Virtual Case Study: Lower Back Pain While Riding

Patient Presentation: History, Background, and Complaints

Davide R. presents to my office, bent at the waist and moving little else but his feet as he shuffles in, and is overheard mumbling through clenched teeth, “I’m no dinosaur and I shouldn’t be feeling like one.”

Davide reports that he has no complaints when he initially begins to ride, but as his legs fatigue he develops a dull ache in his lower back, which often progresses to severe, sometimes sharp, limiting his riding distance and ability to push through the pedals…or the pain.

Davide admits that he is not one for stretching and wasn’t familiar with the term ‘core’, but did remark that he was hungry after his ride and reached into his musette for an apple.

Physical Examination

Davide’s hunched over posture, bent slightly to one side, was a clear indication that his lower back was in spasm, and further examination showed that his pelvis seemed to be rotated forward.  This was confirmed by significant tension and tenderness which could be felt in the muscles surrounding his lower spine. 

Davide displayed marked tightness of the muscles of the front of his thighs (hip flexors) and back of his legs (hamstrings).  While his leg strength is exceptional for an athlete his age, he is significantly lacking in core and glute muscle strength. 

Diagnosis: What is it Called?

Lower back pain while cycling is rarely the result of a specific pathology, syndrome, condition, or injury.  While the side-effects of improper posture and positioning could be considered a syndrome, back pain while cycling is usually not due to a diagnosable condition.

There are many diagnosable spinal conditions, including having a herniated disc, spinal stenosis, spondylolisthesis, spondylosis, and degenerative disc disease, to name a few, which must be ruled out. 

If you experience any of the following symptoms which you suspect are related to your back pain, seek medical care immediately!

• Sharp and stabbing pain which does not subside or worsens after your ride is through.

• Numbness or tingling of your extremities.

• Loss of bladder or bowel function.

• Profound focal weakness of a muscle region which is of sudden onset and varies from the opposite side.

• Lack of coordination in your extremities or loss of the ability to balance.

Etiology: What Causes It?

• Improper Postural Position: Prolonged flexion of the spine while riding creates tension in the low back, tightness of the hip flexors and hamstrings, and weakens the glutes.

• Core Weakness: Improper and prolonged seated positioning on the bike causes the postural muscles surrounding the spine to fatigue and become less effective in supporting and stabilizing the trunk, resulting in progressively worsening pain.  In addition, as a cyclist’s legs become fatigued their posture deteriorates, as does their ability to produce power while pedaling.

• Bike Fit:  Improper positioning on the bike causes repetitive stress and fatigue of the postural muscles of the spine.

Treatment: What Can You Do About It?

• Check your bike fit: Decrease the strain upon your back by making sure you are not too stretched out by adjusting stem height and length, moving your saddle forward, and raising your handlebars.

• Remain relaxed and avoid the tendency to become tenser as the ride progresses, which can act to decrease the time it takes for your back muscles to fatigue and become painful.

• Focus upon a comfortable cadence and smooth pedal stroke, while varying your hand placement on the bars from the drops to the hoods to relieve tension in your back.

• Follow a consistent and effective recovery strategy.

• Address muscle imbalances through a focused strengthening and stretching plan, making sure to only perform exercises that can be done pain-free and without acute or residual soreness.  Be sure to maintain a neutral and stable back during exercise performance.

                      Find The Zom Low Back Pain Program complete with exercise descriptions here

Referral: When is it Time to Ask For Help?

• A proper bike fit performed by a certified professional is always a good idea, especially when the small incremental changes you have made to your setup don’t provide the results or eliminate the pain you are experiencing.

• A progressive periodized training and recovery plan is essential and when followed with the aid of a knowledgeable cycling coach there is a tendency to be more accountable and disciplined.

• If your spinal pain is persistent, worsens, significantly interferes with your cycling, or you experience any of the symptoms listed above, seek the assistance of a Sports Medicine Physician, Athletic Trainer, or Physical Therapist for an expert biomechanical and musculoskeletal assessment and treatment.

The Expected Outcome: Conclusion

Chances are that if you do your fair share of riding you will experience lower back pain at some point in your cycling and everyday life.  

By adjusting your bike set up, addressing posture-related flexibility and strength issues, and maintaining solid core strength, back pain does not have to become a frequent ‘wheel-sucker’.  

In fact, by following a consistent flexibility and core strength routine your back pain will go the way of the dinosaurs!

Next appointment

This overview of the cycling-related causes of low back pain and basic program to address them will be a starting point.  Meant to be a basic framework, we will be introducing a complete core strengthening exercise progression in subsequent posts on the topic.  In addition to other helpful information.

Keep in mind, low back pain has many causes and even more viable treatment methods.  What has been presented here is just the beginning of the conversation.  Seek consultation from a medical professional for personal recommendations concerning your health.

What about you? 

Have you suffered from lower back pain that took the fun out of your ride or made it difficult for you to do things off the bike?  If yes, let your fellow virtual cyclists know what worked best for you. 

Oh yeah, do you know who Davide R. is irl?