Ian is a Senior Orthopedic Officer, and a palliative care specialist currently working at Fort portal Regional Referral Hospital.
One of the questions I deal with commonly among patients with back pain is whether lovemaking can help relieve their pain. In the society where I come from, it is a common belief that regular time between the sheets can help prevent and help relieve back pain. I have a significant number of patients who testify that it does help. Some even suggest that the lack of it is a potential cause for back pain.
At the same time, many people report that the pain in their back affects their ability to perform, or even enjoy the time between the sheets because the movements involved either cause or exacerbate their pain. Research backs this up. For example, in a study on coital position and functioning in patients with chronic back pain, the majority of patients reported that pain interfered in their performance, 64% reported worsening of their back pain, while 56% reported fear of aggravating the pain.
The question then is: Can lovemaking really help? And how exactly can it help?
The simple answer is yes, it can help—and this is how;
It is more helpful in patients with non-specific back pain.
In my observation, while treating back pain, patients who report relief of pain as a result of regular coitus are usually young adults, whose results from radiological investigations (like x- rays) indicate no obvious underlying pathology in the spine. Such patients are usually diagnosed with nonspecific back pain.
According to Professor Chris Maher and professor Rachelle Buchbinder (2017), nonspecific back pain can be defined as back pain that does not have a known pathoanatomical cause, and thus treatment focuses on the management of pain and its consequences.
In such patients, there is no presence of medical pathology or structural injury such as fractures or disease to the structures of the spine. Therefore, the movements involved in the ‘pleasure exercise’ are unlikely to cause (or worsen) structural damage that can result in back pain.
When done regularly, lovemaking can help, but the circumstances must be just right. It is important to remember that there are numerous underlying pathological processes that result in back pain. And therefore, in some situations, the pain will be relieved, but made worse in others, depending on the underlying pathology in the structure of the spine.
It’s exercise that provides movement and strengthens muscles of the back
Movement is good for the functioning of all parts of the musculoskeletal system and the back is not an exception. Lovemaking is a form of exercise that helps work up the muscle of the trunk, which support the spine in bearing the weight of the upper body. These muscles include flexors and extensors of the back (spine).
A study documenting female spine motion during coitus, with a commentary on the implications for low back pain patients found that the majority of the range of motion in the back, was in extension when coitus was performed in the quadruped position (when the female is supporting her upper body with the help of elbows or hands).
This study indicates that the quadruped position engages the extensor muscles of the back. It also recommends the quadruped position for female patients who do not tolerate the missionary position and its variants, which keep the spine in flexion.
Dominant positions like being on top involve the use of both flexor and extensor muscles, for the person in the dominant position. Regular lovemaking is therefore good exercise that can strengthen these muscles of the back.
When done regularly, exercises to strengthen these muscles can greatly improve back pain and quality of life. There is evidence indicating that exercises that build the strength of back extensors and flexors significantly reduce back pain.
Exercise like the Mckenzie and Brunkow programs are typically aimed at strengthening back extensors and flexors, and increasing back flexibility to reduce injury risk, improving mood and pain perception, to reduce the impact of the injury.
A study to determine the effects of the Mckenzie and Brunkow exercise program found significant pain relief for patients who followed the respective programs daily, for a period of at least four weeks.
The right bed plays a role
Making love on the right bed can prevent and relieve back pain. Most people cuddle and fall asleep when they are done. Where and how you sleep after the ‘pleasure exercise’ can have significant implications on your body particularly the spine. The posture you take when you sleep depends a lot on the nature of the mattress on your bed and will affect how your body will feel when you wake up. It may potentially worsen any pre-existing pain in the back.
According to a systemic review by Radwan et al. (2015), medium-firm mattresses were found to be beneficial with chronic nonspecific low back pain. And were rated as more comfortable than soft bedding systems.
Studies have shown medium-firm mattresses to improve sleep quality by 55% and decrease back pain by 48% in patients with chronic low back pain. These mattresses help maintain appropriate sleeping posture, especially in a side-lying position, as they prevent sagging of the pelvis.
The choice of the playing surface, therefore, has a significant role in determining whether the pain will be worse or better, the morning after.
More research is needed to explore and obtain a full understanding of the specific anatomical implications of the movements involved in lovemaking, for patients with back pain.
What to do if love making makes your back pain worse
If the pain is made worse, some things can be done to enable you and your partner to have a good time between the sheets.
Talk to your partner about it
Firstly, talk to your partner and let them know exactly how you are affected. Work together to identify what makes the pain worse, and which positions are comfortable. Talking to your partner is important because his/her sexual needs are also affected, and you need to get through it together.
Slow down and wait for healing to occur
If your back pain is due to structural injuries like a fracture to the bones of the spine, disc prolapse, or injury to the soft tissues of the spine, you may have to slow down and wait until there is significant healing. This may take a few weeks. Movement is usually good for healing musculoskeletal injuries, but if the movements cause pain, then you should slow down until the pain subsides.
As the healing progresses, you can resume intercourse gradually. You will have to identify lovemaking positions that are more tolerable for your back, to avoid the recurrence of the injury. Your doctor or physiotherapist can help with this.
Avoid masking the pain with pain medication
If the back pain is due to a pathological process like degenerative disc disease or spondylosis, certain positions and movements will make the pain worse. Avoid those positions. There is a temptation to take more medication to mask the pain so that you can perform.
Pain medications will only relieve the pain but will not remove the underlying pathological process. Avoid the temptation of masking the pain so that you can perform. This will only make the condition worse.
Work with your physiotherapist to identify offending movements and draw a plan on how to minimize or avoid such movements.
In conclusion, regular sex is good for your health in many ways, including the health of your back. If your partner is unavailable for sex because of a chronic illness like cancer, this article; "Dealing with sexual needs when a spouse has cancer" will be helpful.
Monga, T., Monga, U. Tan, G. and Grabois, M. (1999). Coital position and sexual functioning in patients with chronic pain. ‘Sexuality and Disability’, Vol. 17, issue 4, p.287-297.
Muji, E., Trebinjac, S., Avdi, D., and Akota, S. (2004). Effects of Mckenzie and Brunkow exercise program on spinal mobility comparative study. ‘Bosnian journal of Basic Sciences’, IV (1) p.62-68.
Radwan, P., Darcy J., Meryers, J., Rooney, M., Taylor, J. and Torri, A. (2015). Effect of different mattress designs on promoting sleep quality, pain reduction and spinal alignment in adults with or without back pain; systemic review of controlled trials. ‘Sleep health’, Vol. 1 issue 4 (257-267) [Internet]. Available at: https://www.sciencedirect.com/science/article/pii/S2352721815001400?dgcid=raven (Accessed 14th December 2018).
Sidorkewicz, N. and McGill, S. (2015). Documenting female spine motion during coitus with a commentary on the implications for the back-pain patient. ‘European Spine Journal’, Vol. 24 (3) 513-520 [internet] Available at: https://link.springer.com/article/10.1007%2Fs00586-014-3626-y (Accessed 13th December 2018).
This content is accurate and true to the best of the author’s knowledge and does not substitute for diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed health professional. Drugs, supplements, and natural remedies may have dangerous side effects. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.
© 2018 Ian Batanda