Lower Back Pain - Question

[ghammer]

Context: after many years of on-and-off activity (post kid years, that is), last year I was able to revamp my riding. Specifically, by mid to late summer I was lucky to be able to ride during lunch, plus the wife working from home 2-3x a week made things a lot easier to get out. Plus, the kids are getting older so riding more has become possible. When I say "more", it's still not like back in racing days but better than many years' past. We're talking an average of 4-6hrs a week for years, then ramping to 7-10hrs a week starting in August - a big jump. As reference, I'm a former middle of the pack cat 3 racer for many years (since teens, am 46 now).

By late last year I started having issues with my back, specifically the lower back, of course. I did a ton of research and the area is the Thoracolumbar Fascia. It got very bad, so I went to see a chiro (mistake #1). The chiro *did* make me feel a bit better, but in retrospect I should have looked for a bike fit, then a PT if needed. So there's mistake #2 and #3.

In the meantime I kept exercising, lifting weights, and resumed riding in January after 40 days off the bike (but still lifting carefully, focusing on good form, leaning on the hips rather than legs, taking care of the core, etc).

Now here's the deal: I *never* ever had back troubles. I do have degenerative disc disease of C5 and C6 (courtesy of genetics), but I have it under control so it doesn't bother me. I take care of it with exercises and stretches. I also had a bad case of IT band tendinitis, which prompted me to be careful and smart about stretching and lifting in the off season. Never had it again.

So after a couple of stupidly worthless months of chiro, things are still not better. I learned a handful of excellent lower back stretches, and they help tremendously. Plus I have been exercising regularly so I'm not horribly out of shape. But it might be time to revisit the bike position before I go after the services of a PT. As I remember the last time I had a bike fit was probably 7 years ago or so, on a different bike.

Question: Should I spring for a bike fit, and if doesn't work, do PT? I already address my lower back with core and specific stretches.

Has anyone gone through lower back issues and would care to share outcomes/treatments, etc? I know those issues can be unique from person to person. I'm in good health, lean(ish), and have been working out to address the issues.

Any feedback is welcome.

Thanks,

G

[MattTuck]

Fitters are not shamans that have access to dark secrets. I've had good fits and bad fits -- from well regarded fitters.

Also, fitters are expensive.

You mention back stretches, but you don't mention back strengthening exercises. That would be my first box, if the cost of a fit is a concern.

Look up the books by Dr. Stuart McGill, one of them is geared toward lay people and one is more for professionals. I think the "Back MEchanic" is the one for lay people, but don't quote me on it.

If the cost of a fit is not a concern, then I'd do that also just to make sure you're in the right ball park.

[weaponsgrade]

Your situation sounds really similar to mine. About two months ago my lower back was killing me. Doc confirmed no herniated disc. It looked like I might've torn a muscle. I got a referral to a general PT. Haven't been able to schedule an appt since the PT hasn't been returning my messages. Guess business is good. Since then I've been doing some light stretches and core work and taking time off the bike. I also switched to a standup desk. The back is getting better. I can still feel something in my lower back, but I'm back on the bike. There's a PT I've heard of who specializes in both PT and bike fit. My brother (who also bikes) had to get back surgery a few years ago to fix a herniated disc. The first PT he was referred to for rehab was more of a generalist. He didn't feel he was getting anywhere with that one so he ended up at Revolutions In Fitness. What he liked about that place is that they specialized in bike fit and PT. It wasn't a bike shop with a fit service off to the side. He said it helped a lot and I'll probably be making an appointment there myself.

[chunkylover53]

I’ve had lower back issues, now mostly managed through stretching and other exercises. So, in general, things are very good. I’d actually start by going to a physical therapist. If good (talk to cycling friends for a rec), they can give you a sense of what is going on with your body. I think it would be useful having that knowledge in hand before you see a bike fitter (which is a good idea too). I just think (and there are exceptions, of course), that a therapist will have a better sense of how your particular body works compared to a bike fitter (some of whom, some, really only know what they’ve been taught during a day or two training session).

But as others have said, continue with stretching and strengthening (McGill’s big three exercises - side plank etc). Do a lot of work to open up your hips and psoas muscle (you’ll find plenty of good stretches on YouTube). I find that cycling really tightens my hips, so I do a lot of those types of stretches (and a fair bit of Brazilian jiu jitsu, which works the hips a ton).

[robt57]

Balance your core, and stretch those hammies. For me my back goes crazy achy when tight hamstrings interfere with pelvic tilt. After I lost a bunch of weight and lowered my stacks back to 5 years ago, I feel what higher bars have done.

On a 50+ milers I do 2-3 stretch stops and it helps a lot. Not quite eliminated yet, but it is getting better and better as my posture is reclaiming the body angles while pushing watts.

Maybe you are experiencing similar.

