Low Back Pain in Cycling and How to Fix It
Low back pain is the most common ailment amongst cyclists who contact Summit Physical Therapy. Cycling in our area is very popular and the nature of the sport lends itself to increased stress on the low back, but it is not necessary to ride through the pain. The good news is that in most cases, there are treatment options for cyclist’s low back pain. While it is impossible to provide treatment options for every individual case of low back pain in this article, we will highlight some commonalities we see in cyclists with low back pain as well as a few treatment options.
Our best recommendation for cyclists with low back pain is to work with a physical therapist to get a formal diagnosis. We can determine what specific impairments are causing your issue as opposed to taking a haphazard approach. If you are interested in getting more specific, you can request an appointment now to get a thorough examination to determine a proper diagnosis and plan to rehab your injury.
An Improper Bike Fit Can Contribute to Many Injuries
A physical therapist will be able to help you determine if your injury is more due to physical causes, or due to your bike fit. When reading this article, we will make the assumption that your bike fit is proper and you are comfortable in the position you have been fit to.
The Low Back, Hips, and Pelvis Are ONE Body Part, Not Three.
We call it the lumbo-pelvic-hip complex for a good reason. With every pedal stroke you take, the lower back, hip, and pelvis move in unison and work as a system. This is very important to understand when training for injury prevention or trying to rehabilitate an injury of your own. When bending forward while standing, 50% of the motion comes from the lower back, and 50% comes from the hips. When we sit on a bike, a large portion of the low back range of motion is required to bend forward and put your hands on the handlebars. You can imagine that the lower the bars, the more your lower back needs to bend. Since the lower back will be maximally stretched in the cycling position, it will be very important to make sure the hips have full mobility to not overstrain the back.
Strength of the core and back are also directly linked to strength at the hip. All of the hip muscles attach at the pelvis and the stability of the pelvis is controlled by the abdominals and back musculature. If you picture these two muscle groups as springs, they should both have equal strength in an ideal world. If one spring is weaker, you can imagine that the stronger spring will consistently pull on the weaker spring. This concept is important to understand when thinking about the role of the core in cycling.
What Contributes to Low Back Pain in Cyclists and How Do You Fix It?
Hip Flexibility
The problem: We know that in a perfect situation, 50% range of motion comes from the hips and 50% comes from the back. When the hips can not move through their full 50%, the lower back will frequently overcompensate and move more than its optimal range to allow you to ride. The most common muscle limiting the hip’s flexibility is the hamstrings. The groin/adductor muscles can also be the culprit and less often the hip joint itself can be a part of the problem.
The fix: Stretching is most commonly prescribed to address muscle flexibility issues. This is why most people never get more flexible from stretching. You will find that performing strength training through a full range of motion will be much more effective at improving your hip range of motion than stretching. Strength training has the added benefit of improving your strength. Any time that we use our time more efficiently off the bike leads to more time riding.
Reverse lunges and lateral lunges are great for mimicking the pedal stroke and making sure that you do not compensate with the back. Romanian deadlifts with no back rounding are excellent for forcing your hamstrings to length while becoming strong through the full range. Most people with tight hamstrings have weak hamstrings. Romanian deadlifts are the key to solving both problems.
Core Strength
The problem: The “core” is a fancy word for all of the muscles between your pelvis and the bottom of your rib cage. In some cases, the hip muscles are included, but in this article, we will separate them. The main job of the core is to transfer force between the lower and upper body. In cycling, your trunk should be mostly still and stable while you ride, allowing for a strong base for your legs to push and pedal off of. The core allows you to generate force through the legs without the back moving with every pedal stroke. When the core is weak or lacks the endurance required to ride, the back will compensate and eventually become irritated or injured.
The fix: Abdominal strengthening focused on moving the hips without having the trunk compensate. An example would be the dead bug exercise. These exercises in isolation will not be enough, and eventually need to progress to hip strengthening exercises without low back or trunk compensation.
Hip Strength
The problem: The biggest impairment I see in cyclists as a physical therapist is hip weakness when the knee comes closer to the chest or as they go deeper into squats and lunges. The movement becomes problematic since it is performed thousands of times on the downstroke while cycling. Even though you pedal in circles, the downstroke is the most powerful by an overwhelming majority. There are three main hip muscle groups in charge of performing the downstroke:
Glute muscles
Adductors/groin muscles
Hamstrings
The fix: Weight-bearing, compound strength exercises. The biggest issue I see as a physical therapist is cyclists performing far too easy exercises for strengthening, especially at the hips. You can focus on isolation, or use strong movements like squats, reverse lunges, lateral lunges, and deadlifts to work the whole hip as a unit the same way it performs on a bike. You may notice some overlap here between exercises I recommended for hip mobility!
Riding Beyond Your Limits
The problem: The lower back is one of the first body parts to fatigue when you hit that forsaken wall. Our legs lose their energy and we begin to pedal with our backs, rocking on the seat. I often see patients who do not have pain during or immediately after the ride, but within the next day, symptoms develop.
The fix: Make sure to ride within your limits, especially if you have some weak links in the chain. Strength training allows you to perform more vigorous exercise with less injury risk. This is your best bet at reducing your injury risk, aside from not overdoing it. Proper nutrition and hydration are key in making sure you do not ride beyond your capabilities.
I’m Still in Pain, and I Need Help.
If you’re having trouble managing your pain and recovering from an injury, request an appointment today with one of our highly trained physical therapists. At Summit Physical Therapy, you are always evaluated and treated by a licensed physical therapist which means the highest quality care and treatment for your injury—to get you back to doing what you love.
DISCLAIMER: This information does not substitute for medical advice.