Low back pain and cycling

The American Bureau of Transportation Statistics estimates that more than 49 million Americans ride bicycles at least monthly, with over 5 million people riding at least 20 days/month. With so many people riding, the numbers of cyclists reporting neck and back pain have risen dramatically during recent years. Wilber, et al. found that 44.2 % of male and 54.9% of female recreational cyclists presented for medical treatment of neck pain, while approximately 30% presented with back pain. [Int J Sports Med 1995: 16: 201-6.] That is a lot of riders. This high prevalence of injury, especially in recreational riders, suggests that more understanding is needed by riders and their health care providers to prevent such injuries by proper education and fit. [www.roadcycling.com/cgibin/artman/exec/view.cgi/6/1026] Causative factors for low back pain among cyclists are thought to be prolonged forward flexion, flexion-relaxation or overactivation of the erector spinae, mechanical creep and generation of high mechanical loads while being in a flexed and rotated position. [Man Ther. 2004 Nov;9(4):211-9.] Below is a picture of a segment of the lumbar spine. From the picture and imagining a cyclist sitting in a bent forward position for prolonged period of time, it is easy to imagine that the disc is being statically loaded (as suggested by the green arrows pointing to the disc being compressed in this illustration. Also, the spinal ligaments are susceptible to stretch or creepfrom prolonged maintenance of a forward bent posture.

In a study by Burnett et al. cyclists with and without back pain were evaluated in terms of their spine kinematics. The study demonstrated that cyclists in the pain group showed a trend towards increased lower lumbar flexion and rotation with an associated loss of co-contraction of the lower lumbar multifidus. This muscle the multifidus is known to be a key stabilizer of the lumbar spine. The authors concluded that altered motor control and kinematics of the lower lumbar spine are associated with the development of low back pain in cyclists. [Man Ther. 2004 Nov;9(4):211-9.] As noted above, static lumbar flexion has been suggested to be associated with the development of low back pain. As study by Shin et al. found that not only are ligaments stretched but Fatigue of low back extensor muscles may occur in static flexion due to prolonged passive stretching of the muscles. They suggest that the the degraded force generating capacity of the fatigued [back extensor] muscles can be a significant risk factor for low back pain. [Spine (Phila Pa 1976). 2009 Aug 1;34(17):1873-8.] So what can cyclists do to prevent low back (and neck for that matter) pain. A few suggestions have been put forward: 1. Incorporate core stabilization exercises into your training regimen Lumbar stabilization exercises have been shown to improve the activation of muscles in the core to help unload discs and joints. There is good evidence that dynamic lumbar stabilization is effective in the rehabilitation of chronic low back pain. (J Strength Cond Res. 2009 Oct 24) A few of my favorite exercises are the big four stabilization exercises described by Stuart McGill: (1) curl-up, (2) Cook hip lift, (3) side bride and (4) prone bridge. Following is a link to a description and photos of these exercises for more information on this topic: http://www.backexercisedoctor.com/journal/2008/7/17/back-pain-generalitiesand-my-favorite-back-exercises.html . 2. Work on abdominal bracing exercises with training and during rides One of the primary goals for core exercises, especially as they relate to back pain is the ability to establish and maintain a braced core. This braced core is accomplished by maintaining a mild contraction or tension of the

abdominal wall. Stuart McGill, a reknowned investigator in the field of exercise science refers to this muscle stiffening and terms it abdominal bracing. (Arch Phys Med Rehabil. 2007 Jan;88(1):54-62.) Following is a link to a description and pictures of abdominal bracing exercises for more information on this topic: http://www.backexercisedoctor.com/journal/2009/12/28/abdominal-bracingexercises-and-back-pain.html . Abdominal bracing can be performed not only during core training sessions but also while riding. While riding, the performance of abdominal bracing would counteract the inhibition of these muscles often noted with cycling as described in some of the studies above. 3. Microbreaks There is significant benefit to be obtained from varying position while riding. By varying position, we can spread out static loading to the spine and make sure that we are not overloading one specific area of a disc or joint. A study by McLean et al. looked at the issue of microbreaks in relationship to sitting (not directly at cycling but the results seem applicable). They found that microbreaks had a positive effect on reducing discomfort in all areas studied [neck, upper back and lumbar spine]. They found these microbreaks to be most effective when taken at 20 minute intervals. [Appl Ergon. 2001 Jun;32(3):225-37.] With respect to cycling, a microbreak could mean nothing more than sitting up, extending the back and altering position for a relatively short period of time, just to counteract the effects of static loading.