Bikes and low back pain

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

Click here: Second Opinion Arthritis Treatment Kit

Low back pain is a common problem for cyclists.

The back is often a source of pain for cyclists. This is because cyclists have strong leg muscles but don’t have the core muscle strength to counteract the forces which the legs generate.

Forces directed against the pedals also are transmitted up into the core. If the core is weak, the repetitive pistoning of the legs eventually takes a toll. This leads to overwork and muscle spasm in the low back.

Here are a few tips from David LaPorte, U. of Minn. (

It's been estimated that about 80% of low back pain arises because of poor posture. Posture problems occur when we stand but are even more significant when we sit or ride a bike. We tend to round up our low backs, stressing the ligaments and tendons which lie along the spine. It is the irritation and inflammation of these ligaments and tendons which leads to most low back problems.

Posture. It is important to remember that back pain results from the sum total of ALL the stresses your back experiences. Even if you only experience pain when you're riding, poor riding posture may not be your only problem. For example, you may be sitting poorly at a desk all day or lifting boxes poorly. Since posture is the problem, it is also the solution. Those of us who suffer from low back pain need to be constantly vigilant. We need to maintain some arch in our backs as much as possible.

Sitting. is a particular problem. Most chairs, coaches, car seats, etc. provide little low back support. You can buy low-back support pads at some drug stores. Try them before you buy them because they are not all comfortable. Alternatively, you can fold a towel and put it behind your low back. The key is to maintain some arch without being uncomfortable.

Position on the bike is also important. Get your bike fit checked at a shop that you trust. You should also work on maintaining a flat back when riding. One way to achieve this is to push your belly button toward the top tube. Try to do this by rotating your hips rather than by contracting your low back muscles.

(Caution: The following should only be done after checking with your physician or physical therapist)...

Stretching. Stretching is an important way to achieve flexibility and improve your posture. A very useful stretch is to place you hands on you butt and push your hips forward while standing. You should feel this in the front of your hips. Tight hip flexors prevent an upright posture.

After a few seconds, arch your back and slide your hands down the back of your thighs. This movement puts the arch in you low back. You can do this stretch many times a day. It is particularly useful to do it periodically when you have to sit or ride for an extended period of time.

A more potent stretch that can be done a couple of times a day starts with you lying prone. Using your arms, push your shoulders off the floor. Don't lift with your back. Keep your low back as relaxed as possible. Let your hips hang down, staying as close to the floor as possible. This is a powerful stretch and should be started gradually. Done properly, it can be enormously helpful. Over a period of weeks, you should gradually increase the height you achieve and the time you hold the position. It is also less stressful to do this stretch for short periods with a little rest than for a long period (for example, 3 X 10 sec with 5 sec rest rather than for 30 sec straight).

Once your back starts to heal, you will probably need to stretch it deliberately. This is apparently because of the scar tissue that built up during healing. Keep it gentle, especially at first. You could easily re-injure your back. Here's a good one: lie on your back with your legs straight. Pull your knees up, grasp your thighs by your hamstrings and gently pull your knees to your chest.

Stretching the ham strings can also help relieve low back pain. Tight ham strings tend to pull the pelvis out of line. This can stress your low back. The problem with most ham string stretches is that they also tend to stretch the low back by forcing it to round up. The most appropriate stretch I know requires the use of a doorway. Lie in the doorway with your butt near the wall. Gently slide your foot up the wall until you feel the stretch. Two ways to make the stretch more gentle are (1) bend the lower leg, keeping only your foot on the floor or (2) move your butt further away from the wall. To make the stretch more intense, loop a cord or towel over your raised foot and gently pull it away from the wall. As with all stretches, this shouldn't hurt.

Exercises. Another key to preventing low back pain is to keep your abdominal muscles strong. These muscles help support the back. Do abdominal crunchers, not sit ups. Sit ups emphasize the hip flexors, not the abs, and can be hard on the back. Crunchers are done by lying on your back with your knees bent. Press your low back into the floor and curl your head and shoulders off the floor. Hold for a couple of seconds, then lower back to the floor. Repeat until you can't get your shoulder blades off the floor. Abs can be worked every day.

Strengthening the low back muscles can also be helpful. To start, lie on your front with your arms and legs extended in a straight line with your body. Raise your right arm and left leg. Put them down and raise your left arm and right leg. Put them down and continue. As your back strength improves, try raising both arms and legs at the same time, arching your back in a "reverse stomach crunch". There are, of course, more powerful back exercises, but they are also more stressful and shouldn't be considered until your back is 110%.

Further tips:

Improper fit of the bike, such as handlebars too low or too far forward (or saddle either too far back or too far forward) contribute to back problems. The “aero” position is known for its ability to apply extra stress to the low back and neck. Too much intensity too soon in the training cycle, or hill climbing in the “aero” position, may lead to low back pain.

Sometimes light aerobic exercise can be helpful. Examples are walking, riding a stationary bicycle, and swimming. These aerobic activities help blood flow to the back and promote healing.

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