Biking and Low Back Pain

Should I ride my damn bike if I am experiencing low back pain?

The answer to that is that it depends on the type of back injury that your are experiencing and if the injury is acute or chronic.

Regardless of the low back structures (muscle, ligament, disc, or facet) that may be injured, most low back injuries have a decrease in pain with lumbar flexion or lumbar extension. This directional preference is used by many therapists to guide a low back rehabilitation program and should be used to determine if cycling will aggravate your injury. This strategy of treatment has shown to be more effective than nondirectional treatment or general exercise for low back pain with radicular symptoms and non-radicular pain. ^1,2,3,

Applying Low Back Directional Preference to Cycling

When you are riding your bike your lumbar spine is in position of flexion. This is due to the hip flexion associated with being seated and leaning forward to grasp the handle bars.

I highly recommend cycling as a form of cardiovascular and therapeutic exercise if your low back pain has direction bias of lumbar flexion.

“An example of lumbar flexion would be bending forward at the hips. If you are able to do so without provoking your low back pain, your directional preference would be classified as lumbar flexion and biking would be a suitable form of exercise.”

Low back injuries that will most likely benefit from lumbar flexion during cycling.

• Facet syndrome
• Spondylolisthesis
• Lumbar instability
• Lumbar stenosis

Lumbar Extension Directional Preference and Cycling

You can determine if your low back pain has an extension bias by lying on your stomach and pressing upwards onto your forearms. If this postion decreases symptoms your low back pain would be classified as an extension bias.

An extension bias is typically caused by a lumbar disc herniation. A lumbar disc herniation is where the nucleolus pulpsosus, the inner jelly like core, is not contained by the annulus fibrosis and compresses the corresponding nerve root. When this nerve root is compressed, it produces pain that travels down the leg and produces muscles weakness.

Unfortunately for cyclists, if your low back injury is due to a disc herniation and your directional preference is extension, cycling may worsen your symptoms. This is due to the disc compression and lumbar flexion associated with the activity. While seated as you bend forward to reach for your handle bars, the size of the disc herniation increases and as a result increases the pressure on the nerve root.

Like most people who are passionate about a sport or activity, it may be damn impossible to convince them to stop. Here are some tips to get you back on your bike if your low back pain has an extension bias.

Tips To Get You Back On Your Damn Bike

• Take a short break from biking and see a chiropractor or physiotherapist
  • The research has show that your recovery time is decreased and your resilience to injury increases after seeing a movement professional.
• Try standing instead of sitting while biking
  • If you are standing while biking, you are putting yourself in a cycling position of lumbar extension rather than lumbar flexion.
• Raise the height of your handle bars so that you can ride in a more upright postion.
• Avoid using aggressive road bikes that have you hunched forward while riding.
• Do not ride with your bike seat too low.

“I also recommend that you find a local bike fitter who has experience fitting bikes for low back pain. If they don’t have experience, simply just ask for a bike set up that would postion you more upright.”

References

1. Audrey, L, Donelson, R, and Fung, T. Does it matter which exercise? A randomized control trial of exercise for low back pain. Spine 29 (23): 2593-2602, 2004.
2. Austin N, Difrancesco LM, and Herzog W: microstructural damage in atrial tissue exposed to repeated tensile strains. J Manipulative Physiol Ther 33 (1): 14-19, 2010.
3. Surkitt, LD, et al: Efficacy of directional preference management for low back pain: a systematic review. Phys Ther 92(5): 652 – 665, 2012.