Tuesday, 13 March 2012

Cycling and Lower Back Pain

Our Physiotherapy clinic has been up and running at Pearson Cycles in Sheen for just on 2 months, and overwhelmingly, the condition that I have seen most of, amongst both the clients I see for Physiotherapy and those that I observe having a Cyclefit, is cycling-related low back pain. Not only is the presentation similar, but also the precipitating factors.

Low back pain during (or after) cycling is most commonly caused by prolonged flexion of the lumbar spine. Like any other joint in the body, if you put it at its end of range and leave it there, it will start to hurt. Discs will be compressed, ligaments overstrained, and muscles overtensioned. Pain can be localised to the low back, or it can refer into the buttocks, thigh, leg and foot. And whilst most cases are probably not attributable to the dreaded and more serious “slipped disc pinching a nerve”, it can certainly result in that if your back continues to be subject to this cumulative strain.

Observation of sitting posture is a give-away. If people sit (or stand) a bit like a question-mark ie. flattened lumbar spine, curved upper back, rounded shoulders, head and chin poking forwards, chances are, their postural muscles are not working effectively either on the bike or in everyday life. Add to this the fact that many of us have jobs which involve us sitting most the day… badly. And if you are also good friends with your sofa in the evening, this poor posture is being reinforced for too many hours of the day.

Poor Posture

Once on the examination couch, we often find that people have stiff lower lumbar spines, poor hip range of motion, and tight posterior chain muscles (particularly gluts and hamstrings), or possibly all three! A stiff lumbar spine will mean that you reach your limit sooner into range. Poor hip range can pull your pelvis into posterior tilt and therefore your lumbar spine into more flexion to achieve the flexion needed to get to the top of your pedal stroke. Tight gluts and hamstrings can also limit your hip flexion, and along with your back extensors, can be a source of pain themselves should they develop trigger points and excessive tightness.

And finally, the word we all love or loathe – core stability. Your spine should be in a relatively neutral position when you cycle and you need properly functioning lumbopelvic stability muscles to keep it there. Also, these muscles are required to stabilise your pelvis, providing a platform for which your legs can exert (quite significant) forces on the pedals. To achieve all this, you also need good proprioception, or movement/position awareness.

The solution… increase your lumbar and/or hip mobility and range, stretch your gluts and hamstrings (in fact, all your major lower limb muscle groups would be beneficial), learn how to engage your core muscles, and learn how to do this on a bike! Your cycle-friendly Physiotherapist should be able to help you with all of this. And one final word… consider getting a comprehensive bike fit. If your bike is constraining your body into a poor position, you’ll be fighting a losing battle.