Health: Protect your back

21 comments
By Matthew Barbour, Cycling Plus | Monday, Jan 11, 2010 4.00pm

Cycling might give you the cardiovascular system of someone 10 years younger, but if you want to carry on riding injury-free into your dotage, you need to look after your back.

According to a recent study in the International Journal of Sports Medicine, if your back’s trouble-free you’re in a clear minority. California State University researchers questioned 518 recreational cyclists and found a staggering 85 percent of them harboured at least one recurrent injury.

Clocking an average of 75 miles a week, 79.1 percent reported neck or back problems, almost twice those hobbling with knee issues (41.7 percent), while 36.1 percent harboured groin and buttocks strains, and 31.1 percent wrist and hand pain. Perhaps the most worrying finding was that just 36 per cent sought any professional help to ease the pain.

“Most cyclists think you can just jump on a bike and go, when that’s far from the case,” explains Dr Michael Lanning, a Harley Street chiropractor who specialises in cycling-related joint and spine injuries. The back, he says, or more properly the abdomen, is by far the weakest link for the majority of riders.

“Cyclists have huge leg muscles but don’t have the torso strength to support and resist the tremendous forces which the legs can generate,” he explains. If the torso is weak, he says, that force doesn’t go into the pedals but is dissipated in flexing of the abdomen. “Look at tired riders – every stroke generates an ‘S’ curve in the back, causing fatigue and muscle spasm.”

Here then, is how to prevent that happening – or, if you’re already suffering a niggle or two, how to get back on your bike and stay problem-free through every season.

Neck and upper back pain

Neck and upper back pain is most often caused and exacerbated by riding position and technique, explains elite cycling trainer Andy Wadsworth.

Riding in drop handlebars for long periods will not only increase the load on the arm and shoulders, it will also hyperextend the neck.

“Prolonged hyperextension leads to ‘trigger points’, small rubbery knots that form in muscle and adjacent fascia muscle sheaths, which send pain signals to the brain and contribute to a pain-spasm-pain cycle,” says Wadsworth. 

If the virtual top tube length (top tube plus stem length) is too long for the rider, or if aero bars are used, hyperextension is a near certainty, he says. “It’s especially common in the early season when riders are increasing both their mileage and the time they spend in the saddle.”

To avoid early season overuse injuries, says Wadsworth, you should initially ride at high cadence and low resistance, and only increase training mileage by 10 percent a week, gradually building to goal mileage.

If you suffer from neck pain you should also inspect the setup and fit of your bicycle. You might find you have to raise the handlebars, change to bars with a shallower drop or reduce the virtual top tube length by using a stem with a shorter extension.

“Moving the saddle forward should also reduce virtual top tube length, but be careful as a poor saddle position can lead to knee issues which are just as hard to sort when they set in,” Wadsworth cautions.

Changes to riding technique can also help. Riding with unlocked elbows and regularly changing your hand position from the drops to the hoods can spread the load on key muscles.

Lower back pain

With your lower back, the problem is most likely linked to your pelvic position, a weak core and crash damage. “I see so many riders who spend hours and hundreds of pounds sorting out their bikes after a crash, but don’t think twice about their bodies,” says Joy Potts, an osteopath specialising in sports injuries.

“Without you realising, it can cause the pelvis to become twisted and make your legs different lengths; issues which create muscle imbalances and put huge pressure on your lumbar spine as you twist your abdomen for power. Always, always get a professional once-over after any crash. Leave it too late and it can result in months of pain.”

As with neck pain, focus on your bike setup. “If your saddle’s too high, you’ll rock side to side causing the muscles between your pelvis and lower back to spasm,” she says. “Put your heel on the pedal at the six o’clock position and sit on the saddle – your leg should be almost straight and you shouldn’t have to rock your hips to reach down.”

Pelvic position is paramount, she says. “Tight quads will tilt the pelvis forward, while tight hamstrings will tilt it back; in both cases, your lower back will over-arch and start to take the strain when it should be your much bigger muscles in the core.”

Pushing bigger gears or overdoing your hill sets can overly fatigue the glutes and hamstrings, again leading to pain. “The key message is you need to strengthen your core away from the bike before your back takes the strain, and focus on stretching to maintain pelvic position even when you’re dog-tired," says Potts.

And the one muscle cyclists ignore at their peril? The gluteus medius. On the outside of the buttocks, it’s a muscle we never use when we walk, but when cycling the demand on it increases by a factor of eight.

“It literally holds your pelvis in place so you get an efficient transfer of power in the lumbar region,” says Paul Massey, physio with the British Olympic Association. “Three sets of 10 side leg raises twice a week is sufficient to build and maintain strength here as well as in your transverse abdominals [a major muscle of the functional core].”

