What if I have a bad back?

This is one of the most useful questions on the site and almost nothing is written about it. A large proportion of people doing this are over forty and a fair number of them have a back, a hip or a knee that has opinions. All of it is workable.

Consenting adults only. Everything on this page is about adults over 18 who have freely agreed to it.

Written from first-hand experience or extensive research by the editor.

Then you adapt the position, and almost everything else stays the same. A bad back rules out some ways of arranging a body and rules out none of the activity, which is a distinction people miss because the classic positions all happen to be spine-loading ones.

I am not a clinician and none of this is medical advice. If you have an acute injury, a recent operation, or nerve symptoms down a leg, ask a physiotherapist before you arrange anything. What follows is practical experience, and the detailed treatment is on positions: angle, stability and the body.

The good news first

The target area is nowhere near the problem. Everything lands on the fleshy lower half of the buttocks, well below the tailbone and a long way from the kidneys, which sit higher and to the sides. Nothing about a correctly aimed session goes anywhere near a lumbar spine. See where it is safe to strike.

So the risk is not impact. It is posture: how long a body is held in one shape, how much of its own weight it is supporting, and how it gets back upright afterwards.

Positions by problem

The single most useful adaptation

A pillow, or two, under the hips while lying face down. It presents the target area cleanly, keeps the lumbar spine in a neutral position rather than extended, takes all the weight off the arms and legs, and can be held for forty minutes without anything complaining.

It is also a perfectly good position for a scene rather than a compromise. Nothing about it reads as clinical, and the person delivering has a better view and a better angle than they do over a knee.

Standing time and corner time

Corner time is where mobility problems usually bite, because standing still is harder on a bad back than walking. Ten minutes facing a wall is genuinely difficult with lumbar pain or arthritis, and people push through it because it feels like the sort of thing you are supposed to endure.

The adaptations are easy. Face the wall sitting on an upright chair. Stand with one foot on a low step or a book, which unloads the lower back considerably. Shorten it to three or four minutes, which is quite long enough to do what corner time does. Or replace it with lines, which does much the same job while seated. See lines, corner time and impositions.

Circulation and getting up

Head below heart for a long period makes people dizzy, and that is worse with blood pressure medication, worse again with age, and worst of all right at the end when somebody suddenly straightens up.

So build the ending in. Up onto elbows first, then kneeling, then sitting on the edge of the bed for a minute before standing. Whoever is topping should have a hand on an arm for the last stage of that, every time, without it becoming a discussion.

Numbness and pins and needles during a session mean move now rather than wait. Any numbness still present the following day is a reason to see a doctor.

Structuring the whole session differently

• Shorter blocks. Fifteen or twenty minutes in a position, then a break and a change, rather than one long stretch. This is better practice for everybody and essential with joint problems.
• Warm the body as well as the skin. A warm room and five minutes of moving about beforehand does more for a stiff back than any amount of careful positioning.
• Fewer, heavier implements rather than a long session by hand. Hand work takes time, and time in position is the limiting factor here.
• Plan for the next day. Backs frequently object twenty-four hours later rather than at the time, so a Saturday session with a free Sunday is a better plan than a Sunday one.
• Medication matters. Anticoagulants and long-term steroids substantially increase bruising, and some pain medication will mask feedback you need. Say what you take. See marks and bruising.

What not to do

Do not endure a position because it is the traditional one. Over the knee is a lovely thing and it is unkind to a bad hip, a bad back and a bad neck all at once, and there is no rule requiring it.

Do not use a scene to prove the body is fine. That is a specific temptation for people who have lost mobility recently, and it is how people end up back at the physiotherapist explaining themselves.

And do not let a partner improvise your positioning. If somebody who has been told about your back keeps suggesting the position you said you could not do, that is a failure to listen dressed up as enthusiasm.