Cycling and low back pain: How to fix it.

In the most recent article of Sports Health (Jan-Feb 2017), an interesting study was published by Gabriel Streisfeld, DPT, and colleagues, titled Relationship between Body Positioning, Muscle Activity, and Spinal Kinematics in Cyclists: A Systematic Review.  Having history working as Director of Strength & Conditioning at Endorphin Fitness, one of the top triathlon training facilities in the country (Richmond, VA), I was able to work extensively with both recreational and higher level triathletes.  I have seen first hand the amount of physical torment these athletes will put themselves through to satisfy their insatiable desire to compete (this may be a great side topic in the future).  It is no wonder why this article particularly peaked my interest now that I’m a practicing sports physio.

From Dr. Streiseld’s research, there are some staggering statistics on injury rates in cyclists:

  • 23 million cyclists in the United States will develop at least 1 overuse injury in their lifetime.
  • The majority (51.5%) of cycling-related injuries reported over a 4 year period were from overuse.
  • Of these overuse injuries, low back pain is the most prevalent.
    • 58% of professional cyclists reported low back pain
    • 41% of these cyclists sought medical attention, and;
    • 22% lost time from activity due to their pain/dysfunction.

Some interesting take away’s I found from this research:

  • Cyclists with low back pain experienced fatigue in arm and spinal musculature associated with postural support and stability.
  • Cyclists with low back pain had reduced abdominal and back musculature thickness compared to asymptomatic (non-painful) control group, confirmed by ultrasound imaging.
  • The authors suggests the findings of this systematic review may implicate that decreased endurance of the low back musculature may play a role in spinal kinematics or spinal loading.

The conclusion of the study suggest that spinal and core muscle activation imbalances in a prolonged flexed posture associated with cycling, may lead to maladaptive spinal kinematics and increased spinal stresses contributing to low back pain.  So what can you do to mitigate or prevent this pain from starting?


INTERVENTION IDEAS

Quadruped Frogman Sit-Backs

Start in the quadruped (“all fours”) position.  Position your knees under your hips.  Walk your hands out in front of you to approximately 120 degrees of shoulder flexion.  Push your hands into the ground, thus pushing your thoracic spine towards the ceiling.  Maintain a neutral spine as you slowly sit back towards your heels.  When you feel, or see, your lumbar spine begin to flex (butt wink), return to starting position.  Spend 2-3 minutes here.

 

pushbacks

WHY: This position mimics being on a bike in an aerodynamic position.  By utilizing this mobility drill, you will learn how to keep and maintain a neutral spine while maintaining great deals of hip flexion during cycling.


Jefferson Curls

These have been around in the gymnastics world for quite some time, and have been made popular in recent years thanks to GymnasticBodies.

Start in the standing position. Tuck your chin to your chest, and slowly and incrementally let your spine round as you descend to the ground.  Return to a standing position in a similar fashion.  Start with a PVC pipe, and incrementally add load once your control and mobility improves.

WHY: The spine is designed to move with both mobility and stability.  By allowing your spine to slowly take load both down and up, you can safely strengthening your paraspinals for much needed core stability and spinal mobility.  Remember to stand fully erect and pull shoulder blades down and back at the top of the motion.  Add load incrementally.


Stir the Pot

Grab your favorite physioball.  Go into a plank position, with forearms in the aerobar position.  With control, move your arms forward and backward, keeping your body still and in the “hollow body” position.  Repeat going left/right, and clockwise/counterclockwise.  Shoot for 20 repetitions in each direction, without losing hollow body position, and without resting between movements.

 

stir-the-pot

WHY: This is all about core stability and endurance.  In a hollow body position, you create stability through the core, and with the added benefit of placing your arms in the “aerobar” position, there is specificity with training.  This will help you maintain your core stability and endurance and take repetitive stress away from your spine.  In the top picture, notice the “hollow body” position, while the bottom picture has increased lumbar lordosis/extension, and lack of core stability.


 

CONCLUSION

These exercises should be performed with control.  The goal is to improve spinal mobility, load tolerance, and core muscular endurance in functional positions for cyclists.

 

Thanks for reading.  We hope this article aids you in your quest in Becoming a Better Human.

 

  1. Streisfeld GM, Bartoszek C, et al. Relationship Between Body Positioning, Muscle Activity, and Spinal Kinematics in Cyclists with and without Low Back Pain: A Systematic Review. Sports Health. Jan-Feb 2017.