Sometimes the best you can do is just try to make love in the least painful way possible. Listen to your body, says Dr. pain is your body telling you, quite plainly, which positions to avoid. People with ruptured disks, for instance, would be better off taking the bottom position during sexual intercourse because being on top requires bending forward, which can be painful, advises Augustus M.D., professor of orthopedic surgery at Harvard Medical School and a leading back specialist. (If there is a significant weight difference and the person on top is very much heavier, a side-by-side position might be a better idea.) Also try to avoid positions that involve extreme arching of the back, which puts tremendous pressure on disks and joints in the low back. It's also a good idea to avoid overzealous pelvic thrusting, he says.

In his book Your Aching Back, Dr. White describes several lovemaking positions likely to minimize backache as well as the aggravation to underlying disks and joints. In one back-saving position, both partners lie on their sides, nestled together like spoons, and the man enters from behind. The man and woman should both keep their hips and knees slightly bent. This way, neither partner has to support his or her own weight, or the partner's weight, and the strain is taken off joints and muscles. This is the best position for making love when in acute pain, whether it's the man or the woman who's hurting, Dr. White says. When the woman has a backache, the couple might try a sort of modified missionary position.

The usual missionary position, with the man mounting the woman while she lies prone, can be painful for her. In the modified position, the woman lies on her back, and the man kneels between her spread legs. The woman drapes her legs over his thighs. (His knees are spread about 2 feet apart.) Her upper body should be supported by pillows, and her thighs, by her partner's thighs. The man may also support her lower back a little with his hands. In this position, Dr. White explains, the psoas muscle, which supports the lower back, is relaxed, releasing the strain on her back.

Here's another good position for a woman with back pain: The man lies on his back, and she mounts him, supporting her weight by bending over and putting her hands beside his shoulders. Her legs are spread, her knees bent. This way, her hips are flexed, she avoids arching her back, and she can support her own weight. For spice, she can try turning around so that she's facing his feet, supporting herself by putting her hands on his knees.
A man with back pain can try this position: The woman lies on her back with her legs extending over the edge ofthe bed and her feet flat on the floor. He kneels on the floor between her legs and enters. He can take some of the weight off his upper body by leaning his elbows on the bed, Dr. White suggests.