A Cycling Physical Therapists Approach to Herniated Discs in Cyclists: Understanding the Causes, Treatment Options, and Prevention Strategies
We all know that cycling is an enjoyable and effective way to stay healthy and fit. However, the repetitive cycling motion can significantly strain the body, particularly the spine. As a result, cyclists risk experiencing a herniated disc, a common injury that can cause pain, numbness, and discomfort. Or they can be among the countless individuals suffering from a previous episode of low back pain due to a herniated disc with a passion for cycling.
To avoid falling victim to this insidious problem, exploring the underlying causes, effective treatment options, and practical prevention tips for cyclists to protect their spine is essential. Whether you are an experienced cyclist or just starting, mastering the techniques to safeguard your spine is paramount to preserving your health and avoiding pain while enjoying your passion.
Herniated Discs in Cyclists
Experts consider low back pain the most common musculoskeletal disorder worldwide. Spinal pain and debility are the leading cause of work absenteeism and significantly impact the quality of life of so many of us.
An October 2022 study published in The Physician and Sports Medicine asked almost 63,000 recreational riders about their cycling-related pain history over five years. The researchers found low back pain was the fourth most common recreational cycling injury.
Herniated discs are a common medical condition that can cause discomfort and pain in a large percentage of the general population, and cyclists aren’t immune. Experts estimate that 5-15 percent of individuals complaining of low back pain suffer from disc herniation.
What is a Herniated Disc?
The spine consists of 24 vertebrae separated by fluid-filled discs acting as shock absorbers between the bones. Think of these discs as jelly-filled donuts. A herniation occurs when the jelly inside the donut-shaped disc pops out.
When the inside of the disc protrudes, it can cause pressure on the nearby nerves and lead to pain. Some people use other terms like “bulging disc,” “ruptured disc,” or “slipped disc” to describe herniated discs.
A bulging disc is when the jelly inside the donut pushes against the side enough to bulge out from the vertebrae but isn’t leaking out. A ruptured or slipped disc is an actual herniation, where the donut cracks, allowing the gel-filled center to squeeze out.
As a result, the leaked fluid from herniated discs can cause chemical irritation and inflammation of the spinal nerve roots. The discs allow slight movement between vertebrae, hold them together, and serve as shock absorbers. They are two layers—a tough outer layer and a gooey inner layer.
A herniated disc occurs when the outer layer ruptures, allowing the jelly-like contents to spill and irritate the nerve roots as they emerge from the spinal cord. It can cause pain and numbness in the back, neck, arm, or leg, following the entire nerve’s path through its course.
What are the Symptoms of Herniated Discs in Cyclists?
It is possible to have a herniated disc without experiencing any symptoms, known as asymptomatic herniated discs. However, when pain is present, it can be a sharp and radiating sensation.
Most commonly, herniated discs in cyclists occur in the lower back region, also known as the lumbar area. Herniated discs in cyclists can cause burning pain from the lower back into the buttocks and down one or both legs, sometimes even reaching the feet. Not all pain traveling down our legs is sciatica.
It’s a common misconception that all low back or leg pain is sciatica. That’s not the case. Sciatica pain results directly from disease or injury involving the sciatic nerve and its nerve roots.
Other symptoms may include electric shock-like pain when standing, sitting, or walking, in addition to numbness, tingling, and weakness in the lower extremities.
It isn’t easy to diagnose a herniated disc without the help of an MRI or CT scan. Suppose these scans are negative, and your doctor rules out other injuries. In that case, the diagnosis may be “Non-Specific Chronic Low Back Pain,” which is often the result of the bike position and prolonged stretching of tissues, leading to decreased stability and control of the back segments. When the muscles cannot support the spine, they may compress or shear the discs, leading to further damage.
An injury to bones, muscles, tendons, bursae (pads between the tendons and bones), the hip joint, or a mass in the spinal region can cause similar symptoms. There are a few basic rules of thumb to rule them out.
- You may have injured your hip joint or suffered a stress fracture in your pelvis or femur (long thigh bone) if you experience pain hopping on one leg. An X-ray usually reveals a joint injury, but only a bone scan shows a stress fracture.
- If you experience pain in your buttock when you stretch your legs out straight, you may have a torn muscle or tendon running down the backs of your thighs.
- If you feel pain when you touch the outside of your hip or the lowest point of your pelvis (the part that touches a chair when you sit), you might have irritated your bursae (bursitis).
- If your lower-leg pain radiates into your buttocks, extends down to your feet, includes numbness, tingling, weakness, and lack of coordination, and doesn’t change with position or movement, you may have a mass pressing against your sciatic nerve. Seek medical consultation immediately!
What Caused Herniated Discs in Cyclists?
Herniated discs occur when the jelly-like substance inside a spinal disc leaks out and irritates the surrounding nerves, and in theory, the cause seems straightforward, but it isn’t in every case. It can happen due to pressure on the disc, which can occur suddenly or gradually over time.
Simply stated, when the spine is in a neutral position, the pressure on the discs is even, and the jelly inside distributes evenly. However, the jelly is pushed back when the spine is bent, stressing the disc’s outer layer.
This stress can be prolonged in cyclists who sit for extended periods at work or home and then ride in a bent-over position, adding more pressure to the spinal discs.
Herniated discs are most common in the lumbar region of the spine, specifically the L5-S1 disc, which sits at the base of the spine and is subject to the most bending. Cyclists who do not maintain proper form and hinge from their hips to keep their spine in a safe, natural range are at greater risk of pushing their spine past its limits. Research also suggests poor core strength and endurance can contribute to spinal stress and low back pain in cyclists.
