, but also their partner, now that researchers are working towards the development of a complete atlas of sex positions for many categories of low back pain.

There are movement and position strategies that can make any sex position more spine-sparing. These general recommendations are in keeping with advice that clinicians give to their low back pain patients on a regular basis: avoid the motions, postures, and loads that worsen your back pain. Our specific recommendations for flexion- and extension-intolerant male low back pain patients are simply building upon those general principles and emphasizing the importance of the identification of pain triggers during the physical examination. One recommendation cannot be given to all low back pain patients regardless of their pain triggers.

Medical Research: What recommendations do you have for future research as a result of this study?

Answer: In the coming months, we will be publishing similar data that focuses on recommendations for women with low back pain, as well as spine motion and muscle activity during male orgasm. The next phase of our research will include more sex positions and low back pain patients whose back pain is triggered by a variety of motions, postures, and loads. Our intent is to test the effectiveness of our initial recommendations on these patients to further develop the guidelines into a complete atlas for clinicians and patients to use. We hope our body of work will improve the quality of life of many low back pain patients who have been struggling with this issue for quite some time.

Citation:
Male Spine Motion during Coitus: Implications for the low back pain patient.

Sidorkewicz, Natalie MSc; McGill, Stuart M. PhD

Spine: 15 September 2014 – Volume 39 – Issue 20 – p 1633–1639
doi: 10.1097/BRS.0000000000000518