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.2014 Sep 15;39(20):1633-9.
doi: 10.1097/BRS.0000000000000518.

Male spine motion during coitus: implications for the low back pain patient

Affiliations

Male spine motion during coitus: implications for the low back pain patient

Natalie Sidorkewicz et al. Spine (Phila Pa 1976)..

Abstract

Study design: Repeated measures design.

Objective: To describe male spine movement and posture characteristics during coitus and compare these characteristics across 5 common coital positions.

Summary of background data: Exacerbation of pain during coitus due to coital movements and positions is a prevalent issue reported by low back pain patients. A biomechanical analysis of spine movements and postures during coitus has never been conducted.

Methods: Ten healthy males and females engaged in coitus in the following preselected positions and variations: QUADRUPED, MISSIONARY, and SIDELYING. An optoelectronic motion capture system was used to measure 3-dimensional lumbar spine angles that were normalized to upright standing. To determine whether each coital position had distinct spine kinematic profiles, separate univariate general linear models, followed by Tukey's honestly significant difference post hoc analysis were used. The presentation of coital positions was randomized.

Results: Both variations of QUADRUPED, mQUAD1 and mQUAD2, were found to have a significantly higher cycle speed than mSIDE (P = 0.043 and P = 0.034, respectively), mMISS1 (P = 0.003 and P = 0.002, respectively), and mMISS2 (P = 0.001 and P < 0.001, respectively). Male lumbar spine movement varied depending on the coital position; however, across all positions, the majority of the range of motion used was in flexion. Based on range of motion, the least-to-most recommended positions for a male flexion-intolerant patient are mSIDE, mMISS2, mQUAD2, mMISS1, and mQUAD1.

Conclusion: Initial recommendations-which include specific coital positions to avoid, movement strategies, and role of the partner-were developed for male patients whose low back pain is exacerbated by specific motions and postures.

Level of evidence: N/A.

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Figures

Figure 1.
Figure 1.
Sample data from 1 subject for mSIDE, which demonstrates the variability in spine motion during a trial. Table 3 reports both the absolute maxima and minima scores for each trial, which occur at approximately 19.5 and 11 seconds in this trial, respectively, as well as an average of the local maxima and minima found throughout a 20-second trial.
Figure 2.
Figure 2.
Amplitude probability distribution of average lumbar spine angular displacement (% aROM) across all coital positions. The dashed horizontal lines indicate the amplitude probabilities at which statistical tests were performed (i.e., 0.0, 0.5, and 1.0). The dashed vertical line indicates zero lumbar spine angular displacement (i.e., a neutral spine position in upright standing)—to the left of this line is lumbar spine flexion and to the right of this line is lumbar spine extension. The angular displacement values at any amplitude probability can be interpreted as the probability that angular displacement was equal to or lower than that value during that coital position. Using mMISS2 as an example, 50% of the time during mMISS2, spine motion was equal to or less than approximately 32% of lumbar spine flexion aROM. aROM indicates active range of motion.
Figure 3.
Figure 3.
Histogram showing the means and standard deviations of average lumbar spine angular displacement (% aROM) at amplitude probabilities of 0.0, 0.5, and 1.0 across all coital positions. Statistical significance is represented by the following: *P < 0.001, †P < 0.01, ‡P < 0.05.aROM indicates active range of motion.
Figure 4.
Figure 4.
Initial recommendations of coital positions toavoid for male patients whose low back pain is exacerbated by specific movements and/or postures (i.e., flexion-, extension-, and motion-intolerance). Positions indicated as “to avoid” are those that present the greatest risk of exposure to the pain-provoking biomechanical variable, thus exacerbation of low back pain. Note: These recommendations are limited to specific motion intolerances and male-centric positions and did not consider kinetics nor include individuals experiencing pain.
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