Cyclist
How to prevent lower back pain on the bike
Back pain can be as common among cyclists as tan lines. That aching feeling in the small of your back that dully throbs towards the end of the ride and long after you’ve stepped off the bike, too.
In fact, a Norwegian survey of cyclists found that the most common overuse injury sustained on a bike is not the legs, nor specifically the knees but actually the back.
Cyclist‘s own editor Pete Muir is one of those cyclists that has battled the long and hard war against back pain when cycling and he wanted to know what could be done to cure and prevent the problem
Why is back pain so common?
‘Back pain is the biggest cause of medical care in the world. It’s the number one reason for people to go to their doctor,’ says Chris Pettit, physiotherapist with Movement Perfected in London and a keen cyclist.
‘It depends on age more than anything. The most common thing we see is people who sit for a long time in the day, then they go and cycle 100 miles at the weekend in a flexed posture, so they’re never giving their back the break it needs in terms of flexion. As a result, they’re gradually developing muscle imbalances that are contributing to their back pain.’
At British Cycling, head physio Phil Burt has a more evolutionary explanation for the prevalence of back pain: ‘We don’t get eaten by predators any more, so there are fewer environmental pressures on selecting out people with back pain. If we’re sitting here and a sabre-toothed tiger comes along, and you can run faster than me because I’ve got a bad back, I get removed from the gene pool.’
With more people being genetically predisposed to back pain, exacerbated by lifestyles that include a lot of sitting followed by brief, intense moments of activity, we modern humans have created the perfect environment for back pain problems to flourish. But is it limited to cyclists of a certain age with mainly desk-bound jobs?
‘Around 80% of the pro cyclists that I’ve worked with have had some sort of back problem,’ says Matt Rabin, chiropractor for EF Pro Cycling and author of The Pain-Free Cyclist. ‘A lot of them won’t talk about it. It’s something they just deal with and they continue to perform at the top level.’
But that doesn’t mean cycling itself is the problem – in fact, riding a bike is one of the better activities for people with back issues. ‘I don’t think cycling is bad for backs,’ says Burt. ‘You may have back pain while cycling, but if you compare it to sports such as rugby, football and squash – high-impact sports – the beauty of cycling is that it’s very low-impact, unless you crash of course.’
How to tackle back pain on the bike
My own back story began about 20 years ago, when a vigorous game of squash resulted in a nasty wrenching noise from my lower back, which left me bed-bound in agony for the next three days.
Since then, I’ve had numerous episodes, ranging from mild aches to debilitating pain, and explored treatments including surgery, drugs, ointments, spine-stretching and acupuncture. I’ve had nerves cauterized, injections in my discs and endured ‘Chinese fire needles’ (a form of acupuncture using burning hot needles, which is every bit as horrific as it sounds).
The problem came to a head in early 2015 when the surgical interventions that had served me well in previous years suddenly stopped working. I found myself in pain a lot of the time, unable to ride a bike, getting frustrated and unfit as the year wore on.
It became obvious that I needed a new solution. I’d done physiotherapy before – it was always part of the post-surgical rehab – but I have to admit that it was often a half-hearted effort.
‘Evidence suggests that compliance with physio exercise goes off a cliff after about a week,’ says Burt. ‘We’re trying to manage back pain. I don’t think you can ever actually fix someone. Once you’ve got a bad back, it’s there for life. It’s about how you manage it.’
With that in mind, I resolve to commit to a programme of regular exercises. I just need to find the right ones.
‘With degenerative discs, from a cyclist’s point of view, you really want to build up the muscles in your back, make them a lot stronger,’ says Pettit, ‘And really loosen off the hip flexors, particularly the psoas muscle which attaches to the lumbar spine.’
The psoas isn’t a muscle I’ve heard of before, but it’s something that Matt Rabin confirms needs attention: ‘Your psoas helps to stabilise your spine. Because you’re in that flexed-over position when you ride, your psoas tends to get a bit shorter, so it gets tighter and will pull on your spine.’
When I enquire about the importance of core strength, my expert sources suggest that we first need to establish what we mean by ‘core’. Rabin says, ‘For me it means the space between your arms and legs – your trunk, your torso. You want to make it strong enough so you can transmit energy through the pedals without getting too much imbalance or irritation of your spine or pelvis.’
Phil Burt adds, ‘Core tends to be a much-misunderstood and misquoted term. I don’t think the word “core” is a very good one. You have torso strength and stability and control. Most people look at “core-concentric” exercises – sit-ups – which is often the worst thing they can do.’
Exercises that help back pain
Pettit suggests, ‘Work on the muscles that cycling creates an imbalance with. You get strong quadriceps muscles so you are pulling forwards against the spine, and if you strengthen up the hamstrings and back muscles, the compression should become less.
Also, with cycling everything is in a straight line forwards, so the muscles that operate your side-to-side function are getting dominated by the muscles that go forward and back, so you need to be doing exercises to work the lateral structures – things like side planks, glute bridges and clams.’
Rabin confirms that I should base my regime around planks and bridges, as well as squats and single-sided exercises to help iron out muscular imbalances. ‘I like exercises that are closed-chain, by which I mean that your foot is on the floor,’ he says. ‘That’s how your brain moves weight around and how your nervous system is set up. You want to be able to move your own bodyweight or hold it in a certain position.’