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Workouts

“You need to incorporate core stability, flexibility and conditioning drills into your training to make your time in the saddle more comfortable, less likely to develop muscle imbalances, and improve performance and speed,” says Paula Coates, author of Exercise Yourself to Health: Back Pain. “Mix and match the following exercises and stretches in a simple 20-minute workout twice a week and in just a month you will see noticeable improvements.”

Walking lunges

Targets: Quads, core and hip flexors

3 x 15-20 reps

1 Step forward into a lunge position, bending the front knee and ankle to 90 degrees which will help you keep your knee behind your toes. Keep your weight on your back leg and clench your buttocks.

Walking lunges: walking lunges

2 Dig your front heel into the floor and step the other leg forward into the lunge position. Keep your steps wider than your pelvis as this will increase your base of support and stability.

The cat stretch

Targets: Spine and core

Unlimited – repeat little and often

1 Kneel on all fours with your knees a hip distance apart and your hands a shoulder width apart. This can also be done sitting on your bike.

Cat stretch 1: cat stretch 1

2 Imagining your pelvis is a bucket filled with water, tilt your pelvis forwards and backwards for one to two minutes as if you were tipping water out of the front and back of the bucket.

Cat stretch 2: cat stretch 2

The Bug

Targets: Core

3 x 10 breaths

1 Lie on your back with your arms reaching up towards the ceiling and your hips and knees bent to 90 degrees. If this feels too difficult, you can support your legs on a gym ball or on the arm of your sofa.

The bug: the bug

2 Making sure your spine is flattened gently against the floor and your pelvic floor is lifted, hold this position as you gently breathe in and out. Repeat three times for 10 breaths, resting between each set.

> You should feel this in the tummy not the back; if you have back pain, wait until you’re stronger or reduce the time you hold the position.

Variation 1: Arm floats: As you breathe out, slowly raise your left arm over your head, then breathe in and return your arm to the start position. Repeat with your right arm and alternate each arm for 30 seconds, increasing to one minute as you become stronger.

Arm floats: arm floats

Variation 2: Leg floats: As you breathe out, slowly lower your left foot towards the floor, but only as far as you can while keeping a neutral spine. Breathe in and return the hip to the start position. Repeat with your right foot. Alternate legs for 30 seconds, increasing to one minute as you become stronger.

Leg floats: leg floats

Crucifix stretch

Targets: Lumbar spine and hips, buttocks, back muscles and hamstrings

2 x 10-15 reps

1 Lie on your back with your arms stretched out at right angles to your sides and both your legs straight, as if you’re on a crucifix. Keep your arms in contact with the floor at all times.

Crucifix stretch: crucifix stretch

2 Lift your right leg 2in off the floor and swing your leg over and across your left leg so the toes on your right foot are sliding towards your left hand. Only swing your leg as far as you can comfortably.

3 Return your right leg to the starting position and repeat with the left leg. Do two sets of 10–15 repetitions.

> If your flexibility is poor or you’ve had a flare up of low back pain, bend your knees, keeping your feet on the floor, and roll your knees from side to side.

Dynamic hamstring stretches

Targets: Hamstrings, piriformis, tensor fasciae latae and calf

10-20 reps in each position after every ride

1 Standing with your feet together, take three small steps (heel to toe) so you stop with one foot in front of the other.

Dynamic hamstring stretch:

2 Lean forward and slide your hands down your leg to your ankle. The forward movement should come from your lower back and your hips.

Dynamic hamstring stretch:

3 Take three more small steps so your opposite foot is in front, and again reach your hands down to your ankle. Repeat 10-20 times.

4 The next stretch starts in the same way – take three small steps but turn the toes of your front foot out with the outer side of your heel level with the big toe on the back foot. Repeat 10-20 times.

5 The final stretch starts in the same way with three small steps, but this time turn the front foot in, keeping the inside of your heel level with the big toe on the back foot.

Thoracic extension stretch

Targets: Spine and chest

Daily 15-20 minutes

1 Use an exercise ball, or roll up a small bath towel so it has a diameter of 10-15cm and secure with rubber bands.

2 Lie on the ball or, if using a towel, a bed with the towel lengthways down your spine, from the base of your neck to the middle of your back.

Thoracic extension stretch:

3 Raise your arms to either side of your head and let them hang or rest on the bed. If this is too much of a stretch, support or rest your arms on pillows to reduce the pull across your chest.

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User Comments

There are 21 comments on this post

Showing 1 - 21 of 21 comments

  • Good advice!

