Take preventive measures
Planning can make sex better. If your back is sore, taking a pain reliever before sex (as with any physical activity) can help, Marks says. He recommends an NSAID, but other non-narcotic pain relievers are fine, too.
If you have muscle spasms in the back, a hot shower before sex is a good idea, Marks says. “Sex can be a physical sport. If you’re taking cold muscles in spasm and going through vigorous activity, you could aggravate it.”
Besides taking a relaxing shower before sex, you could also try icing the troubled area afterward, Marks says. “Icing relieves any overstimulation of the muscles, any excessive stretching or anything like that -- just like an athlete after competing winds up icing whichever body part they’ve had problems with,” Marks says.
Try new positions
To make sex more comfortable, “[Couples] may need to modify the positions that they’re in,” Marks says.
That takes knowing your own body. Some people, such as those with disc problems, feel more pain when they bend forward, Hebert says.
For these people, the best positions allow the lower back to feel supported and relaxed, experts say. “Usually, the person with the back problem is going to find that they’re going to want to be on the bottom,” Marks says. “The key is, you want to make sure your back is in a well-supported position. It may be that you need to put a pillow underneath your back,” he says. A pillow in the small of the back will support the lumbar region. Placing pillows underneath the knees to make them slightly bent also takes pressure off the back, he says.
“In essence, you have the ability to still have sex,” he says, “but you may not be as vigorous as you would be otherwise.”
Others have more pain when they lean backward, typically those with arthritis or spinal stenosis, Hebert says. When they lean or hunch forward, their pain eases. This group may find that a side-by-side position works better. For example, a man with back pain will lie on his side, with his partner lying on her side with her back to him. Then he can enter from behind. He can control the position of his back, including being able to bend slightly forward.
Hebert says that physical therapy can help someone with chronic back pain improve flexibility and stability of the spine. “They should…see a physical therapist who is expert at spinal mechanics,” Hebert says. “[The physical therapist] will show them stretches and strengthening exercises that will build ability of the spine to move, to assume positions, and to stabilize themselves in those positions.”
Know when to stop
Sometimes, back pain doesn’t happen during sex, but occurs later, Hebert says. “You can be doing something wrong, you can be doing too much of something, and the pain will be encountered in a delayed manner. You have to look out for that.” Limit sexual activities to a safe level of intensity, he says.
During sex, “mild discomfort may be acceptable,” he says, but not stronger pain.
If back pain strikes during sex, stop right away, Marks says. “It’s no different from the person who’s got back pain and says, ‘I only have a few more games to finish the tennis set. You do that -- your recovery time’s going to be even longer.”
A couple can always try again on a day when back pain has improved.