Monday, June 1, 2009

Cycling and Back Pain Part III

How can something so good for you as cycling be so bad for you? In exploring the various potential causes for back pain while cycling, it’s time to face up to the problems caused by improper bike fit or the act of cycling itself…

By Rick Rosa, D.C.,D.A.A.P.M.Get Fit(ted)We’ve plugged it here on RecoveryDoc before, but the best thing you can do for yourself is to get a proper bike fit to make sure you and your bike are a pair of happy amigos throughout your long and passionate relationship. Much of the way we set up of bikes often has more to do with style and what we think the pros do, rather than what type of riding we actually do and the way our body works. With bike fit we have several areas to consider when it comes to influences on pain. Please note that the below are just general principles to consider along with recent trends, and that your exact needs are individual and can only be discerned by professional bike fitters.

• First off, improper position of the saddle will increase the load on the lumbar spine, and we definitely don’t want to do that. In fact, a study done at Chaim Sheba medical center in Tel Hashomer Israel examined saddle position and found that if they changed the seat height from a horizontal to 10 to 15 degrees rise, it decreased symptoms in 70% of the study population.

• Next, chances are that with proper saddle height you avoid the rocking back and forth motion in an effort to reach the pedals as well as the change in lumbar muscle recruitment patterns by having the seat too low. • An overly long reach to the bars may also stretch your back an increase spine loading, and two recent studies found benefit from moving the seat forward. Next, you can use a handle bar with less drop, especially if the problem occurs while racing. Remember to train in the drops as well as on the tops to allow your body to be adapted to both positions. Another quick fix is a shorter stem and/or raising the stem as this will help with the position of your spine and create less stress. Bad Bike Bad!Apart from the way we fit ourselves to our bikes, the very act of biking itself, with its restricted and repetitive range of motion, can conspire to magnify any existing problems with physiology or bike fit. Some things to consider about the act of cycling itself, and more importantly what we can do to minimize the stress:

• Road vibration on the road or the trails can really pound on your back, especially as it’s in a stretched out position horizontal to the vibration itself. So what can you do to decrease this road vibration? Change hand positions, don’t lock your elbows, and use padded gloves and handle bars. Consider some of the elastomer inserts that are appearing on the road market in forks and handle bars and tape, and seat tubes. Lastly, wider tires can also help decrease road vibration.

• Most of us are aware that leg length discrepancies can be problematic with cycling. However, most people do not realize that many changes in leg length can be functional in origin, meaning that the muscle and joint tissue on one side is causing the decrease in leg length as opposed to say a shorter femur on one side. Functional changes can be treated by a professional only and can basically even out the legs. Structural changes need to be evaluated as well. You may have either a custom orthotic measured or you can use some of the shims that are used at the pedal. This will correct the biomechanics and thus correct the problem.

• The riding position also creates strength differences between your back and abdominal muscles. You are flexed over the bike for extended periods of time and this not only stresses the lumbar spine, but over activates it. This means that the signal that is sent to the brain and back kinda keeps ringing while the abdominals get less and less signal so that over time you develop comparatively weak abdominals. In addition, riding a big gear and climbing up hills changes the recruitment pattern and utilizes the muscles of the lumbar erector group as well as gluteals to a higher degree. So what can you do to correct this problem? Core training does not just mean abs and back. It also involves the hips and shoulders.

• Active stretching, along with other workouts including pilates, yoga, and resistance training, results in flexibility of the back and hips. This will increase the length of the muscle and will decrease the pull on the pelvis and low back marinating normal biomechanics. One quick fix while on the road is to stretch back first (assuming you do not have a disc herniation or facet syndrome) and contract those back muscle while holding that position make sure your knees are bent slightly. Then flex forward trying to touch you toes. Lastly, turn your feet in and then out and repeat. This will target the inner hamstring fibers and adductors as well as gluteal muscles and hip rotators. You’ve heard it since you were a wee lad/lass in gym class, but these off-bike flexibility and core based workouts really pay off in decreased injury risk in both the short and long-term.
• One other problem I see with athletes, especially during the off-season, is that they will miss a few workouts and then proceed with a super hard work out in the trainer with the front wheel elevated. Needless to say, the next day their ass and back are screaming. Well that’s because they just overloaded the muscle group with little rest. Don’t make up for lost pedaling by going nuts when you get back on the bike. It never, ever, works out and you will end up injured, I promise.

References1. Fanucci E, Masala S, Fasoli F,Cammarata R, Squillaci E, Simonetti G. Cineradiographic study of spine during cycling: effects of chaning the pedal unit position on the dorso-lumbar spine angle. Radiol Med (torino) 2002 Nov-Dec;104(5-6):472-62. M Salai, T Brosh, A Blankstein, A Oran and A Chechik Effects of changing the saddle angle on the incidence of low back pain in recreational bicyclists. Br. J. Sports Med. 1999;33;398-4003. Ganzit GP, Chisotti L, Albertini G, Martore M, Gribaudo CG. Isokinetic testing of flexor and extensor muscles in athletes suffering from low back pain. J sports med phys fitness 1998 Dec;38(4):330-6.4. Bressel E, Larson BJ. Bicycle seat designs and their effect on pelvic angle, trunk angle, and comfort Med Sci Sports Exerc. 2003 Feb;35(2):327-325. Green BN, Johnson CD, Maloney A. Effects of altering cycling technique on gluteus medius syndrome. J Manipulative Physical Ther. 1999feb;22(2):108-136. Callaghan MJ Jarvis C. Evaluation of elite British cyclists: the role of the squad medical. Br J Sports Med. 1996 Dec:30(4):349-537. Mellion MB Common Cycling Injuries. Management and prevention. Sports Med.1991 Jan;11(1) 52:-708. Angus F. Burnett, Mary W. Cornelius, Wim Dankaerts and Peter B. O’Sullivan. Spinal Kinematics and trunk muscle activity in cyclist: a comparison between healthy controls and non-specific Chronic low back pain Subjects-a pilot investigation.9. Salai M, Brosh T, Blankstein A, Oran A, Chechik A. Effect of changing the saddle angle on the incidence of low back pain in recreational bicyclists. Br J Sports Med 1999;6;398-40010. Usabiaga J Crespo R, Iza I, Aramendi J, Terrados N, Poza J. Adaptation of the lumbar spine to different positions in bicycle racing. Spine 1997;17:1965-911. Mellion M. Neck and back pain in bicycling. Clin Sports Med 1994;1:137-64
About Rick:Rick Rosa, DC, DAAPM, is a practising chiropractor based in Maryland. He is the owner of Rosa Rehab in the Washington, DC area, and has worked as a team doctor for a wide variety of champion boxers and cycling teams.
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