Having recently seen several cyclists with low back pain at Elite Performance Therapy, we thought best to share some of our key preventative measures to keep your spine healthy and pain-free.
Whether it’s a dull ache that sets in towards the end of a ride, the odd twinge getting in and out of the chair at the coffee stop, or a raging sciatica that prevents cycling altogether, many of us have experienced some form of back pain. And the sad truth is, these problems often seem to be brought on – or at least exacerbated – by riding a bike.
You might be frustrated; you might be in pain; but one thing you certainly won’t be is alone!
Causes of Low Back Pain
Unfortunately number one is our lifestyle! We spend a lot of time at a desk and we weren’t particularly designed to sit at desks, which puts a lot of strain on our thoracic [mid] and lower back. That’s pretty unavoidable for most people.
The posterior chain – the muscles in your back, bum and the backs of your legs – is king. Unfortunately, these muscles get ‘switched off’ by sitting for long periods.
Don’t (always) blame your bike set up…
Correct bike set-up can certainly help to avoid low back pain (and we’ll come to that later), but what else could be going on?
Some research has shown that muscle fatigue may play a role. In one study, scientists demonstrated that when cyclists pedalled to exhaustion, their hamstrings (rear thigh) and calf muscles became progressively more fatigued (as expected).
What was surprising, was that this fatigue seemed to produce undesirable changes in muscle movement patterns, which then affected the back – specifically, the degree to which the cyclists were bent forward in the lumbar region and also how far their knees were splayed out.
Impaired Spinal Movement can cause Low Back Pain
Another study looked at the effects of holding a static bent-forward (flexion) position on the all-important back extensor muscles that help maintain stability in the lower back.
It found that after prolonged periods of static flexion (when a cyclist is on the drops), these muscles became less effective at generating the forces required to maintain spinal stability.
More evidence for this effect comes from Australian research, which compared nine healthy (symptom-free) cyclists and nine cyclists with chronic lower-back pain. In short, the researchers found that the cyclists in the pain group tended to have excessive increased lower back flexion (forward bending in the lower back), which was associated with reduced activity of deep low-back muscles called multifidus – key stabilisers of the lumbar spine.
The notion of impaired spinal-movement patterns as a major cause of lower-back pain in cyclists is also supported by Belgian research, which found that cyclists measured riding their own bikes, and who were chronic lower-back pain sufferers, tended to ride with more flexion in the lower lumbar spine. They also tended to experience a steady increase in pain over a two-hour period compared to healthy cyclists.
The scientists concluded that rather than poor bike set-up, it was the cyclists’ impaired motor control patterns in the lumbar region that led to poor movement patterns, specifically excessive flexion, resulting in lower back pain.
Adjust your Expectations
The back is a crossover point in the body, where all the forces we have travel through our back, whether it’s rotational or position-based, and also it’s the bit that holds us together.
It sounds like a recipe for disaster, but in essence the back is exceptionally well designed, but what we ask of it is probably quite a lot, particularly through cycling. The blame lies not so much with our backs, but with our expectations.
Some of us need to view our bodies a little more sympathetically. Cycling 100miles is an awful lot to put on your body, but quite normal for a lot of people, particularly nowadays.
So what if you enjoy riding long distances? If you’re a regular racer or club rider, riding up to 100 miles are probably part of what you love about bike riding. Thankfully, you don’t necessarily have to give these up to preserve back health. Much back pain seems to be preventable given a little attention, both on and off the bike.
How to Prevent Low Back Pain
SELECT THE CORRECT FRAME GEOMETRY
Although lower back pain often arises as a result of weakness or improper movement as a result of fatigue, it is a good idea to assess your bike fit too as this can be a contributing factor.
This could be as simple as tweaking your current setup. Shuffling some of the spacers sitting on top of your stem down underneath it will raise up your handlebars, meaning your back won’t have to bend as severely to reach them. Equally, swapping out a long stem for a shorter one will prevent you from having to stretch out quite so far, also reducing the stresses on your spine.
