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Does sex give you a backache?

Science based recommendations and how therapy can help you

Does sex give you a backache?
Do you avoid sex due to your low back pain?

If you are thinking “YES,” you are not alone. In a study by Bahouq et al. in 2013, 81% of clients with low back pain reported sexual problems and 66% of those clients reported never bringing the subject up with their doctor. As we all know, sex is an important activity for many. Today’s post will shine a light on the latest science based recommendations sex positions for those with low back pain and how the therapists at Fusion Wellness and Femina can help.

Science Based Sex Positions

In the 2014 study "Male Spine Motion During Coitus, Implications for the Low Back Pain Patient" and the 2015 study "Documenting Female Spine Motion During Coitus With Commentary on the Implications for the Low Back Pain Patient,"  Sidorkewicz and McGill used infrared cameras and electrodes to biomechanically test five common sex positions to analyze the strain they put on the spine. This was the first investigation of its kind.

Their investigation revealed that sex positions are not one size fit all- it depends on the type of back pain you have. Some people get backaches with spinal flexion (like the position bending over to tie your shoe or bending forward), while others become more aggravated with spinal extension (leaning backward or arching).  Layered on top of this, some people experience more back pain with excessive movement, while others do not. Various sex positions can decrease or increase these types of movements, aggravating or allowing pain-free movement. 

The study suggests that when receiving penetration, extension-intolerant people (pain made worse with arching) try the missionary position. Adding a low-back support, such as a pillow, can also help keep the spine in a more neutral position. For those receiving penetration who are flexion-intolerant (bending forward), the findings suggest trying spooning or doggy-style with the receiver supporting their upper body with their hands.

For those giving penetration, the atlas recommends that those who are extension-intolerant try missionary on elbows or spooning. For those giving penetration who are flexion-intolerant, try doggy style with the receiver supporting their upper body on their hands. Additionally, the study recommends a hip-hinging motion rather than thrusting when penetrating, to conserve spinal movement.

Some examples of recommended sex positions based on types of low back pain are highlighted in the figure at the bottom of this article:

Is this too much information? Not sure what kind of back pain you have? Have other issues like wrist, pelvic, or shoulder girdle pain that would make these positions difficult? The therapists at Fusion Wellness and Femina PT are trained and ready to help you.

How Can Therapy Help?

A pelvic health occupational or physical therapist with the skills to help you troubleshoot the mechanics of your favorite activities (including sex) can provide great insight into your pain with a thorough assessment and evaluation of your current range of motion, muscle strength, posture, and body movement.  We also welcome partners to sessions to make therapy client centered and tailored to your needs.

In the treatment of low back pain, you can expect a variety of modalities such as manual therapy, therapeutic exercise to gain muscular strength and length, and functional movement training to help you get back to your beloved activities (including sex) without pain! 

The physical and occupational therapists at Fusion Wellness and Femina are well equipped and ready to help, contact us today.

***This information is for educational purposes only and is not intended to replace the advice of your doctor.***


Bahouq H, Allali F, Rkain H, Hajjaj-Hassouni N. (2013). Discussing sexual concerns with chronic low back pain patients: barriers and patients' expectations. Clin Rheumatol. 32(10):1487-92

Volpe, K. (2015). Improving the Sex Lives of Patients With Chronic Pain. Practical Pain Management. https://www.practicalpainmanagement.com/treatments/psychological/improving-sex-lives-patients-chronic-pain

Sidorkewicz, N., McGill, SM. (2014). Male spine motion during coitus: implications for the low back pain patient. Spine (Phila Pa 1976). 39(20):1633-9

Sidorkewicz N., McGill SM. (2015). Documenting female spine motion during coitus with a commentary on the implications for the low back pain patient. Eur Spine J. 24(3):513-20

Image source: https://www.practicalpainmanagement.com/treatments/psychological/improving-sex-lives-patients-chronic-pain

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