Lower Back Pain - Is the bike to blame?

Prolonged periods of sitting have been associated with musculoskeletal dysfunction, especially low back pain. Both sitting and cycling demand this position, so what can be done to prevent it?

Non-specific low back pain is tension, soreness and / or stiffness in the lower back region. 

Talk to a few people and you will begin to realise that almost everyone is affected by it at some point in their lives. 

Thankfully it is usually short lived and sufferers will return to full pain free function regardless of any advice or treatment.

A small portion do however go on to develop more long term pain and disability, with 2.6 million people seeking advice from their GP in the UK each year. Several structures in the back, including joints, discs and connective tissue may contribute to symptoms but what causes them to hurt in the first place? It’s a problem that continues to trouble clinicians both in identifying causative factors and managing symptoms.

When trying to identify causative factors, of which there are many, prolonged periods of sitting have been associated with musculoskeletal dysfunction, especially low back pain. Throughout our lives in the modern western world we sit down for a large portion of our day, whether its at work, travel or at home, so it’s a significant issue.

Cyclists face a similar problem, with the cycling posture reaching the limits of lumbar flexion for extended periods of time. Low back pain and anterior knee pain are the most common symptoms in professional and non professional cyclists and are the most likely to cause time off the saddle. 

Cyclists who have pain show a trend towards increased lower lumbar flexion and rotation, with an associated loss of co-contraction of the lower lumbar multifidus (and this muscle is known to be a key stabiliser of the lumbar spine). It is argued that sustained kyphosed postures are insidiously harmful to the spine in that they may contribute to disc degeneration in the absence of pain. Sustained kyphosed postures also adversely affect spinal ligaments, muscles and joints and lead to neuromuscular and cumulative trauma disorders and loss of spinal stability. This suggests altered motor control and kinematics of the lower lumbar spine is associated with the development of LBP in cyclists.

Bike set up and fitting is also an essential tool in becoming comfortable on a bike. If your position is not optimal it can be very difficult to achieve a suitable posture and produce the maximum amount of power. Correct seat height and handlebar drop allow the hips to move in a comfortable range without putting unwanted loads through the upper and lower back. Correct cleat set up is also useful to address any tracking issues occurring at the knees. Advise on suitable equipment is also valuable, as shoes and frame size are often difficult factors to get right.

Whether your aim is to get more comfortable on the bike, perfect your time trial / triathlon position or optimise your road position, then a bike fit can help you with this. Of course your body will guide how you are fitted on a bike and this will not necessarily be the optimal position. 

To access the optimal performance oriented positions on a road or TT bike it may be that changes need to be made to flexibility and strength first. A bike specific functional screen with a Physiotherapist, Osteopath or Chiropractor can help identify these limitations and give you the tools to address them.