Lower Back Pain Issues - UPDATE

Training
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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 (on my own), 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

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Find a bike fitter with a physiotherapy background who can assess the bike and you.

If in the UK ai can recommend Bianca who now works at the Boardman Performance Center.

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If you did a ton of research you may be familiar with these resources already. But if not I’ve found them very helpful.

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I had lower back issues about 15 years ago which stopped me doing triathlon - then I ran for about a decade - now back time trialling and my back is fine - even in my 50’s. The key thing that helped me was CORE exercises - lots of planks, side planks (building up to 5 min planks, and 90s side planks on straight arms and 2:30 on elbows). Also lower back mobility - the old wind screen (shield - in the USA!) wiper knee movement 3 x day and other twists for the lower back. Takes a couple of weeks to work but was like magic for me. I do the core routine 3x week ….but YOU HAVE TO KEEP DOING IT LIKE…FOREVER - if you stop the problems return…good luck :smiley:

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Consistent planks and core work completely changed my climbing performance, especially at the century distances, major muscular lower back pain before. Getting a fit ball was key to this. Really makes the compliance to core sessions better.

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Funnily enough Abi Carver (Yoga15) posted about this very thing earlier today.

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I feel your pain @Gustavo_Cinci. I’ve had back problems off and on for about 30+ years. I would get back aches every now and then, sometimes more painful than others. I’ve had cortisone shots, physical therapy, more physical therapy, muscle relaxers (I don’t recommend these) and massages (which seemed to help the most but only lasted for 3 days) and several chiropracter sessions (wasted my time with these). For me these were all temporary solutions.

A month after I retired (4 1/2 years ago) I was driving while on vacation and after about 5 hours my back began causing me a little discomfort. One hour later I had to pull over as I was in excruciating pain and my wife had to take over for the remainder of the trip.
What a way to start retirement, I was fairly distraught.

After returning back home I saw my doctor. For six months I did a lot of physical therapy which helped somewhat. Also tried a device called a TENS unit which provided electrical stimulation to my lower back area, while at the same time doing PT. The TENS plus PT helped quite a lot with the discomfort but the pain would always come back, but not to the point as while on vacation 7 months previous. Then it started getting worse, to the point where it was excruciating to pick anything up off the floor. And the more it hurt, the more I dropped things on the floor. Funny how that works.

Finally one day it was more than I could take. I emailed my doctor and he scheduled an appointment with a neurologist. I got in the next day. They took a lot of x-rays in various positions. Come to find out I had spinal stenosis (narrowing of the spinal canal and squeezing the spinal cord - about 75% closed) and the L4/L5 disks were sliding back and forth as I leaned forward and backward, so no stability in those verftibrae. Two days later I had my pre-op and three days after that I had surgery to resolve the stenosis (laminectomy) and spinal fusion of the L4/L5 disks complete with 4 screws and 2 connecting rods.

The surgery was more successful than I could have ever imagined. My back feels better today than it has in 30 or 40 years with no pain whatsoever. I couldn’t ride my bike for six months and that the doctor said to start out at just 10 minutes at a time, slowly building up to longer rides. Of course my first ride was about 40 minutes long and I was down for about a week and a half. After that I followed the doctors instructions! I also have a 30# weight limit on lifting things for the rest of my life. This is doable.

Six or seven months after that, so a little over one year since the surgery, I was riding OK but not totally healed. I tried a 75 mile fundraiser ride and had to pull out after 25 miles. A year after that I completed a century ride with no problems, and three or four metric centuries. All in all my full recovery was over a year long. I was 66 when I had the surgery. I’m 70 now and am having no issues at all with my back. Funny thing was that when I was having all my back problems I could ride my road road bike without experiencing any pain, zero. Once I got off the bike though it was another story.

So for me surgery was the answer. But at the level of pain I was experiencing, and nothing else worked, surgery was about all I could do. I’m not recommending surgery though but I would highly recommend seeking out the advice of a doctor and formulating a plan from there. PT, yoga, careful exercise, maybe losing some weight, and carefully watching not to overdue your back may be all that’s required for you to get back to normal.

So this is my story. Hopefully it provided some knowledge and insight into things for you. I sincerely hope your back gets better.

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This might add nothing you haven’t addressed already, but how flexible are your hips? As in pure hip motion, not hip plus low back rounding-out motion. Wonder if that could have stiffened up over the period of time spent not on the bike. Typically one’s back is more than flexible enough to handle simply being on a bike (which is why comments above about core strength are so on-the-money), even in the drops/TT position, and the limiter (if it’s a flexibility issue) is from down south.

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That’s intense. I’m sorry you went through on that. Glad it was helpful.

