Sexual Positions That Cause Back Pain and What to Do About Them

If you have back pain, adjusting sexual positions (or trying new ones) can help you enjoy intimacy with your partner without undue pain.

Certain positions are better suited for sex if dealing with spinal conditions like a herniated disc, facet joint pain, spinal arthritis, and sacroiliac joint pain. Moreover, it is possible to have sex while protecting your back from injury and pain following spinal surgery.

This article describes some best positions for sex when faced with these common spinal and lower back problems.

Couples with sore backs in bed
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Sexual Positions for Disc-Related Back Pain

Disc problems such as a herniated disc can be irritated by excessive spinal flexion movements. These are the forward-thrusting of the lower back, pelvis, and hips, such as is involved in the missionary position. Spinal flexion causes the spaces between the spinal bones (vertebra) to widen, further aggravating the bulging of the injured disc.

For the "top" (insertive) partner with a disc problem, one of the best options is to switch to the supine position in which you lie on your back with your partner on top. To further protect the lumbar (lower) spine, place a rolled-up towel or pillow under your back to retain the natural arch.

For the "bottom" (receptive) partner with a disc problem, the prone position (in which you lie face down) automatically puts more arch into the back. If you need more arch, place a pillow or bolster under your hips. You can raise up even higher by doing a small press-up action with your forearms.

Take your time and work with your partner to find the right amount of arch. Keep away from extreme positions, and make further adjustments if any movement causes pain.

Sexual Positions for Spinal Arthritis

Spinal osteoarthritis, also known as wear-and-tear arthritis of the spine, is caused by cumulative damage to the spine over time. This can cause back pain as bone spurs start to develop between the vertebra or facet joint pain as the cartilage between the vertebra starts to wear down.

With spinal osteoarthritis, pain is generally felt during spinal extension (the arching of your back) due to the compression of the space between the vertebra.

For the top partner with spinal arthritis, the supine position is ideal, but you can also try the "doggy-style" sex position in which your partner is on all fours and you approach from behind while on your knees. By keeping your back stable, you can limit spinal extension by thrusting with the hips or having your partner "back into you."

The doggy-style position may also be suitable for the bottom partner as long as the lower back and core muscles are stabilized, and the top partner doesn't thrust too aggressively.

Sexual Positions for Sacroiliac Joint Pain

The sacroiliac joint is the joint that connects the sacrum (tailbone) to the wing-like ilium bones of the pelvis. Sacroiliac joint pain is generally one-sided—either the right side or left—and is typically worsened with spinal extension or when weight-bearing pressure is placed on the hip or buttocks.

The best way to deal with sacroiliac joint pain during sex, whether as the top or bottom partner, is to bend the knee of the painful side. This takes stress off the joint and allows for freer movement during sex.

For example, the bottom partner can lie on their side—with the painful side up—and wrap their leg around their partner. Or, the top partner can keep one knee on the bed and the other in a seated position while engaging in doggy-style sex.

Sexual Positions After Spinal Surgery

If you're recovering from back surgery, it can take time before you can comfortably engage in sex without pain or possible re-injury to your back. This is why it is important to ask your surgeon when it is safe to engage in sex and which positions are best suited for you. Sure, it can be awkward to ask, but spinal surgeons are generally well-versed in this.

The position that is best suited for you can vary based on where on the spine the surgery took place and whether the approach was anterior (entered from the front of the body) or posterior (entered through the back).

Depending on these and other factors, you may be advised to start with the missionary position as the top partner, supporting your body weight with your arms, or to have sex while standing with your partner bent over a chair or table.

A "spooning" position, in which each partner is laid comfortably on their sides, can be a good position for both a top or bottom partner following back surgery.

As with any back or spinal problem, don't rush things, communicate with your partner, and stop if any sexual position causes pain.

3 Sources
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  2. Goode AP, Carey TS, Jordan JM. Low back pain and lumbar spine osteoarthritis: how are they related?. Curr Rheumatol Rep. 2013;15(2):305. doi:10.1007/s11926-012-0305-z

  3. Jonely H, Brismée JM, Desai MJ, Reoli R. Chronic sacroiliac joint and pelvic girdle dysfunction in a 35-year-old nulliparous woman successfully managed with multimodal and multidisciplinary approach. J Man Manip Ther. 2015;23(1):20-6. doi:10.1179/2042618614Y.0000000086

By Anne Asher, CPT
Anne Asher, ACE-certified personal trainer, health coach, and orthopedic exercise specialist, is a back and neck pain expert.