  • A very good post indeed. I'm glad to see this as I suffered from severe back pain a few years ago. Personally I have found that a combination of stretches / core strengthening and a lot of good high quality swimming has really helped my bike posture and dramatically reduced fatigue.

  • I think I'd prefer a swim to 20 minutes of thoracic extension stretches.

  • I do over twice the milage per month compared to whats in the survey. and i only have back issues when i don't cycle for a while.

  • This is particularly relevant for those of us that are more sprinter types. If you have huge legs and a small torso, you're going to have back problems.

    I started training (with a trainer) once a week almost a year ago, and my back hurts much less. It was never really acutely painful, but it would be tired and irritated for days after a long ride.

    IF you have back problems and you're a cyclist, basically, you should do more core exercises. I mentioned my back problems to the guys at my bike store years ago, and they all agreed that I'd gotten too strong for my body to support, and it was really noticeable when riding cross, which is all about burst power and bone-jarring abuse.

    Some people aren't going to get it for any number of reasons, but it's certainly helped me to think more about my core.

  • Great article! I have spent a lot of time at the chiropractor due to a very weak core. I've used similar exercises and they really help. It doesn't take much time and the effort pays off very well.

    I thank you for the timely reminder. In the winter months in NE Ohio we tend to get a little soft. I'm printing this out and posting it on my wall in the exercise room tonight. I'm planning on doing some of these regularly along with my bike training sessions.

  • I appreciate what the author is trying to do here. I agree that the pelvis is integral to correcting back pain. The forces acting through the legs and pelvis, though, are too great to correct just with core strengthening. That is because the leverage of the legs, and muscles attached to them,affect the pelvis in such a way as to weaken the abdominals. Strengthening them without addressing the levers acting on themwill merely offer temporary results at best.

    Furthermore, the forces affecting the pelvis also contribute to poor alignment of the femur head in the hip socket, altering its axis of rotation and therefore torquing the pelvis to cause pelvic and back pain. These issues are fairly easily corrected however to say that core strengthening will achieve this is not entirely correct.

    Also the lunge depicted here emphasizes that the knee should stay behind the toes. Why? There is little credible evidence to support this technique. If this is the case then why is our ankle and knee designed to move well beyond the toes? Allowing the knees to pass in front of the toes, together with appropriate hip flexion, activates all the major muscles of the lower leg and pelvis, rather than straining the knee.

    Although I disagree that the gluteus medius is never used when we walk. However I do agree with the need to strengthen it, especially in cyclists and runners.

    Thank you for your article.

  • "Here luv, let me rub that better for you..."

  • As someone unable to walk two months ago - back twisted like a corkscrew - I fully appreciate this article. The back, especially the lower part, is the weakest, most vulnerable part of the human body - it hasn't evolved enough to withstand the forces that we subject it to, notably by being upright. It was designed for moving around on all fours. To put it simply, we are an advanced, faulty prototype that shouldn't have been put into mass production - cf the brilliant, durable design of say, a cat.

    The way to protect the back from the long hours of abuse - this includes the modern day curse of sitting in front of a computer - is, as this article so rightly points out, to increase flexibility and build a ring of 'steel' around the spine by strengthening the muscles - abdominals and erector spinae - as much as you can.

    All these exercises seem pretty good to me, although I have formed my own routine based on suggestions from such things as yoga and pilates - ignore names and connotations, they're all good. I now like to think I have a core as strong as I ever had (once upon a time I would invite punches in the stomach) which has given me the confidence to get back on the bike.

    On the bike itself I am conscious of the spine and can stretch it out a la 'cat' position above. Having a 'flat' back - ie nicely stretched out parallel to the top tube to avoid any strain - seems to help too.

    Some other tips that spring to mind:-

    1, Climbing 'en danseuse' ie out of the saddle is good. It is. It works the lower back muscles very well indeed. Pick somewhere steep and go gently.

    2. Hamstrings not only need stretching, they need loosening as well. Back problems, as well as cycling itself, will result in them tightening. Tight hamstrings pull down on the back leading to greater problems. All you need is a tennis ball and a hard surface to sit on. Insert ball under hamstring and push and roll hard. Warning - might bring tears to the eyes until the muscle softens. Persevere and the whole body benefits.

    3. Inversion table - google to see what I mean. The ancient greeks would hang patients by their ankles from trees to stretch their backs out. This is the updated version. Nothing like an upside down dangle to return everything in the back to where it's meant to be. Works well as a stretch after a ride. NB Go easy to begin with. Takes some getting used to but, by golly, it's worked for me. OK that's me done. Happy painfree riding everyone.