If those adjustments aren’t sufficient – or if you’re looking to purchase a new bike anyway – opting for a model that best matches your flexibility will help you stay injury free. Generally, this would involve opting for an ‘endurance’ model rather than a ‘ race’ model, the former of which will tend to place you in a less extreme and more relaxed position than the latter.
Remember, it’s still perfectly possible to ride hard and fast on an endurance bike, should you wish. A comfortable and sustainable position that allows you to put the power out will see a better performance than overreaching with too aggressive a geometry.
Getting a professional bike fit will help ensure that you’re riding in an optimum position
OPTIMISE YOUR BIKE SET-UP TO MINIMISE INJURY RISK
If you’re happy that you’re sitting aboard a frame with geometry that suits you, you need to get set up on it correctly. Here’s a look at the key elements to look at:
Saddle height: This should be positioned so that when the pedal is at the bottom of the stroke and the ball of your foot is on the pedal, your knee should have a slight bend in it. Hips shouldn’t move sideways during crank rotation and you shouldn’t have to stretch at the bottom of the pedal stroke.
Saddle angle: This should be in a horizontal position, parallel with the floor when viewed side on (but sometimes a very slight downwards tilt can be helpful for those who experience a lot of pressure in the perineum area).
Forwards/backwards position of the saddle: With the pedals adjusted so that they are at the three o’clock and nine o’clock positions, a vertical line dropped from just behind the kneecap on the outside of the forward knee should pass through the axle of the pedal.
Handlebar position: Handlebars should be adjusted so that you neither have to stretch to reach them, or feel confined by having them too close to your body. You should be able to comfortably reach the bars from an upright position and your elbows should be slightly bent when resting on them.
In addition, it’s also good to make sure that your gearing matches the demands of the terrain. Keeping the cranks spinning using a lower gear – rather than loading your muscles and joints with excessive force when stuck in one too big – will help to reduce the chance of injury.
A local bike fitter (here at Elite Performance Therapy we 100% recommend Antonio in Alhaurin!) will be able to give you more specific advice for the terrain around you. But in general, 50/34 tooth chainrings and an 11-32 tooth cassette will provide a good range for most people in most places.
When it comes to pedals that you clip in to, proper cleat set up is vital to make sure that you’re not putting yourself through injury-inducing stresses. On the flipside, once you have got your cleats set up, spinning the cranks takes very little thought or coordination as your feet are fixed in place, which reduces the risk of injury.
What should you do if you do find yourself troubled by Low Back Pain?
Generally if you are still suffering from low back pain after 2 weeks and it stops you from doing day to day things, or is severe, “it’s a good idea to get help.”
Here at Elite Performance Therapy we are a team of physiotherapists, chiropractors and sports massage specialists and would be happy to chat with you to understand your symptoms better and work out the best treatment plan for you.
There are many different types of back pain but the major ones are ‘muscles’ and ‘discs’.
Muscles can suffer as a result of going a bit too far or hard on the bike, or even lifting something too heavy, leaving you nursing a strain. Strains can cause painful spasms, your body’s way of ‘freezing’ your back to stop you doing any more damage, and can take weeks to heal. The good news, is that exercise and movement can help the healing process.
Discs issues, as we have seen, are extremely common – though many such cases involve no pain, and the effects are difficult to predict. The classic cause of pain is a damaged disc that bulges outwards from the spinal column (a so-called slipped disc) and impedes the sciatic nerve, resulting in pain, often down the leg, that can vary from mild to severe. Disc issues can also cause spasming.
Exercises to avoid Low Back Pain from cycling
The key is to incorporate core stability, flexibility and conditioning drills into your training to make your time in the saddle more comfortable. Combining the following exercises on a regular basis will go a long way to help avoid back pain from cycling.
Walking lunges
- Targets: Quads, core and hip flexors
- 3x 15-20 reps
1. Step forward into a lunge position, bending the front knee and ankle to 90 degrees, which will help you keep your knee behind your toes.
