title: Documenting female spine motion during coitus with a commentary on the implications for the low back pain patient.
abstract: OBJECTIVE
  To describe female lumbar spine motion and posture characteristics during coitus and compare these characteristics across five common coital positions. Exacerbation of low back pain during coital movements and positions is a prevalent issue reported by female low back pain (LBP) patients. To address this problem, the first study to examine lumbar spine biomechanics during coitus was conducted.
  
  
  METHODS
  Ten healthy males and females performed coitus in the following pre-selected positions and variations: QUADRUPED (fQUAD1 and fQUAD2 where the female is supporting her upper body with her elbows and hands, respectively), MISSIONARY (fMISS1 and fMISS2 where the female is minimally and more flexed at the hips and knees, respectively), and SIDELYING. An electromagnetic motion capture system was used to measure three-dimensional lumbar spine angles that were normalized to maximum active range of motion-a transmitter and receiver were affixed to the skin overlying the lateral aspect of the pelvis and the spinous process of the twelfth thoracic vertebra, respectively. To determine if each coital position had distinct spine kinematic profiles (i.e., amplitude probability distribution function and total range of lumbar spine motion), 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
  Female lumbar spine movement varied depending on the coital position; both variations of QUADRUPED, fQUAD1 and fQUAD2, were found to use a significantly greater range of spine motion than fMISS2 (p = 0.017 and p = 0.042, respectively). With the exception of both variations of MISSIONARY, fMISS1 and fMISS2, the majority of the range of motion used was in extension. These findings are most pertinent to patients with LBP that is exacerbated by motions or postures. Based on the spine kinematic profiles of each position, the least-to-most recommended positions for a female flexion-intolerant patient are: fMISS2, fMISS1, fQUAD1, fSIDE, and fQUAD2. These recommendations would be contraindicated for the extension-intolerant patient.
  
  
  CONCLUSIONS
  The findings provided here may guide the clinician's specific recommendations, including alternative coital positions and/or movement patterns or suggesting a lumbar support, depending on the female LBP patient's specific motion and posture intolerances.
authors.affiliation: Department of Kinesiology, Spine Biomechanics Laboratory, University of Waterloo, Waterloo, ON, Canada, nsidorke@uwaterloo.ca.
authors.forename: Natalie
authors.initials: N
authors.lastname: Sidorkewicz
authors.forename: Stuart M
authors.initials: SM
authors.lastname: McGill
mesh_terms: D000328:Adult; D001696:Biomechanical Phenomena; D003075:Coitus / Q000502:physiology*; D005260:Female; D064368:Healthy Volunteers; D006801:Humans; D016014:Linear Models; D017116:Low Back Pain / Q000503:physiopathology* / Q000517:prevention & control; D008159:Lumbar Vertebrae / Q000502:physiology*; D008297:Male; D009068:Movement; D011187:Posture; D016059:Range of Motion, Articular