Back Pain for cyclist


Lot of people have taken cycling just not as hobby or way of keeping active but it has sport which people are taking it to professional level. Although cycling is a sport which has relatively low injury rate compare to other sports. It's easy to understand why: crashes and collisions apart, cycling is almost impact free and the pedalling action of spinning the cranks takes place in a very controlled environment, requiring minimal coordination and reducing the risk of injury due to poor technique.



Although with so much support but still cyclists spending long hours in the saddle can and regularly do suffer cycling overuse injuries. Now, you might think that it's your knees that would be most vulnerable to high volumes of cycling. However, research on the incidence and type of overuse injuries sustained by pro cyclists found that lower back injuries were most prevalent (45% of recorded injuries) - almost twice as likely to occur than knee injuries.


Why is low back pain so prevalent among cyclists?


One possible explanation concerns bike set up. Getting the correct rider/geometry on the bike is crucial to minimise unwanted loading on the lumber region (as well as the knees, shoulders, neck etc...). However, in the study above, the cyclists were supervised by national coaches with access to advanced facilities, so incorrect bike geometry would almost certainly not have been a plausible explanation.

Another possible explanation is that research shows a direct link between the degree of muscle fatigue and subsequent changes in a cyclist's movement patterns during cycling - specifically changes in the degree of "trunk lean" and hip angles². These altered muscle movement patterns could lead to lower back pain in cyclists undertaking hard training or competition. Also, constant static lumbar flexion (i.e. leaning forward in a fixed position) has a negative effect on core stabiliser muscles and other spinal tissue during prolonged pedalling. Just five minutes of static lumbar flexion weakens the power of important stabiliser muscles of the lower back (multifidus) and induces "tissue creep" (unwanted stretching of tissues) - all of which makes it harder to generate the forces needed to maintain spinal stability and correct posture³. This in turn greatly increases the risk of low back pain. We also know that prolonged and excessive forward flexion of the spine on the bike is quite literally a pain in the back; cyclists who suffer back pain are much more likely to have excessive lower spine flexion with less active lower lumbar stabilising muscles (multifidus)⁴.

Recommendations

The bottom line then is that while correct bike geometry and set up is vital for triathletes seeking to reduce the risk of low back pain, it may still not be enough. In particular, prolonged periods of low lumbar flexion, fatigue of the back extensor muscles (especially multifidus) and impaired motor activation patterns all seem to increase the risk and severity of low-back pain. So at the time of year when many are beginning to build up their cycling mileage, how can cyclists with a history of back injury stay pain free? Here are some tips:

• Firstly, ensure your bike is correctly set up. In particular, it's important to ensure that you're not "overreaching" (i.e. the top tube and stem length is not excessive) and that your handlebar position is not too low - both of these will increase the degree of static lumbar flexion and fatigue in your back extensor muscles.
• When you increase your training load (volume or intensity), or if back pain becomes a problem, consider using stem spacers to raise handlebar height, which will help alleviate static flexion and loading of the low lumbar extensors.
• If you get back pain and your bike set up is 100% correct, you may want to consult a physiotherapist. He/she can examine your functional core stability, paying particular attention to your muscle activation patterns, multifidus function, gluteal (buttock) strength and hamstring strength/flexibility, and prescribe some appropriate remedial exercises if necessary.

 

 

References
1. Am J Sports Med. 2010 Dec;38(12):2494-501
2. IEEE Trans Biomed Eng. 2008 November; 55(11): 2666-2674
3. Spine (Phila Pa 1976). 2009 Aug 1;34(17):1873-8
4. Man Ther. 2004 Nov;9(4):211-9