As a doctor of chiropractic I get asked a lot of questions about how to handle activities of daily living while experiencing back pain. The question I rarely get asked is, ‘How do I continue to enjoy sex while I have low back pain?’ Low back pain can hinder many activities and can be aggravated by sexual activity. However, sexuality is a natural part of a healthy romantic relationship and whenever possible should be maintained.
The most important factor is communication with your partner. When one person is experiencing pain, they may avoid sexual contact of any kind with their partner because they are fearful of aggravating he injury. However, the partner may interpret the avoidance as a rejection of them which can strain a relationship. Expression of concerns can help alleviate fears and help both individuals work towards maintaining a healthy sexual relationship. Don’t forget to bring in things such as candlelight, soft-music, and a nice meal to help enhance the mood. Use this as an opportunity for experiment with more romance in your relationship. Not only is this fun, but it will help to ease any nervousness one or both people might be feeling.
When I do get asked about sex positions, the answer is surprisingly simple: ‘Work with your partner to try different positions that don’t aggravate the pain. If it hurts don’t do it.’ If bending forward increases pain then choose a position where the injured partner is lying on their back or standing up straight. If arching the back hurts, choose a forward bend position, sitting, or kneeling. And remember sexual activity does not have to include penetrative sex. Let the injured partner take the lead and never force a person to try certain movements if he or she feels that they will be too painful. If one partner is in too much pain to consider activities that involve spinal movement, sexual contact can still be maintained through other forms of touch. For those couples that haven’t experimented as much with change in their sexual routine, and are reluctant to talk to their health care practitioner, there are a variety of sources both online and at your local library that offer tasteful and practical how to guides.
Based on the University of Waterloo’s 2015 research recommendations for heterosexual intercourse while experiencing low back pain, here’s some suggested positions for men and women:
- Pain felt with flexion/bending forward: One of the best positions is to enter from behind with the woman on her knees, leaning on her elbows (leaning on the hands is also good, but does not allow the man’s spine to stay as neutral). This allows the man to keep his spine upright and the low back in a neutral position. The second-best position is common missionary. Again, the man can maintain a neutral spine, as he will be in slight extension in this position.
- Pain felt with extension/leaning back: Any position that allows the man to bend forward will help. For example, the woman can be on her hands and knees and the man can embrace her from behind.
- Pain felt with flexion/bending forward: Keep the spine in neutral position. Classic rear-entry positions with the woman on her hands and knees allows for the low back to stay in neutral. The best is with the woman leaning on her elbows. The second best is the side-lying ‘spooning’ position, followed by the rear-entry position with the woman putting her weight on her hands.
- Pain felt with extension/leaning back: Missionary position works for this type of pain when it is altered by having the woman bend her knees to help avoid over arching of the low back. Alternatively, Classic Missionary position can be used if the low back is supported using pillows or other form of support.
Dr.Jennifer Thomas’ approach to treatment is one that focuses on each patient’s individual needs. Techniques practiced include Diversified adjusting, and myofascial soft-tissue techniques. She believes that active patient care is an important component in the achievement of health goals, incorporating exercise and lifestyle counselling in treatment.