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by Paul Argent
October 24, 2018
Photography by Supplied, Kristof Ramon and Cor Vos
So you’ve tried a professional bike fit, perhaps more than one. You’ve put your saddle up, down, forward and back. You’ve raised your stem, inclined your brake levers, and asked for advice from every cyclist you know. But still your back hurts. Perhaps the problem lies with you and not your bike?
In this article, injury rehabilitation specialist Paul Argent takes an in-depth look at how to prevent lower back pain from cycling by making changes to your body, not your bike.
First of all, you’re not alone. Although it may be of little consolation, lower back pain from cycling is seemingly universal. In a recent study of professional road racing cyclists, 45% reported having back problems in their career. A whopping 58% said they had suffered from back pain in the past year.
Watch any professional cyclist get off their bike after a long race and you can probably identify with the discomfort they’re in as they struggle to stand up straight.
Essentially it’s the position you’re in and the amount of time you spend there. There’s no getting away from that unfortunately. Unless you want to adopt the aerodynamic properties of a wall, you have to bend forward. Bending over for long periods of time has been implicated in back pain whether you do it on a bike or are just sitting slumped in a chair.
It’s thought this causes something called flexion relaxation, a situation where the muscles of the spine simply turn off. Instead, you rely on passive structures such as ligaments to help maintain your position. This could be an energy preservation strategy by your central nervous system (CNS), or it could be due to a lack of endurance in those muscles.
We can’t do much about the former but the latter can be improved. More on that in a moment.
Research shows that how you achieve your position on the bike can make a difference. In the traditional cycling position you are dealing with two different types of flexion (or bending): flexion of the hip and flexion of the lumbar spine.
Flexion of the hip is the narrowing of the angle between your thigh and your trunk. Flexion of the lumbar spine involves bending the spine itself. Notice the difference in the images below. Peter Sagan (left) achieves the position by flexing more at the hip, whilst Jan Ullrich (right) flexes more from the spine.
It’s the second position in particular that’s more associated with lower back pain in cyclists.
One research group found there was a significant relationship between both increased lumbar spine flexion and spinal rotation in cyclists who experienced lower back pain. Although their sample size was relatively small, all the subjects who developed back pain whilst cycling had weakness in muscles that rotated their trunk to one side or the other.
So it appears that lower back pain from cycling is associated with both increased lumbar spine flexion and perhaps also a rotation component. That being the case, let’s take a look at some solutions to the problem.
If you think you’re more of a back-bender than a hip-flexor there are a couple of things you can work on:
1. Train your hip flexors
Almost nobody recommends training your hip flexors for cycling. The general wisdom is that they must be tight and need stretching in cyclists. This is based on little more than looking at the position cyclists spend their time in.
However, you can’t assess which muscles are tight and which are weak simply by looking at a posture. It’s the equivalent of a car mechanic telling you what’s wrong with your car by watching you drive into the garage. It’s far better to assess the performance of your hip flexors directly.
2. Check your hip flexion range
Try this for a second. Lie on your back and slide your hands between your lower back and the floor. Now bring a bent knee up towards your chest as far as it will go without the pressure on your hands increasing. That’s your available active hip flexion range. Notice that if you bring your leg further up you have to round out your lower back to do so (as felt by the pressure increasing on your hands).
How far did you get? Get someone to take a picture or look in a mirror.
Now compare the angle between your thigh and your trunk, to the position you adopt on your bike when you get down on the drops.
If that angle is a lot smaller on your bike, then you’re breaching your active hip flexion range of motion on the drops. That may explain why your lower back is flexing and causing issues.
Use this exercise to improve the performance of your hip flexors. Lie down on a weight-lifting bench that’s been set up with a small incline. Note the greater the incline, the more difficult the exercise. Keeping one foot firmly planted on the floor, slowly bring a bent leg up towards you, keeping your knee and hip in line throughout. Lift the leg up as far as you can and hold that top position for a second or two before slowly lowering to just above the floor.
Repeat until you begin to feel fatigue in the area around the front of your hip. Now try the other side and note if there’s a difference between the two.
3. Train your back extensors
Another possibility is that the muscles of your lumbar spine aren’t capable of holding a flexed position for long periods. There’s plenty of research to suggest that people with back pain suffer from wasting of the lumbar spine muscles. This effect has also been shown in cyclists. There’s also a bunch of research to indicate that getting these muscles stronger reduces back pain.
From a performance perspective, a stronger lumber spine will also help you transmit more power down to the pedals. What’s not to like? Less pain and better performance. It’s a win-win! The tricky bit is choosing the right exercise and pitching it at exactly the right level for your current capabilities.
The best results come from isolating the lumbar spine muscles as much as possible, particularly if they’re weak. This reduces the risk of your central nervous system using other muscles to compensate.
Without specialist equipment this is difficult to do, however, as these muscles quickly become dominated by the larger hip extensors. This is why exercises like the back hyperextension and the deadlift don’t always produce the best results.
If you don’t have access to a lumbar extension machine use the following exercise. While it has its limitations, it will provide a valuable starting point.
What we’re trying to do here is isolate the muscles that extend the lumbar spine as much as possible. We’re also looking to have them work through as much of their range as possible.
A Bosu ball will help you do this because it enables you to introduce a little flexion to the lumbar spine. It’s preferable to a Swiss ball because it’s stable and allows you to have your knees bent. This will prevent you from using your hamstrings to assist in the motion.
Position yourself on the ball so your belly button is level with the apex of the dome. Squeeze your stomach muscles as if performing a crunch and slowly curl your abdomen down over the ball. When your stomach muscles can’t take you any further, stop. It’s important not go past this point. If you can’t contract into a position, it’s very difficult to contract out of it without compensating.
Keeping your gluteus maximus (butt muscle) soft, slowly extend your spine as far as it will go. Hold the top position a second or two before squeezing your stomach muscles to come back down again.
Note that changing the position of your arms will alter the challenge. Having them at your side makes the exercise easier. Moving them to the side of your head makes it more difficult. This provides a way to increase the challenge as necessary.
Repeat the exercise until you feel a mild fatigue in the muscles of your lower back.
4. Assess your trunk rotation
To check whether rotation of the spine might also be an issue, use the following range of motion assessment of your trunk (torso). Sit tall on a bench with your feet planted firmly on the ground. Cross your hands loosely over your chest and slowly rotate your trunk to one side. Don’t allow your hips or your pelvis to move. Note how far you went and repeat in the other direction.
If you are limited to one side, that’s an indication you have weakness in the muscles responsible for motion in that direction.
Try the following isometrics (muscle contractions without movement) to improve motion on the restricted side.
Again, sitting tall on a bench, rotate your trunk towards the side you found limited. This time have somebody block you in this position by placing their hand on the front of your shoulder. Gently rotate into their stable hand as if trying to twist further. Hold the contraction for five seconds before returning to the start position. Repeat a further five times and you should start to see your range of motion increase.
Unless you want to swap your road bike for something with a bell and a basket, you need to be able to tolerate a forward-flexed position. The exercises described above are designed to help you achieve that position for longer and with less discomfort.
They’ll also help you improve your performance on the bike. Outstanding.
Paul Argent is a former Category 1 road racing cyclist from the UK. He now runs an injury rehabilitation and sports performance business in the City of London, Human Movement, which specialises in helping chronically injured athletes and weekend warriors alike get back to doing the things they love better than ever.
The article above is an edited version of a piece that first appeared on the Human Movement website.
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