Your Bike, Your Back – Lower Back Pain and the Cyclist

Of all the vile inventions misbegotten by mistake

The thing they call the bicycle does surely take the cake,

‘E’s ugly an’e’s vulgar, and ‘e’s dangerous to ride,

An’ he fills the man as rides ‘im with a sort of beastly pride.

Oh, the bike, oh the bike! Oh, the scarin’ tarin, Bike!

‘E’s just a ‘oly terror going scorchin’ down the road

With a grinnin’ idiot clingin’ to the ‘andles monkey-like

‘is shoulders ‘unched above ‘im like a ‘umpy sort of toad.

“The Bicycle Craze” in Humors of Cycling – Rudyard Kipling

From: Cycling, p.45; Oxford University Press, 1981.

Dr. Andy Pruitt, Ed.D., Founding Director, Boulder Center for Sports Medicine in Boulder, Colorado lists back pain and specifically pain in the lower back as the second most common cyclist problem he sees at his Center. He notes that even though cycling is theoretically safe for the low back there are four general culprits that can cause low back pain in the cyclist. They are skeletal design, skeletal disease, isolated deconditioning or over-conditioning and bike fit (ergonomic positioning).

While cycling is a low impact and low weight bearing sport, the weight of the cyclist is supported by only three contact points. These three points of contact are the cyclist’s feet on the pedals, the cyclist’s hands on the handlebars and the cyclist’s sit bones on the saddle. Of these three contact points really the saddle and bars support the majority of the cyclist’s weight. A cyclist with proper weight distribution has about 55-60% of their weight on the saddle and about 40-45% of their weight on the bars when in the seated riding position. As you may have noticed, neither the bicycle saddle nor the bars have a particularly large surface area to support the weight they need to bear while a cyclist is riding. These factors make it especially important for the cyclist to have proper positioning on the bike.

The back does not like to be in the same position for extended periods of time – whether it is seated at a desk, in a car, or flexed forward on a bike. These common positions result in a shortening of the hamstring muscles and lower back.  This shortening is felt as a lack of flexibility.  The shortening of these muscles can be counteracted, however, by moving from the static seated position as often as possible and by stretching. At the upper end of the back and shoulders the result of all this forward positioning is a rounding of the shoulders and again the simple remedies are changing position and stretching.

Dr. Pruitt notes that our individual skeletal design determines our flexibility patterns, posture and skeletal asymmetries. Concerning the bony parts of the low back skeletal design the most common causes of low back pain is leg length discrepancy. There are two types of leg length inequality, the first being structural, which means that the segments that make up your lower extremity are of actual different length right versus left, while functional leg length inequality could be caused, for example by one flat foot and one high arched foot or a degeneration of soft tissue in a knee joint. The key thing in cycling when faced with a skeletal design flaw or inflexibility would be to make sure the bike looks like the rider instead of trying to make the rider fit some formula or style. This can be as simple as having your brake hoods in different locations to level out the shoulders or a spacer under the short leg’s foot.

            Skeletal disease such as degenerative joint disease (arthritis) or degenerative disc disease can occur simply with time and activity, but many times is accelerated or exacerbated by existing skeletal design flaws. A comfortable position for a cyclist with skeletal disease can usually be found for a cyclist by making the appropriate bike fit accommodations. Cyclists are notorious for isolated conditioning and de-conditioning. Riding develops the quadriceps and gluteus, but does not do so much for the hamstrings or abdominals.  This imbalance needs to be addressed and even if it is not done during the season, the off-season affords the opportunity to work on the imbalance. When the time devoted to riding due to cold temperatures, inclement weather and less daylight is reduced the cyclist should devote more time to addressing the imbalance.

            Bike fit is all about taking into account the rider’s body and creating a bike that fits rather than making the rider adapt to the bike, but there is only so much that bike design can accommodate.  If you are trying to touch your toes and cannot reach much past your knees then you will need a fairly upright position to cycle with much comfort.   This is not a good situation and should be addressed before cycling enjoyment becomes a memory due to injury.  Fortunately a lack of flexibility can be changed with work.  My ten year old son really only wants to have steak, but unfortunately he has me telling him that he also needs to eat vegetables to grow strong and be healthy.  If you think of riding as your steak, you should think of your stretching and muscle balancing exercise as your vegetables.

            Dr. Pruitt puts it succinctly when he concludes, “I think the most important thing to consider in dealing with low back pain in the cyclist is the potential for leg length inequality, weak abdominals and tight hamstrings, faulty skeletal design of some type, degenerative disease of either bony articulations or the cushioning discs and lastly an appropriate individual positioning on the bicycle.”

            I’m happy to be the grinnin’ idiot clingin’ to the ‘andles, but I’ve no intention of riding with my shoulders ‘unched above ‘im like a ‘umpy sort of toad. Bike fitting is more than just getting the right size frame.  The fitting process should also teach a bit about how to maintain your flexibility and core body strength so you can ride stronger and be more comfortable too.

Questions? Give me a call at 914 328 9811 – Ed Cangialosi

Sources:

Serotta International Cycling Symposium, Dr. Andy Pruitt Presentation, 2007

CRCA Newsletter, June 2007.