Lower back pain in cyclists: causes, cures, and preventatives

It’s arguably the most common injury in road cycling. But thanks to one of the world’s leading physiotherapists and bike-fitters, this could be the year that lower-back pain is a thing of the past…

You’re riding along, mentally high-fiving yourself that, in your mind’s eye, your pedalling technique resembles that of track-nurtured-road-flourished Elisa Balsamo and your new over-priced polyester top effortlessly conceals the curves cotton tops cannot reach, when yakety yak, there goes your back. Again. Your chances of progress are once again deflated and you haven’t even had a puncture.

“The incidence of lower back pain in cycling is hard to quantify because not all lower back pain is reported and it’s hard to disseminate sometimes between cause and effect; in other words, is cycling causing the pain or is something else, like working in front of a computer for 10 hours a day? That’s the real reason for the injury but it manifests itself more painfully when cycling.” 

That’s Bianca Broadbent, top physiotherapist and bike-fitter who’s worked with both recreational cyclists and the world’s elite, including Team Jayco-Alula’s Lawson Craddock, when asked how common lower back pain is in the global cycling peloton. Broadbent’s a scientist and not prone to hyperbole. She’s the very definition of a pragmatist. But after mulling over a library’s worth of studies in her head, she settles on a figure. “Around 19%,” she says. “That’s been reported as how many cyclists suffer, or have suffered, from back pain.”

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One in five of us creaking our way through a ride – if the pain’s bearable, of course – is nothing to be sniffed at. But that’s nothing compared to the professionals, for whom a Norwegian study reported out of 116 elites, 49 had at some point reported lower back pain. That’s 42%. It begs the question, what are the main causes of lower back pain in cyclists and how can you prevent it in the first place (or at least reduce your chances of enduring time off the bike)? But first things first, it sounds an obvious one but what exactly is lower back pain? 

Muscular roots… or maybe neural

“As you’d expect, it’s generally a muscular issue,” says Broadbent. “It’s the same with your legs – overload them and the muscles will really hurt, which can sometimes tip over into injury. However, it’s also possible to endure neurological pain. Sometimes the position you’ve adopted causes pressure on certain structures and, as a result, the back suffers as a secondary structure. For instance, you might have nerve pain from the buttocks that’s causing lower back pain or it could be nerve pain radiating up from your legs.”

“Multi-faceted” is one of Broadbent’s favourite word when talking about lower back pain, both when it comes to the physiological and the biomechanical, namely what are its root causes when it comes to on-the bike angles? “One of the key hypotheses is a high drop,” she explains. “In other words, you might have too a low bar position. In turn, that increases lumbar flexion and sacral tilt [akin to pelvic tilt].” That cranks up the stress in your lower back and you endure pain. 

“Another hypothesis [pragmatist Broadbent loves this word, too] is that the rider’s at the extreme end of their flexibility and the load is too much. It’s like if you fell asleep on a plane. Your neck falls to one side and, when you wake, it hurts because it’s just not used to this position.”

“And a further key reason behind lower back pain could be the saddle angle where the saddle’s titled up,” Broadbent continues. “Again, this comes back to the hypothesis of increasing lumber flexion. The shape of the saddle can also play a part, as will saddle height. If it’s too high, you’ll have too much motion on the saddle, which can cause lower back problems. Ultimately, this all comes down to the one common denominator that you’re asking your lower back to do too much.”

Seek out a professional

Saddle position, too low a handlebar set-up… all of this is pointing at heading to a professional bike-fitter to assess your experience, flexibility, strength, injury history and riding goals with the aim of not only making you a more efficient cyclist but also a more bulletproofed one. This is good for your body but might be less so for your ego as an overly aggressive position for your riding ability is common. But reeling it in – in other words, perhaps a higher bar position and shorter stem – could pay huge dividends.  

