Cycling and Low Back Pain
This article is by Julie Curran the massage therapist at Islington's Angel Massage Clinic. Julie has plenty of experience in the treament of low back pain in athletes and she has a number of patients that train and compete in triathlons and Iron Man competitions.
Julie works closely with the physiotherapist, the osteopath and the chiropractor at the Angel Wellbeing Clinic in London and this multi disciplinary approach has proved very successful.
Low back pain is a common complaint amongst cyclists and those who have experienced low back pain will be aware of just how debilitating it can be. The effects of low back pain are far reaching, having impact on your work, social life and sports performance.
Causes of low back pain in cycling
The most common low back pain whilst riding a bike is due to prolonged flexion of the lumbar spine. This can lead to muscle fatigue, chronic tension of ligaments within the spine and compression of the discs. It is important to remember that although the disc may be a source of pain it does not necessarily mean it has herniated or ruptured.
Pain arising from the structures in the spine may remain localised within the spine but pain may also refer into the buttocks, groin, thigh and even down to your feet. In chronic back pain the pain often has its origins from a multitude of sources.
Where to look for the cause
Usually, upon examination, cyclists who have low back pain will also have a stiff lower lumbar spine, poor hip range of motion, and tight posterior chain muscles (particularly gluts and hamstrings), or possibly all three!
♦ A stiff lumbar spine will mean that you reach your limit sooner into range.
♦ Poor hip range can pull your pelvis into posterior tilt and therefore your put your lumbar spine into more flexion to create the flexion needed to get to the top of your pedal stroke.
♦ Tight gluts and hamstrings can also limit your hip flexion, and along with your back extensors, can be a source of pain themselves should they develop trigger points and excessive tightness.
The solution is the same as the method of prevention of low back pain when doing most sports = Core stability and correct movement patterns.
The lumbopelvic stability muscles not only have to tolerate prolonged flexion of the spine but they also have to provide a stable platform to absorb the massive forces generated by the legs and to prevent the rotation of the pelvis and thus causing too much rotation of the lumbar spine and the lumbar discs.
Each time the legs push down onto the pedals, a force is also directed up into the trunk. You may have noticed that when a cyclist becomes tired they have more uncontrolled movements occurring at their trunk (i.e., increases in lumbar flexion, rotation or side flexion) as they push down with their legs. This is because the trunk is not strong enough to absorb the forces from the legs and maintain a neutral spine, which then causes fatigue and back pain.
With good core stability, cyclists are better able to control these movements, absorbing the huge forces from their legs more effectively and, therefore, cycle faster!
Transversus abdominus is a very important muscle which provides crucial support to the core stability important for cycling. According to the massage therapist in islington this helps prevent back pain when cycling. Transverse abdominus is your deepest abdominal muscle and acts like a corset around your trunk.
Studies have shown that people who suffer with low back pain do not have adequate transverses abdominus activation.
In addition and probably more importantly, it has been shown that following spinal injuries and once back pain has subsided, this muscle does not automatically reactivate. Therefore, it is paramount that transverses abdominus is retrained following a back injury to prevent a recurrence.
If you suffer from low-back pain when riding, try increasing your lumbar and/or hip mobility and range, stretch your gluts and hamstrings (in fact, all your major lower limb muscle groups would be beneficial), learn how to engage your core muscles, and learn how to do this on a bike!
Another way to help prevent the low back injuries that are prevalent to cyclists is stretching the hip flexors. One of the big problems with this is that there are very few activities of daily living that stretch out this muscle group. The flexibility of this group in general is poor at best.
As cyclists, we are forced to perform in a position that forces the hip flexors somewhere between 'short and shorter'. These 'short and shorter' muscles are very susceptible to fatigue and spasm.
One example where short hip flexors is problematic is during a ride with a long climb so imagine how Bradley Wiggins will feel in the 2013 Tour de France on stage 18. This stage on July 18th requires the riders to climb Alpe D’huez twice, a total climb of 3510m.
After a relatively short amount of time, the rider gets tired and the lower back can become uncomfortable or even painful. To get some relief, the rider will stand. The standing in the pedals is where the rider experiences the benefit of stretching the hip flexors.
"standing in the pedals is where the rider experiences the benefit of stretching the hip flexors".
Remedial massage can help with releasing the appropriate muscle groups that are contributing to the tight areas. Working specifically through the lower back region, hamstrings & gluteal muscles, quadriceps (especially the rectus femoris), Iliotibial band & the hip flexor/psoas areas.
How I can help you?
Firstly it is important to make sure you fit your bike perfectly. There is no point working on your back problem and getting you back to fitness if the moment you get back onto your bike and mess things up! We recommend Denver Collins who is an expert bike fitter at On Your Bike in London Bridge. For more information about Denver’s specialist service click here.
It is my experience that a two-pronged attack is the best approach initially. Physically helping the muscles to relax through massage (therapeutic) rehabilitation exercises for retraining the movement pattern that has been hindered by the injury.
The second phase of the treatment involves the return to fitness and the return to pre-injury training levels and how to minimise a recurrence. This in itself is a big topic and deserves its own dedicated article.
If you are a keen cyclitst or if you are in training for a triathlon or Iron Man competition call Julie at the Angel Massage Clinic in London and arrange an appontment to acces you on how you can improve your performance and prevent injury.