Keep your weight on your back leg and clench your buttocks.
2. Dig your front heel into the floor and step the other leg forward into the lunge position.
Keep your steps wider than your pelvis because this will increase your base of support and stability.
The cat stretch
- Targets: Spine and core
- Unlimited – repeat little and often
1. Kneel on all fours, with your knees a hip-width distance apart and your hands a shoulder-width apart.
This can also be done sitting on your bike.
2. Imagining your pelvis is a bucket filled with water – tilt your pelvis forwards and backwards for one to two minutes as if you were tipping water out of the front and back of the bucket.
Then bow your spine into this shape.
The Bug
- Targets: Core
- 3x 10 breaths
1. Lie on your back with your arms reaching towards the ceiling and your hips and knees bent to 90 degrees.
If this feels too difficult, you can support your legs on a gym ball or on the arm of your sofa.
As you progress, try to hold your legs in the air.
2. Making sure your spine is flattened gently against the floor and your pelvic floor is lifted, hold this position as you gently breathe in and out.
Repeat three times for 10 breaths, resting between each set.
You should feel this in the tummy not the back; if you have back pain, wait until you’re stronger or reduce the time you hold the position.
Variation 1: Arm float – as you breathe out, slowly raise your left arm over your head, then breathe in and return your arm to the start position.
Repeat with your right arm and alternate each arm for 30 seconds, increasing to one minute as you become stronger.
Variation 2: Leg floats – as you breathe out, slowly lower your left foot towards the floor, but only as far as you can while keeping a neutral spine.
Breathe in and return the hip to the start position.
Repeat with your right foot.
Alternate legs for 30 seconds, increasing to one minute as you become stronger.
You could also add weights to your arms and legs.
Crucifix stretch
- Targets: Lumbar spine and hips, buttocks, back muscles and hamstrings
- 2x 10-15 reps
1. Lie on your back with your arms stretched out at right angles to your sides and both your legs straight, as if you’re on a crucifix.
Keep your arms in contact with the floor at all times.
2. Lift your right leg 2 inches off the floor and swing your leg across your left leg, as far as it will comfortably go. Your right toes should now be towards your left hand.
3. Return your right leg to the starting position and repeat with the left leg. Do two sets of 10 to 15 repetitions.
If your flexibility is poor or you’ve had a flare-up of lower-back pain, bend your knees, keeping your feet on the floor, and roll your knees from side to side.
Dynamic hamstring stretches
Targets: Hamstrings, piriformis, tensor fasciae latae and calf
10-20 reps in each position after every ride
1. Standing with your feet together, take three small steps (heel to toe) so you stop with one foot in front of the other.
Do these when your muscles are warm after a ride.
2. Lean forward and slide your hands down your leg to your ankle.
The forward movement should come from your lower back and your hips.
Hold at the bottom of the stretch for a few seconds.
3. Take three more small steps so your opposite foot is in front – again reach your hands down to your ankle.
Repeat 10-20 times.
4. The next stretch starts in the same way – take three small steps but turn the toes of your front foot out with the outer side of your heel level with the big toe on the back foot.
Repeat 10-20 times.
5. The final stretch starts in the same way with three small steps, but this time turn the front foot in, keeping the inside of your heel level with the big toe on the back foot.
Thoracic extension stretch
Targets: Spine and chest
Daily 15-20 minutes
1. Use an exercise ball, or roll up a small towel to a diameter of 10-15cm and secure with elastic bands.
2. Lie on the ball or, if using a towel, a bed with the towel lengthways down your spine, from the base of your neck to the middle of your back.
3. Raise your arms to either side of your head and let them hang or rest on the bed.
If this is too much of a stretch, support or rest your arms on pillows to reduce the pull across your chest.
Here to help!
There is a lot of info here and we appreciate you might be at a loss how to proceed, or maybe you just need a friendly ear to guide you. Do contact us here and we would be happy to discuss your case with you and find you the best treatment plan for you 🙂