Wednesday, May 20, 2009

Back Pain and Cycling

I think many of you might be surprised to hear that the number one complaint reported by cyclist has been back pain, with numbers ranging from 60-70% in various studies. The first question that should be answered is what the cause of back pain is for cyclist.

One interesting study was done by the British Cycling Federation on the squad medicals of its elite cyclists and found that 60% of the 500 elite riders had low back
pain. Bicycling is one of those unique sports where the human-machine interface is paramount. As we discussed previously when discussing cadence and PowerCranks, the repetitive and constrained motion of cycling is an invitation to injury if the interface is not optimal. While everyone can benefit from a top-notch bike fitting session, it’s not always the primary reason behind back pain, and the first question that should be answered is what the cause of back pain is for cyclist.

Four major sources of problems that may bring about back problems include:

1. The first cause can be some type of spinal disease that may or may not be related to the activity of cycling (i.e. Disc herniation, arthritis, metastatic disease.)

2. Acute trauma from a fall or crash while ridding like Tyler Hamilton had in the 2004 Tour de France.

3. Bike fit, from proper seat angle and height to stem length and drop position has been shown to cause back pain.

4. The biomechanics of cycling itself and your body’s ability to adjust.

First thing I would recommend that you have your back pain evaluated by a chiropractor, physical medicine specialist or orthopedic surgeon that has a background in sports injuries. One potential serious cause of back pain, namely spinal disease, can only be determined by a proper examination that may include x-rays, MRI, Bone scans and blood work. Due to the many cause of spinal disease some may limit or take you off the bike while others would actually benefit from riding. The key here is to have a proper diagnosis made so you can treat the problem properly.

Second, acute trauma from a fall or crash can result in a fracture of the spine which is very serious injury and should require immediate attention (except if your name is Robbie McEwen and you finish Le Tour 2004 and win the Maillot Vert anyway – wow!). If we don’t fracture the spine we can bruise the muscle and joint tissue and as well as cause a sprain/strain injury of the ligaments, tendons and muscle that support the spine. This can be very painful and would leave you with a significant decrease in power. This was evident a few years back at the Tour when Tyler Hamilton had to abandon due to back pain. Remember, this is the same guy who rode the Tour de France with a fracture collar bone the year before, so it’s not always something you can shrug off!

Bike fit is very important because small changes in biomechanics of the spine can lead to increase in load, stretch or compression on bone, muscle, ligaments and tendons. Seat position and angle, the length and angle of the stem, as well as the amount of drop of the handle bars all can contribute to low back pain and stiffness. Lastly vibration while riding can aggravate any symptoms you may have.

The biomechanics of cycling itself, even if perfectly fitted to the bicycle, can cause back pain. A study done In Australia in June of 2004 looked at muscle activity of cyclist that did and did not have back pain and they found that the more forward flexed the rider was during the test the more likely he was to develop pain in the muscles that are on each side of the spine ( lumbar erectors). In addition, a small spinal muscle that is a stabilizer called the lumbar multifidus muscle was not contracting when it was supposed to and the abdominal muscles showed decrease activity. Both muscles are spinal stabilizes. So what? You say. Well basically this sets up an imbalance and puts a large demand on the low back.

So what can you do to help yourself with any of these problems or better yet prevent them from occurring in the first place?

Check out part II of cycling and back pain.

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