[Ed-B]

Just want to reinforce what has been said about keeping your hip flexors (psoas) stretched. That's a muscle that also pulls on your lower back and can cause problems for me, personally. Of course the whole posterior chain (glutes, hamstrings, calf muscles) needs stretching, but hip flexors are easily overlooked, especially cyclists.

[verbs4us]

About a month ago I had a fitting at the Hospital for Special Surgery in NYC, with Happy Freedman. It combined the two things you mentioned: it began with an evaluation by a PT to determine asymmetries, strength and flexibility from neck to toes. Then Happy measured me and the bike and put me on the trainer. He determined most of my knee and hamstring strain was related to poor bike posture. Mainly what I needed to do was unlearn 40 years of bad habits and practice the good habits. So far, he has been right. The PT gave me a custom program mainly of strength exercises and some stretches. If I were retired, I would have time to do them all I one session, so I rotate through them in the course of a week. Biggest surprise: Rolling quads, hamstrings and glutes had a big positive effect on hip and low back pain. Happy moved the saddle aft about a 1/2 cm and that recruited more glutes, which unloaded the quads and hamstring, helping the strain.

[Ti Designs]

Fitters are not shamans that have access to dark secrets.

I have access to lots of dark secrets, mostly about the bike industry...


Also, fitters are expensive.

Lawyers are expensive, plumbers are expensive, porn stars are really expensive if you win an election. A good bike fitter is a bargain.


Your location says Boston - I've heard of it. As a bike fitter I've never put someone on a trainer and gotten the feeling that I'm seeing the whole picture. I would much rather see someone on their bike on the road before I started making changes. Getting me out on my bike isn't very hard.

[Peter P.]

Under what conditions does the pain occur?
Hard efforts only, or all the time?
Long rides? Short rides? Hills?
Does it matter whether you're riding the drops or the tops?

Have you changed bikes? Are trying to emulate the "new generation" slammed stem setup that's in style now?

[choke]

https://yoga15.com/article/pain-relief/yoga-for-back-pain-sequence/

https://www.youtube.com/watch?v=ok-OupCTyK4

[seanile]

Balance your core, and stretch those hammies. For me my back goes crazy achy when tight hamstrings interfere with pelvic tilt.
This!

[Clancy]

I’ve had 4 back surgeries with the end result a 4 level fusion starting at L5-S1. Over the past 20 years I’ve learned a lot, unfortunately most of it the hard way. Today I have chronic pain but am able to do the everyday activities that I want and enjoy, I ride my bike and usually without too much pain.

Here’s my suggestions. First, check out this article from NPR about the Spine Boot Camp that’s run at the New England Medical Center. In the article there’s a link to a YouTube video showing the boot camp.

Next, since you’re in the area and if it’s possible, go there. I discovered this video long after my surgeries. Had I found it before, I would have flown to Boston and gone through their program.

Last, I’d think about putting off a bike fit until you get your back straightened out. We develop compensation patterns when dealing with physical issues. These compensation patterns cause our bodies to become twisted and out of alignment. My right shoulder was 2 inches lower than my left due to how I had twisted my body over the years. Took a lot of PT to get me truly upright and straightened out. Doing a bike fit before getting a good assessment might not only be a waste of money but might cause more issues.

LINK

https://www.npr.org/sections/health-shots/2014/01/13/255457090/pain-in-the-back-exercise-may-help-you-learn-not-to-feel-it

[TiminVA]

As someone else above said, my lower back issues have been caused by tight hamstrings. I have to make sure that's a major part of my stretching routine.

[MattTuck]

Lawyers are expensive, plumbers are expensive, porn stars are really expensive if you win an election. A good bike fitter is a bargain.

Your location says Boston - I've heard of it. As a bike fitter I've never put someone on a trainer and gotten the feeling that I'm seeing the whole picture. I would much rather see someone on their bike on the road before I started making changes. Getting me out on my bike isn't very hard.

Ed is right on here. And I would certainly give him a try if you can. I'd say it is a minority of fitters that actually want to ride with you and see you on a bike out on the road. Finding a good one is the tricky part. And since you pay the money up front, and don't fully experience their results until well after the fit, it is putting your faith in that person.

That said, and my comment about them being expensive wasn't just the cash for the fit. It is the time with them, almost always they want to sell you additional stuff, a new stem, a new post, new foot beds, etc. Then, the cost of 4-6 weeks on the bike as you adapt to the new position.

If you have the cash, and just want to get a sanity check, do it. But, if you are a little hesitant on the investment, I'd try some exercise targetted at the problem first. THEN, do the fit.

As someone else above said, my lower back issues have been caused by tight hamstrings. I have to make sure that's a major part of my stretching routine.

It is worth noting that in many cases tight hamstrings are associated with weak glutes. Stretching hip flexors and hamstrings only does so much if the biggest muscle in your body has forgotten how to work because of our sedentary jobs.