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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

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My lower-back pain experience had no relation with the bike. Finetuning no longer helped, once it developed. I would have the same pain riding a MTB (XC) as my roadbike or on the hometrainer for that matter. Also no difference between different frame bikes (old 26" MTB vs new 29"). I think that once the pain develops, any such change is just a finetuning and will not address the core issue (pun intended), which is the weak core muscles that you need to work on. In fact, if you mitigate the pain by adjustments, it may give temporary relief, but your core will continue on a declining path and things can get much worse before they get better. Same way that a headache should not be treated with taking meds, but by finding the cause and dealing with that. So I would definitely not focus on the bike.

TL;DR: the solution for my lower back pains was a combination of core exercises, but due to time constraints (esp. when doing a proper TR training plan) and no easy access to a gym, my go-to is the use of a Fit-ball that I sit on ALL DAY when working. The fit-ball is a cheap and passive solution, provided you sit a major part of your day. The issues will never disappear fully though and reemerge within days when not following a routine or using the Fit-ball, but the stronger the core muscles, the lower the chance of issues to reemerge, for years even.

My story and how I learnt from it:

  • 50 now, was a swimmer my whole life and only started cycling+racing (MTB XCM) about 10 years ago, so total change of muscle use. Lack of cardio and leg power at first, improved after some years of riding but came with decrease in balanced muscle tone through the body
  • Neglecting upper body and core caused an imbalance for me in muscle tone mainly, but still no back troubles the first few years. No underlying disc issues or such, though low muscle mobility (below hip)
  • bike fit well before any back issues started. I think a bike fit is the best investment from the start for all bikers to prevent INDUCED pain and for efficient pedalling.
  • Lower back issues started when I changed my XCM races from short (1,5 hr) to medium (2,5-3 hrs) distance: no pain until about 1,5 hours in a race, issues started from there, all the way to losing all power due to pain.
  • Tried the following:
    1a. chiropractor: relief for a few days only, quite expensive
    1b. Physio-therapy: short relief and gave some basics to do at home, but expensive and a qualified core training expert in the gym will get you farther at much lower cost and in a motivating environment. In addition, not all PT’s are doing a good enough job.
  1. Massage: relief for a bit longer and solves some acute issues, but no long term solution and expensive, expertise varies as well.
  2. Stretching: right at the end of a workout, improves mobility but not sure about back pain relief
  3. Foam roller: excellent tool, use it after each workout for about 10 minutes, major difference in mobility, not sure whether it contributed directly to lower back relief though. Highly recommended for improved recovery and best take a course on methodology. A one-day mobility course will set you up with basics and covers more areas of mobility that can prevent other injuries, so worth investing in.
  4. Electro-stimulator (TENS): used it a lot when acute issues, similar relief as PT but no lasting effect.
  5. Core exercises: This was THE solution for me. I thought the gym coach was bragging when she said my pain will be fully gone from day 2, but she was right. If you have a good coach (I had group exercises with all the usual like plank, dead-bug, reversed snow-angel, TRX, etc.) the improvement is better than any other of the above combined. And very fast results. The caveat: you need to keep doing it, no stopping. I did two one-hour sessions a week and that did it for me without overload, next to my 5 weekly cycling workouts. As soon as the gym closed due to the covid measures, within a few weeks my back was giving me a hard time again. So make sure you prepare home-made plans to continue when no access to the gym.
  6. Fit-ball: this is the number two solution and the good thing about it is that you don’t need a gym and no spare time or expended energy that go at the cost of your cycling. You just sit on it and your muscles do the job :slight_smile: . It has some caveats as well though: make sure your posture is the correct one (plenty of vids on this) and it does take effort initially and weeks of getting used to. The first few days are hell and you’ll hardly be able to sit for 20 minutes before it starts hurting. This is a good hurt however: tiring muscles. So you have to increase the time spent on it every day, at your own pace. Before you know it, after some months you are sitting all day on it (if you’re tied to desktop work) and you won’t even feel the effort. Soon enough, your lower back pain is fully gone, as your muscles have been strengthened by this passive exercise.
  7. Swimming: when I can, I hit the pool once a week and this helps as well, probably due to complex core muscle use (freestyle, 3km). Limited pool access due to Covid restrictions had a clearly negative impact on me and this proves how important it is to not only train the very static cycling that creates imbalances, but mix it up with more complex exercises, be it core or swimming or crossfit.
  • I no longer have pain on races or during workouts or through the day. However, a few times a year, when negleting core training or even when sitting on the soft couch for hours to binge-watch a TV-series for example, the pain will reemerge within a few days and dissipate only slowly.

Hope I could add some thoughts and takeaways, good luck! :slight_smile:

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