Many cyclists suffer from pain in their backs. Compared to many sports, cycling is one with a relatively low injury rate (crashes and collisions apart) however cyclists do need to take care of their backs. Probably the most common complaint from cyclists is about pain in the back. The hunched over position on a road bike often takes its toll on the back. Low back pain is reported by more that 50% of cyclists. Lower back pain causes the highest rates of functional impairment and medical attention amongst cycling overuse injuries. A 2010 article noting that future efforts to prevent overuse injuries in competitive cyclists should focus on lower back pain and anterior knee pain.
Why do cyclists get low back pain
- Poor Bike Fit eg incorrect saddle height, uneven saddle
- Knee less than 25% bend at the end of the stroke forcing cyclist to rock their pelvis side to side to get sufficient power at bottom of stroke. Putting stress on low back muscles.
- Handlebars too far forward causing cyclist to over stretch the low back.
- Too much hip flexion, flexing lower back and causing core abdominal muscles to be in a poor position to work efficiently. (A longer crank may be needed.)
- Back posture on the bicycle can strain the lower back (lumbar spine flexed) so a long time in the saddle can take its toll on the back.
- Using big gears ie too slow cadence. Look for a cadence of 90 RPM. Extra stress at a lower cadence puts more stress on your back muscles.
- Insufficient length of hamstrings, causing pulling on the pelvis and rotating the spine into flexion.
- Insufficient core muscle strength putting more stress on the lower back.
- Position on the bicycle, with the neck arching back, can strain the neck and upper back, particularly so for cyclists with aerodynamic bars
- Bumpy terrain increases jarring and compression to the spine, which can lead to back pain
- Length of cycling done weekly. A 20110 study found that a significant difference existed between self-reported km cycled per week and LBP in recreational cyclists. Those cyclists who reported riding an average of 160 km or more per week were significantly more likely ( 3.6 times more likely) to report LBP than those who rode less km.
Physiotherapy for Cyclists Back Pain
- A good analysis of the cyclist (subjectively and objectively) should be undertaken both on and off the bike.
- The Bike fit should be examined with cyclist in riding position.
- Subjective examination should include these questions: does the rider cycle often and how far; has the routine changed; is it a new bike or been adjusted recently; what type of terrain and gradients are being ridden; what cadence is the cyclist doing; see if bumpy terrain is an issue (a good chamois in bike shorts and/or a gel seat cover can reduce the shock transmitted to the pelvis and spine)
- A lumber Spinal assessment should be undertaken noting any aberrations from the norm.
- Muscle lengths ( and fascial bands) and strength should be assessed in the major muscles involved in cycling. These being
- core muscles ( A 2017 systematic review found that core muscle activation imbalances, back extensor endurance deficits, and increased lumbar flexion while cycling are often present in cyclists with low back pain. )
- back extensors and thoracolumbar fascia
- gluteal muscles and TFL
- latisimuss dorsi
Focus on the issues you identified in the examination. Remembering the most common fixes involve
- Check the bike fit. A 2016 international retrospective study found that "an association between bike fitting and reported comfort and pain while cycling" and recommended bicycle fitting along with maintenance.
- Check the cadence , seeing if it needs be increased. A low cadence puts more strain on the muscles.
- Strengthen the core and back extensors. The low back is not designed to take that much hard work, the core should protect it. The following exercises are an example of some good basic strengthening exercises for the core and back muscles. Also see this comprehensive link on core stability.
Prone Bridging on Elbows
Lie on your stomach on a table or mat with your forearms/elbows on the table/mat; rise up so that you are resting on your forearms and toes; maintain abdominal draw in; your back should be completely straight; hold this position for 15 sec – 1 min. Progress in increments of 15 seconds. Repeat 5-10 times.
Side Bridging on Elbow
Lie on your side with your elbow underneath you; rise up so that you are resting one forearm/elbow and foot on same side; hold this position for 15sec – 1min. Progress in increments of 15 seconds. Repeat 5-10 times. Make sure to complete exercise on both sides.
Lie on your stomach on table or mat with legs extended and hands palm down just above shoulders; retract shoulder blades down and in towards the midline of your spine; maintaining that position, lift your chest off of the floor; hold for 3-5 seconds keeping the back of the neck long and making sure front hip bones stay in contact with mat during entire movement.. Repeat 10-20 times.
