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Surprise, Surprise, Sex and Back Pain don’t go together very well do they?

And if you or your partner are among the 35 million people who have back pain, you know that back pain can disrupt your relationship.

Sex is an important part of the intimacy between couples, and attitudes about sex, about rejection and about our self-image when we don’t feel up to a sexual encounter can haunt a couple for a long time.

Sex is supposed to be pleasurable for both of you and the fear of

hurting yourself or your partner inhibits the spontaneous joy that

you probably felt before your back pain developed. But what can you

do about it? Most couples in which one or the other is restricted

by back pain will eventually get around to realising that back pain

does not automatically mean no more sex. What it does mean is that

you will need to make some accommodations to the pain and or the

fear of it. It also means you will need to talk about sex in a

slightly different way than you are used to.

Let’s back up for a second and begin with a very strong suggestion.

Because pain has both a psychological component and a physical

component, getting a sound diagnosis is critical to putting your

mind at rest about what is wrong and secondly having a sound

diagnosis will also give you guidelines for your physical

limitations.

Secondly, after you have the diagnosis, involve the doctor or

physical therapist in a frank discussion about do’s and don’ts.

Maybe that’s an uncomfortable subject for you, but these days we

are talking more openly about sex and you should tap into the

doctor’s experience here. In a perfect world the doctor would open

the discussion for you, but if they don’t you may have to initiate

it. Ideally your partner should be present because he or she will

have his or her own questions and concerns.

Sex Advice

Starting off right

To start sex off right, start off with a massage, or ice down the

painful area. A warm shower together might help too. That way the

muscles are relaxed.

Positions

Here are some sexual positions that can help you enjoy a pain-free

experience.

For males:

1. Lay on a firm surface and use pillows to support your knees and

head. You might like to try placing a small rolled towel under your

lower back.

2. Try a side-by-side position.

4. Place a pillow under your lower back while your partner straddles

you on top. You can also sit in a sturdy chair instead of lying down.

For females:

Try missionary position with the legs bent toward the chest.

2. Sit on the edge of a chair and have your kneel between your legs

for entry.

3. Rear entry may also be more comfortable for women with back pain.

Try it kneeling on the bed or lying on your belly with a pillow under

her chest.

4. Sit on your partner’s lap as he sits in a chair.

Remember, the health of your back is dependent on many dynamic factors.

Your symptoms may change over time so you may need to work with your

health care provider from time to time as you go through the many

stages of recovery. A word of caution is in order at this point. It

is pretty common to begin feeling better and then overdo it and have

your back pain symptoms flair up. I call this, the Eureka effect

and it can happen to anyone. Just remember that as you improve

gradually, so should your activity level also increase gradually.

As I mentioned earlier pain has two parts. There is the physical part.

This is the actual stimulation of the nerve, like a painful tooth or a

herniated disc pressing on the nerve. And then there is the subjective

or the psychological part. This is how it feels to you and includes,

among other things, such attitudes as fear that it will get worse or

last forever, what will it means to be chronically disabled, and what

you believe your partner thinks about it as well as how you are coping

with your condition.

So, at the top of your agenda there needs to be a frank discussion of

your pain limitations and expectations about sex. It is a mistake to

believe that your partner understands what it feels like. It is your

responsibility to communicate those limitations as clearly as possible;

it is their responsibility to listen and try to understand. Pain, after

all, is invisible and subjective. That means your pain is unique to you.

We have heard people liken back pain to everything from a hot poker

going down one or both legs to a chronic aching sensation localized to

the lumbar area. It doesn’t matter what words you use, just try to

explain the pain, what causes it (position, certain movements, or

whatever), and what feels good or is what is comfortable for you.

Is it obvious that if it hurts, don’t do it is generally good advice but

some positions and techniques hurt more than others? It may require some

gentle experimentation to find out what works but as in most sex advice,

“gentle” is the best place to start.

In terms of maximizing yours and your partner’s sexual pleasure, it is

very important to stress that all you really need is your imagination and

the willingness to experiment to open up new areas of intimacy. But it

all begins with willingness to try. And given that, you just may find

that the challenge of your back pain can be turned into the juice of new

sources of mutual pleasure!

Terry O’Brien

Back Doctor UK

 



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During my 17 years practicing medicine, patients and friends constantly ask me:

“What is the most likely cause of my back pain?”

I’ve written this simple guide for people who have the same question in mind.

The commonest type of back pain is caused by tears or strains to ligaments, tendons or muscles around the lower spinal cord. The underlying factors are straining, poor posture, incorrect lifting and inactivity. The pain usually appears 36-48 hours after the strain or can be gradual in onset. The symptoms can be mild to moderate depending on the level of injury.

Herniation of a vertebral disc may be associated with back pain and also sciatica…shooting pain down the back of one leg. It is most often seen in people in their 30′s and 40′s but can also occur in the elderly. The condition is caused by underlying disc degeneration. This can lead to a gradual rupturing of the disc and Herniation of the disc contents. This process can be exacerbated by physical straining or exercise. The sciatica occurs when the disc contents press on the neighboring spinal nerve. The pain, which can be very severe, may be associated with numbness or tingling in the area supplied by that nerve (dermatome).

