Back pain is indeed a complete pain, but what should you do when you have needs? It depends!
"Back pain is typically aggravated by either flexion (bending forward) or extension (bending backward), and choosing the best pain-free sex position depends on which category they fall into," says doctor of physical therapy Stephanie Stamas, pelvic-floor rehab specialist and inventor of the Chelsea Method, a fourth-trimester rehab protocol for postpartum moms.
You might not know if you've got a flexion or extension situation going on, so you'll have to experiment. What's best for one is the worst for the other. Fun! "My advice would be to try to maintain a 'neutral spine' no matter what position one is in," suggests doctor of physical therapy Theresa Marko, board-certified clinical specialist in orthopedics and owner of Marko Physical Therapy.
In the longer term, try these stretches for shoulder and upper back pain or glute stretches if you're experiencing a literal pain in the ass. If the pain in the ass is more metaphorical and might actually be your partner, you can go deep with it and have a look at what back pain says about your relationship.
(And if you're experiencing any pain with sex, it could also be caused by something else like endometriosis, trauma, or even just a partner with a really big dick. Try these positions if penetrative sex is painful, and if those don't help, check with doctor to make sure everything's okay. "Sometimes lower-back pain during sex can be radiating from pelvic-floor muscle tension being aggravated from intercourse. If there is any accompanying pain in the vulva, at the vaginal opening, or deep within the pelvis during or after sex, definitely seek out a pelvic-floor physical therapist! We really can help improve sexual satisfaction and eliminate any sex-related pain syndromes," says Stamas.)
If you're feeling brave, set out some safety cones and try these.
1The Long-Handled Lovin'
"One of the most comfortable and safe ways to masturbate is on your back and with a toy. I recommend using a toy so that you aren't hunching your shoulders to reach your sweet spot. This way your back isn't stressed while you are pleasuring yourself," says sex coach and writer Carmel Jones. "Consider using a toy with a long handle. By adding an extension to your arm, you're able to reach your vulva without having to put extra strain onto your back, says Megan Stubbs, sexual wellness, relationships, and body image expert.
And if you have lower-back pain and tight hip flexors, prop your legs over a couple of pillows to decrease tension, says physical therapist Heather Jeffcoat, owner of ortho and pelvic health-based practice Fusion Wellness & Physical Therapy.
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2Standing Doggy
"When you have a bad back, you need to avoid bending and flexing as much as possible," says Emily Brooks, sex and relationship coach for BeyondAges.com. "Standing doggy-style is very easy on both of your backs. This position allows both of you to keep your backs relatively straight while using your legs and hips to thrust. It also avoids either person from having to carry the weight of the other."
3Safety Spoons
"The spooning position with rear entry is a good position for those with back pain, as the paraspinal muscles are relaxed in this position," says doctor of physical therapy Kristen Gasnick, board-certified physical therapist. If using your hand or even a long-handled toy to get the clit stim you need is too much, prop a small but powerful toy between your legs and let it attend to you.
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4Mission Sciatica
"When we have radiating back pain that goes down the back of the leg, it is a sign that the nerve in the spine may be inflamed. We want to avoid any extreme motions on the spine such as bending, twisting, or extending," says doctor of physical therapy Sara Mikulsky, orthopedic physical therapist and owner of Wellness Physical Therapy, who recommends sticking to missionary. "If the person on their back can lift their legs and keep their knees bent, it will also prevent placing more pressure on the nerves to prevent further pain." Bending your hips at a 90-degree angle is the best way to keep a neutral spine, says Marko.
5Careful Lotus
"Lotus is just another way of saying 'sitting on your partner's lap with a penis or dildo inside your body,'" says Gigi Engle, certified sex coach, sexologist, author, and SKYN Condoms sex and intimacy expert about the ancient tantric position. "You're literally just sitting face-to-face, either on a penis or dildo. If you're not interested in penetration, you can use a vibrator and forgo that part of it. Everything is adaptable. You can set the pace, rocking back and forth, grinding your clitoris to reach orgasm."
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