Is Cycling Good For a Herniated Disc?
Cycling can benefit people with a herniated disc, as it is a low-impact activity that can help promote circulation, improve flexibility, and strengthen the muscles that support the spine. However, it is vital to take certain precautions to avoid exacerbating the condition.
Cyclists with a herniated disc should ensure that their bike fits their body and that their posture is correct while cycling. They should also avoid riding in a position that places excessive strain on the lower back, such as riding in a low, aerodynamic position for extended periods.
Listening to your body and taking breaks is essential if you experience any pain or discomfort. If you are unsure whether cycling is safe for your herniated disc, it is always best to consult a healthcare professional before starting any new physical activity.
How are Herniated Discs in Cyclists Prevented and Treated?
According to a 2020 scientific paper titled “Slipped Disc: Overview,” approximately 90% of individuals who experience pain and restricted movement due to a slipped disc will experience relief within six weeks, even without medical treatment. Scientists suggest this is because the body naturally eliminates part of the prolapsed tissue or repositions it so that it no longer irritates the nerves.
However, physical therapy or a sensible self-rehab program can help to expedite this healing process. Your physical therapist, athletic trainer, or coach will recommend mobility exercises for the hip and lower extremities and core strengthening.
Exercises geared towards flexibility and range of motion in the spine are counter-productive since part of the problem is too much motion in the spine, to begin with. Strengthening of the muscles that support the spine will counteract the problem.
The prolonged posture and repetitive cycling motion are problematic without an optimal bike fit. The repeated stress and strain on the spinal structures and lower extremities will progressively worsen lumbar pain when cycling.
An excessive forward bend at the trunk causes the hip to maintain a flexed position without the opportunity to open up. You can correct this by adjusting the crank length, handlebar size and position, saddle height, and fore-aft position to avoid the excessive range of hip motion at the top of the pedal stroke or rocking in the saddle.
Focus on a comfortable cadence and smooth pedal stroke, and avoid pushing too hard during the downstroke. Follow a consistent and effective recovery strategy.
Address muscle imbalances through a focused strengthening and stretching plan, ensuring that exercises are pain-free and without residual soreness.
What To Do When Your Herniated Disc in Cyclists Symptoms Worsen
If your herniated disc when cycling pain persists or gets worse and significantly interferes with cycling, seek the assistance of a Sports Medicine Physician or Physical Therapist. An expert biomechanical and musculoskeletal assessment or consultation with a physician is always a good idea.
If you experience the sudden onset of muscle weakness, like in your lower leg, that causes your foot to slap on the ground when you walk (foot drop), it could be a sign of a more severe condition. Bowel and urinary incontinence, sudden numbness, and the progression of symptoms could also be signs of something more significant. Contact your healthcare provider immediately.
In a small number of cases, surgery is the answer if rehabilitating your injury fails. Back surgery has improved these days but is not without risk and should be the last resort once all conservative means are exhausted.
A discectomy is when surgeons remove part, or all, of the disc between the vertebrae. It releases the pressure from the nerve and reduces the pain immediately if successful. Rehabilitation is also essential as this area will be vulnerable to re-injury. An orthopedic surgeon or a neurosurgeon will recommend surgery on a case-by-case basis.
Core Strengthening for Herniated Discs in Cyclists
Cycling mainly uses the leg muscles, so proper cycling posture is essential. However, adequate posture alone is not enough to develop core strength and protect your spine. The untrained core muscles can quickly tire out during cycling, leading to a decline in form and power production and efficiency.
It is crucial to have a solid core to prevent unnecessary body movement while cycling, which, in turn, decreases irritation and pressure on the discs. This stability allows riders to pedal efficiently using all their muscles, not just their quads, and from a centralized base.
Even with strong leg muscles, cycling without a stable core is ineffective and can lead to injuries and poor posture. Therefore, a strong trunk is vital for better pedal power transfer and overall performance.
Here is a Solid Core Progression to Prevent and Treat Herniated Discs in Cyclists
The Front Plank
The Superman Series
Conclusion—Herniated Discs in Cyclists
Herniated discs in cyclists can be a significant concern, but with proper precautions and awareness, it’s possible to minimize the risk of injury. Cyclists can reduce the likelihood of developing a herniated disc while cycling by taking simple steps like ensuring proper bike fit, maintaining good posture, and engaging in core-strengthening exercises.
If you experience symptoms of a herniated disc, it’s vital to seek medical treatment promptly to avoid further damage. By following these guidelines and staying attuned to your body’s signals, you can continue to enjoy the many benefits of cycling while keeping your spine healthy and pain-free.
Semi-retired as owner and director of his private Orthopedic Physical Therapy practice after over 20 years, Chris is blessed with the freedom to pursue his passion for virtual cycling and writing. On a continual quest to give back to his bike for all the rewarding experiences and relationships it has provided him, he created a non-profit. Chris is committed to helping others with his bike through its work and the pages of his site.
In the summer of 2022, he rode 3,900 miles from San Francisco to New York to support the charity he founded, TheDIRTDadFund. His “Gain Cave” resides on the North Fork of Long Island, where he lives with his beautiful wife and is proud of his two independent children.
You will read him promoting his passion on the pages of Cycling Weekly, Cycling News, road.cc, Zwift Insider, Endurance.biz, and Bicycling. Chris is co-host of The Virtual Velo Podcast, too!