Lie on your stomach on a table or mat with your arms at your side; lift your head and chest off the table/mat; hold your glutes (buttock muscles) tight and squeeze your shoulder blades together; hold briefly and return to starting position. Repeat 10-20 times.
Lie on your stomach on table or mat with arms and legs extended; retract shoulder blades down and in towards the midline of your spine and draw in abdominal muscles; maintaining this position, lift opposite arm and opposite leg ensuring that your hips stay in contact with the floor; hold for 3-5 seconds and reverse sides. Repeat 10-20 times.
Quadruped Opposite arm/leg
In a quadruped position (on all fours); keep head straight with knees bent to 90 degrees. Engage your core to keep back straight during entire exercise and use your hamstrings, glutes, and low back muscles to lift your leg straight while simultaneously lifting opposite arm; Repeat 10 times each side
4. Improve flexibility and mobility. Pulling on the pelvis and low back by shortened muscles leads to increased lumbar flexion, which is associated with increased back pain.
5. Check the milage and check slow increase.
6. If an area of concern is identified in the assessment treat as applicable. eg.bike fit advice or referral, releases of myofascia, joint mobilisations and manipulations, muscle energy techniques, taping and specific exercise regimes
NB If pain persists or any flags are indicated, always refer as needed.
- Adding a stretching routine to any cyclists routine is ideal. See Stretching for great information re prescribing stretches. The most common muscles to include in a stretching routine to prevent back pain are shown in diagrams below
The video below shows the most commonly needed stretches for a cyclist to do. Of course add any that have been identified in your examination to the routine.
Cycling is a great exercise and most cyclists with low back pain can overcome this once the cause has been identified.
- Streisfeld GM, Bartoszek C, Creran E, Inge B, McShane MD, Johnston T. Relationship between body positioning, muscle activity, and spinal kinematics in cyclists with and without low back pain: a systematic review. Sports health. 2017 Jan;9(1):75-9. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5315261/ (accessed 23.8.2019)
- Clarsen, Benjamin & Krosshaug, Tron & Bahr, Roald. (2010). Overuse Injuries in Professional Road Cyclists. The American journal of sports medicine. 38. 2494-501. 10.1177/0363546510376816. Available from: https://www.researchgate.net/publication/46288399_Overuse_Injuries_in_Professional_Road_Cyclists (last accessed 24.8.2019)
- Bike Fit Advisor. Back Pain on the Bike // beyond "the bars are too low" Available from: https://www.youtube.com/watch?v=LszLxRZD8BU (last accessed 24.8.2019)
- Streisfeld GM, Bartoszek C, Creran E, Inge B, McShane MD, Johnston T. Relationship between body positioning, muscle activity, and spinal kinematics in cyclists with and without low back pain: a systematic review. Sports health. 2017 Jan;9(1):75-9. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5315261/ ( accessed 24.8.2019)
- Global Cycle Network. How to prevent lower back pain. Available from: https://www.youtube.com/watch?v=FAwwutF11Qg (last accessed 24.8.2019)
- Schultz SJ, Gordon SJ. Recreational cyclists: The relationship between low back pain and training characteristics. International journal of exercise science. 2010;3(3):79. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4738893/ (last accessed 24.8.2019)
- Priego Quesada JI, Kerr ZY, Bertucci WM, Carpes FP. The association of bike fitting with injury, comfort, and pain during cycling: An international retrospective survey. European journal of sport science. 2019 Jul 3;19(6):842-9. Available from: https://www.tandfonline.com/doi/abs/10.1080/17461391.2018.1556738?af=R&journalCode=tejs20 ( last accessed 26.8.2019)
- Princeton University. Athletic Medicine. Lumbar core strength and stability exercises. Available from: https://uhs.princeton.edu/sites/uhs/files/documents/Lumbar.pdf (last accessed 27.8.2019)
- mapmyrun. 5 fixes for cycling related lower back pain. Available from: https://blog.mapmyrun.com/5-fixes-cycling-related-lower-back-pain/ ( last accessed 25.8.2019)
- Global Cycle Network. Top 5 Stretches To Do After A Ride | Cycling Fitness. Available from: https://www.youtube.com/watch?v=1VCM7xnL2QY&feature=youtu.be ( last accessed 25.8.2019)