[temeyone]

Yoga has helped me a ton with this, specifically poses that open up the hips and flexors. Pigeon pose has been the one single thing that really opened up my eyes to what a difference yoga could make. Seriously, give it a try.

[zap]

edit


By late last year I started having issues with my back, specifically the lower back, of course. I did a ton of research and the area is the Thoracolumbar Fascia. It got very bad, so I went to see a chiro (mistake #1). The chiro *did* make me feel a bit better, but in retrospect I should have looked for a bike fit, then a PT if needed. So there's mistake #2 and #3.
G

What is the professional diagnosis? Have any imaging of the lower back done?

Chiro can be very good. Bad ones can be bad......I know. Much depends on diagnosis, preadjustment process (if any is needed-I need it) and then a chiro who knows what the hell they are doing. Many don't.

But remember, an adjustment is just that, an adjustment. It will not correct any underlying issues so......

PT is good.

Good bike fit is important.

Get up/out of the chair/sofa.

I have lower back issues. If I keep riding my bikes my back is pain free. Long and low bike position for me. High (hbar) and short (all showroom production bikes) are madpainful. I also stretch to open the hips and use a hard foam ball to loosen up muscles.

[Dired]

Do you have access to a swimming pool? I suffer from herniated discs and swimming a few times a week has been life changing.

[semdoug]

Do yourself a favor, get a diagnosis from a specialist with expertise in back sports related issues and injuries.

[mtechnica]

just want to reinforce what has been said about keeping your hip flexors (psoas) stretched. That's a muscle that also pulls on your lower back and can cause problems for me, personally. Of course the whole posterior chain (glutes, hamstrings, calf muscles) needs stretching, but hip flexors are easily overlooked, especially cyclists.

+1

[ERK55]

edit

I have lower back issues. If I keep riding my bikes my back is pain free. Long and low bike position for me. High (hbar) and short (all showroom production bikes) are madpainful. I also stretch to open the hips and use a hard foam ball to loosen up muscles..

I’m a bit confused. Wouldn’t a “long and low” position do the opposite, eg narrow the hip angle instead of open it up....after all your upper body is flexed more forward/down (?).
FWIW my own experience is the opposite. The more drop and stretch, the more I’m going to pay dearly later with back pain and sciatic symtoms.

[zap]

.

I’m a bit confused. Wouldn’t a “long and low” position do the opposite, eg narrow the hip angle instead of open it up....after all your upper body is flexed more forward/down (?).
FWIW my own experience is the opposite. The more drop and stretch, the more I’m going to pay dearly later with back pain and sciatic symtoms.

For my condition I need to open up my lower back. Hip angle is not a concern......other than maximizing performance. Plus I have a broken tailbone but thankfully my pelvic tilt is such that it is not a problem on the bike. Actually, shortly after I broke the tailbone the only way I could sit down was when I was riding my bike.....

Sciatica, yes you want to open up the hip angle. Good cycling buddy suffered from sciatica and that's what he ended up doing.

[bitpuddle]

About a month ago I had a fitting at the Hospital for Special Surgery in NYC, with Happy Freedman. .

This is the way to do it, if you are able. They have a serious, science-driven program.

[robt57]

"open up my lower back. Hip angle is not a concern."


Errr, very connected things... In my minds eye, tilted back pelvis = not open back, just saying.

Ignore if you mean that for you it is not a concern I suppose. ;)

Or ignore for general purposes. :rolleyes:

[ghammer]

To everyone who has contributed to this topic, a HUGE thank you. I used a variety of suggestions and can gladly say that I’m 99% better. I did a good 80km ride on Saturday and had zero issues, and that was my 5th day of riding in a row. That being said, I have not let up the consistent stretching and core exercises.

One thing that caught my attention is in regards to frame materials. I have 2 road bikes that are set up identically: a Caad 10 and a Supersix. They have the same geometry and position set up, yet when i ride the Caad 10 my lower back feels tortured. Last week out of desperation i flipped the stem, had the handlebars higher than on my Supersix, yet the lower back complained vociferously. Also, on the Supersix i have just put latex tubes and vittoria tires at 75lbs (28mm tires on 23mm wide wheels), and what was already a forgiving ride became a magic carpet of deliciousness, hence/probably the healthy back.

Would it be that both materials affect our physiology in such impactful manners? I ordered latex tubes to put on the Caad 10’s wheels. Am very curious and would like to know if others out there have had similar experiences.

thanks,

Gus

[zap]

Ride never had an impact on my lower back issue. Heck, one bike that I really enjoy has an unpadded carbon saddle. For me and my condition lower longer is most important.

Everyone is different and you are obviously working it through and finding success so keep at it.

[mac.]

FWIW, my roommate just got an inversion table and it's done wonders for his lower back. But his pain wasn't necessarily cycling related.