At a professional bike-fit, beyond the biomechanical assessment of how your limbs sit within the bike, they’ll examine the saddle itself. This opens a can of worms as the correct saddle for you is such an individual choice. Broadbent mentions that Specialized’s Power saddle range has flown off the shelves and is a very good unisex saddle, while I’ve had discussions in the past with bike-fitter Phil Burt, who used to work with Team Sky and now runs a clinic within the shadows of Manchester City’s Etihad Stadium. “A good starting point to finding the right saddle for you is by measuring the sit bones to give you an idea of pelvis width,” he said. “You can do this by sitting on a piece of paper and identifying pressure points.” Broadly, men’s sit bone width ranges between 100mm and 140mm, while women’s range between 110mm and 150mm. Saddle manufacturers will cater for this, albeit that’s a very broad brush.

“Unfortunately, this is very much a starting point,” he continued. “Take women. They might have wider hips and wider pressure points but it doesn’t mean they need a wider saddle. They might be more comfortable with a cut-out saddle so they can comfortably park their bits in the gap.” He also suggested that saddle discomfort and its potential lower back repercussions could actually be down to bike-short choice and the chamois pad – “whether it moves with you or works against you” – rather than the saddle itself. It’s complicated. So get a bike fit.

Too long a crank’s another potential irritant to the lower back as, come the 12 o’clock position, your knee and hip become too squeezed, which can send pain shooting down the kinetic chain. A shorter crank will open up both your hips and knee angle, and ease the burden on your lower back.

Harder, faster… injured

“You should also be aware of how your back reacts to changes in intensity,” Broadbent explains. “You should look at a study in the journal ‘Sports Biomechanics’…”

I do. It’s entitled Effect of incremental intensities on the spinal morphology and core muscle activation in competitive cyclists. The catchy headline and research was delivered by a group of Spanish scientists, who analysed the impact of increasing intensity on spinal posture and the eight core muscles of 12 competitive cyclists. The conclusions were hardly surprising for any of you who’ve wrestled with the likes of Hardknott Pass or Porlock Hill: “A significant increase in muscle activation was observed in all core muscles” with the rectus abdominis (for those of you lucky to possess one, this is the top layer referred to in some cyclists as a “six-pack”!) Also, “as the intensity of cycling increased, cyclists significantly increased the thoracic and lumbar-spine flexion”.

In short, when you’re riding harder, you’re not only putting your heart, lungs and leg muscles under greater strain, but your lower back, too. The authors don’t suggest never riding hard but it’s something to keep an eye on, as it could help a bike-fitter identify the cause if it becomes a real issue. 

Ride or rest?

Which brings up the question of when it’s safe to ride through the lower back pain or spend a spell on the saddle sidelines. “If the pain’s solely on the bike, then see a good physiotherapist and/or bike-fitter,” says Broadbent. “If you have a problem off the bike as well as on it, you should see your GP who’ll refer you to a suitable professional. If it reaches the stage where you’re losing control of your bowels and your bladder, that’s considered a medical emergency and you’re advised to go to A&E immediately. Again, it’s so important to differentiate between what’s an on-bike issue and an off-bike issue.”

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If it’s an on-bike issue, beyond the bike fit and potentially new saddle, you’ll be helped by off-the-bike work. Greater core strength and increased flexibility make you a more robust cyclist so regimented gym and stretching work are recommended. Yoga and pilates are two must-dos and, especially as the years roll by, arguably it’s better to sacrifice a ride or two for these off-bike essentials. They’re also particularly beneficial for riders who’ve come from team sports, where the twisting, turning nature of sports like football and rugby can lead to asymmetry on the bike and, again, potential lower back issues.

So, there you have it. Having a professional assess you as a rider and your position on a bike is advised whether you’re injured or not but, clearly if you’re suffering, it’ll have health benefits over purely performance. You might need a new saddle, and even a new bike if yours is far too large or small for you. So, there might be expenditure. But ultimately, with 19% of riders either suffering or having suffered form lower back pain, it would be money well-spent. 

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