Burt warns me not to over-complicate matters by taking on more than I can reasonably manage as part of a busy day: ‘When Bradley Wiggins went to T-Mobile [in 2007] he was given a DVD with 27 exercises for him to do.
He said, “I did them all yesterday, but I had no time to ride my bike.” What I would do is give you three exercises, then three more if you’ve got the time, and three more if you’ve still got time. If you’ve got all day, do all nine, but make sure you do the main three every single day.’
Cyclist’s quick back workout:
- Glute Bridge (3 sets x 10 reps)
Lie face-up on the floor with your knees bent and feet flat, close to your backside, arms on the floor by your side. Raise your hips, squeezing your glutes until your shoulders and knees are in line. Hold for three seconds then lower.
- Side Planks (3 sets x 30 seconds each side)
Lie on your side, feet together. Place your forearm straight on the floor under your shoulder and raise your body into a straight line. Hold the position, keeping your hips raised, for 30 seconds. Repeat on the other side to complete the set.
- Bodyweight squat (3 sets x 10 reps)
Place your feet shoulder-width apart. Pull your shoulders back, push your chin up and backside out. Drop down keeping your back straight until your legs are at a 90-degree angle. Hold for a few seconds and then slowly rise back up.
- Good mornings (3 sets x 10 reps)
Stand with your feet shoulder-width with your hand behind your head. Engage your core, pull your shoulders back and look up through your eyebrows. Pivot forward from your hips, not your waist, bending your knees to keep a flat back.
Lifestyle changes to help back pain
It’s a slow start as I try to adapt to a daily routine of exercises. Work colleagues get used to arriving in the office to discover me crouched behind my desk, engaged in a series of squats, lunges, glute bridges, planks and press-ups.
As the weeks progress, I adapt the exercises to keep my muscles guessing (and prevent boredom setting in). So planks become side planks, single leg planks, unstable planks, rotating planks… and small bits of new equipment get introduced, such as stretch-bands and foam rollers.
Postural muscles are strengthened, tightnesses are relieved, and imbalances are balanced. I commend myself for sticking with it, but it occurs to me that my exercise regime only accounts for about 20 minutes
of each day. What about the other 23 hours and 40 minutes?
‘Being mobile is the most important thing,’ says Rabin. ‘If you have a sedentary job, don’t sit in the same position for more than half an hour. Get up, go to the water cooler, go to the bathroom, get moving.’
Burt agrees, saying, ‘If you have a desk-bound job that’s obviously going to place a postural load that’s very different from cycling, set an alarm and get up and walk around every 20 minutes or so. Changing position frequently is good for your back.
‘You also want a firm, supportive chair,’ he says. ‘My golden rule is to have your knees below your hips. The more extension you’re in, the more pressure you get occurring at the back of the discs.’
‘I recommend a simple £20 wedge that sits on your chair and tilts your pelvis forward by 15°-20°,’ says Rabin. ‘It puts the natural curves back in your spine, so even if you’ve got a thousand pound ergonomic chair, I’ll say, look, get this cushion.’
I duly get myself set up with a standing desk option, put a tilt in my office chair, and even pay attention to my hip position when I go to sleep at night. There’s only one more aspect to take care of: my time on the bike.
How a bike fit can cure back pain
‘What you’re generally looking for is you don’t want the hip too closed, and you don’t want your back angle lower than perhaps 20°,’ says Burt, who as well as being head physio at BC is author of the book Bike Fit.
‘You want a back angle that isn’t too acute, but don’t go too far the other way – sitting up in a “shopping” position can be really awful for some backs because you’ve got no flexion at all and you take every hit in the road in a much more loaded position in your back.’
Unsurprisingly, Burt recommends getting a professional bike fit to ensure the best position to suit your physical condition and riding goals, but he suggests that a good starting point is to get the saddle height right: ‘You can use a formula for that, like the LeMond formula [leg inseam x 0.883].
‘Weekend warriors sometimes sit too high for what they can physically do, and you see a lot of rocking of the pelvis from side to side because the hamstrings can’t cope, but also a lot of people just sit artificially too low. They need to get the saddle up and forward to underneath their bottom.’
Burt cautions against making too many dramatic changes to my bike set-up too quickly. ‘It’s evolution, not revolution. When you make changes you need to give your back a chance to catch up. The bike is adjustable, the human being is adaptable, and it depends how adaptable you are. It may take six months, but you need to regularly reassess along that journey.’
It’s advice I take on board, and I come to realise that ‘journey’ is perhaps the best way to describe my new relationship with my dodgy back. Whereas before I saw it as a problem to be fixed, I now view it as a situation to be managed. Happily, the result is I now have long periods without pain, my fitness is returning and, most importantly, I’m riding long distances again.
Has the problem gone? Of course not. My discs are still damaged and I still get aches and pains, but I’m no longer looking to someone else (usually a surgeon) to provide the solution. I have taken responsibility for my own condition, and I’ve learned to accept that I have a life-long commitment to look after my spine. After all, it’s got my back.
The UK Addiction Treatment Centres promote the benefit of a non-drug approach to back and neck pain, with the aim of helping sportspeople understand the dangers of using opiates to manage pain. UKATC provide a free, confidential support line for those who may be struggling with opiate addiction and wish to talk to an addiction expert: 0203 993 3401
You can find out more here: ukat.co.uk/opiates/dangers-opiates-back-neck-pain
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