Facet Joint Arthropathy can result from arthritic changes, degeneration or trauma to the facet joints of the vertebral bodies of the spine. These joints are normally covered with cartilage and lined by synovial membranes. Arthritis leads to wear and tear of the cartilage and inflammation of the membranes. This leads to grating movements between the two facet joints. This type of back pain is worsened by torsion or elongation of the spine. The pain is normally well localized and may spread to the buttocks.

Narrowing of the spinal canal (Spinal Stenosis) is more commonly seen in the elderly. It is secondary to vertebral degeneration. It may also occur with infection, trauma, tumors and arthritis of the spine and with bony spurs and disk herniation. It can progress to severe spinal cord injury. It is associated with back pain as well as pain, numbness and weakness of the buttocks.

Radiculopathy (‘a pinched nerve’) is associated with back pain and pain, numbness, weakness and tingling of the legs. It occurs when inflammation of a spinal nerve is caused by pressure or friction. The underlying factors can be tumors, bony spurs, disc herniation, and fractures of the vertebrae. The presence of muscle weakness in the legs as well as pain in the back… indicates severe symptoms. In such cases you should seek a doctor’s advice immediately.

Tumors of the spine, whether they originate in the spine or spread from distant organs, can cause terrible back pain through pressure on the nerves and spine. Chronic persistent pain despite treatment is suggestive although not diagnostic of a spinal tumor. Be suspicious when such pain is associated with generalized signs of cancer such as weight loss, loss of appetite and tiredness.

Infection of the spinal cord or surrounding tissues causes pressure on the spine and can result in severe back pain and loss of function of the affected spinal nerves. Examples include spinal meningitis and osteomyelitis.

Pathology of the vertebrae of the spine can cause pressure on the spinal nerves, inflammatory conditions and degeneration. Examples include osteoarthritis, osteoporosis and ankylosing spondylitis. Ankylosing spondylitis is characterized by pain in the back and stiffness. This stiffness is more pronounced in the morning as is not helped by rest. There may also be pain in the shoulders, neck and mid-spine. Osteoporosis ( low bone mass) leads to fractures. Fractures cause sudden severe back pain localized to the area of the fracture. Osteoarthritis, the wear and tear of joints with age, leads to chronic back pain which tends to be poorly localized. It is normally associated with stiffness and pain which is not eased by rest.



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These days it is not rare to find people affected by heel pain that is so severe that it may prevent experiencing everyday things in life. Today, heel pain is a very common type of foot condition. It can begin as an irritating pain that you feel every now and then, and develop into an intense pain that is felt every day. Sometimes, a hurting heel can go away on its own, but, if left untreated, heel pain can get very painful.

There are usually two places on the heel that people complain of pain, under the heel and in the back of the heel. Usually, when people suffer from pain in the back of the heel it is related to excessive use or inflammation of the Achilles tendon. When people feel heel pain, it can be caused by a person stepping on a large stone or rock which bruises the heel, or the plantar fascia can be inflamed. A heel that is injured by a sharp object will heal on its own over time. Nonetheless, if the heel pain is caused by inflammation of the plantar fascia, there are a few things that need to be done to help including plantar fasciitis exercises and orthotics.

The plantar fascia is the soft tissue on the bottom of the foot that connects the heel to the toes. Under normal conditions, the plantar fascia is a flexible and strong part of the foot that helps the foot to hold up our weight and keeps us balanced. If the foot is under abnormal stress, such as excessive body weight, repetitive movements from sports, age or compromised foot function, it can create small tears in the plantar fascia. These small tears typically are found near the heel bone, where they become inflamed and cause pain. If this tissue is repeatedly stretched it can create the creation of heel spurs. Heel spurs are boney growths on the heel that can be the reason for quite a bit pain.

If you are feeling heel pain, a popular strategy to help alleviate the stress on the plantar is to use orthotic arch supports and do plantar fasciitis stretching exercises, that will strengthen the plantar fascia as well. One of the prescribed plantar fasciitis exercises is to stretch the foot before rising from bed. The Plantar Fascia tends to tighten when you sleep, which tends to cause the strong pain that people feel when they get up. By stretching the foot arch before putting pressure on it, you can help reduce the pain that you experience with your first morning steps. Another useful exercise for stretching out the plantar fascia is to roll a tennis ball or rolling pin with the arch of your foot. As this becomes less and less painful you can try standing up and doing the same exercise.

The next helpful thing to do is immediately put on a sturdy pair of shoes and orthotic inserts. This will help to cushion and support the foot arch and help to keep it from more injury. If you make use of the proper plantar fasciitis exercises and orthotic arch supports, you will see a great improvement in your heel pain. You should really pay attention to your body and if you are feeling foot pain, see a doctor as soon as possible. This will ensure that your pain does not turn into a more serious issue.



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