  • Good advice from both the article and the comments from the people above.

    A good bike fit will also help keep aches and pains at bay and is crucial to comfort if you are doing long rides.

    The link below is a good place to start, providing a video step-by-step guide to getting the right basic fit to your bike. A simple change such as flipping your stem so it points up instead of down, or changing the stem length can make a world of difference to your comfort on the bike, and the state of your back!

    http://www.competitivecyclist.com/za/CCY?PAGE=FIT_CALCULATOR_INTRO

  • Good article this, i have suffered with back pain cycling for 4 years, and my torso is twisted, and leg length different, i have seen loads of physios and they stress how important it is to do back excersise, if you suffer from bad back long hours in the saddle his a no no, thats what they told me. I have had to cut down my hours,.

  • plank

    just plank

  • I did my back in a couple months ago and its taken a long time to get rid of the pain. I've done a couple of weeks on the turbo trainer, 30 mins to an hour at moderate pace.

    What has improved my core has been my new vibro trainer, after an hour on the bike i do 5-10 mins standing on it in the 'downhill skier' position and it really does work the muscles you don't get involved on the bike. Only 100 quid too, may not be as big and technical as the 5k ones you get in the gym but does the trick.

  • 26 years of racing and not looking after myself and I have the exact injury described.

    This article is very helpful.

  • The article was dated 1995., that not what could really be called "recent" in the world of research. (Int J Sports Med 1995; 16(3): 201-206) A search of pubmed.gov and a few other journal databases did not indicate a vast amount of epidemiology research in cycling. So perhaps this indicates that after 15 years, and a number of advances in cycling technology, maybe it's time to update the database. I think a study examining those who are more than recreational but not hardcore cyclists would be in order.

    Another point of contention I had was with the statement about the gluteus medius: "it’s a muscle we never use when we walk". There is, however, a substantial record of research publications which have evaluated the GM in walking, even going back to the late '70s and early 80s. One could even read Soderberg's 1978 study which indicated that the GM has 3 functional sections, on the basis of neuromuscular activation.

    Many of the exercise shown are relevant to low back pain, I have often had patients doing the same ones for LBP, so that is a good thing from this article. But I would rather see _recent_ studies quoted, and some statement of factual science too, especially when coming from practicing clinicians.

  • didnt read a word, great great photos though...

  • After reading the comments on this artical I did find it very ineresting to what your thoughts are.

    In Feb 2008 I was cycling back from work didnt see black Ice on the road then finding myself on the ground hearing a crack I was in shock and in alot of pain I had to walk to the main road limping knowing that I had to get back on my bike and ride a further 6miles to pick my baby up from nursery as I didnt want to get charged for leaving him. I couldnt ring anyone to pick me up as there was no phone signal. At this point I was very frightened that I had broken something. I managed to get home finding a few hours later I was in pain and ended up in A & E for 4 hrs having xrays as the pain I had sounded like I had broken my pelvis They did say that they couldnt find anything wrong thank god. It took me 4months before I returned to cycling and found it very painful and stopped for a while.

    over the last 2 months I have been using Shaun Ts core abs Dvd and Shaun Abs Insanity Dvd this is mostly ab work Excellent workout and yes you do see results. I'm now using my turbo trainer for extra exercise. Im very scared but if I dont go back out I never will. Doing lots of core work helps does help and support my back and will keeping doing these dvd

    I do get some pain can cope with it

  • It's really hard to do a diagnosis online, and also where you impacted would matter. The 'crack' you described when you went down could have been from a number of sources, whether the helmet hitting the pavement, something in your pocket (mobile maybe?) or even a part of the bike striking the road.

    I would suspect that absent a fracture, you may have bruised the periosteum. That is a tough fibrous sheath that surounds the bone. They are very well innervated, hence the pain, but, sadly, they have a very poor vascular supply, thus they take a long time to heal.

    If you want to send me an email, I may be able to give you some more advice, and depending on where you live, I can offer some more recommendations for treatment / rehabilitation.

    It's good to get involved in the core strength training. If you think about it, the legs are effectively rotating around the axis of the pelvic girdle. If that is not anchored to a strong core, then you will not be as efficient. I have just read a few research articles on this topic. Specific to cycling, I would suggest reading the latest issue of "Journal of Strength and Conditioning Research" for a study into resistance training for cyclists.

    Bonne chance!

  • Thank you for the advise I will look into reading the journal of strength. Thank you again .

    Best regards Em

  • I have managed to track down and contact the author of the "recent" research which was used as the basis for this blog posting. I have received a hard copy and scanned the pages. If anybody would like a pdf copy, please email me.

  • useful images

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