It’s an uncomfortable truth that lower back pain is common among cyclists. But are we really more prone to back issues than people who do other sports and activities? And if so, is it caused directly by our position on the bike, being leant over to varying degrees, or other less obvious factors? In other words, how can we separate the truths from the presumptions, the researched facts from the pseudo-science-spun myths? In doing so, maybe at least some of us can avoid falling victim to back pain in the first place.
My interest in this topic piqued very suddenly one Sunday morning a few weeks ago when, having dipped into a squat in my home gym, I began to push up and… Aaargh! A paroxysm of pain shot through my torso with such intensity that instinct took over and hurled me onto the adjacent sofa as the dumbbells hitherto at my shoulders clattered to the floor. For a few hours, I wasn’t sure what to do: my back was completely seized and any significant movement, e.g. getting up, felt not just too painful but literally impossible. I’m in serious trouble here, was all I could think.
I called 111 but couldn’t get through, so eventually – having satisfied myself that I had no sinister symptoms such as loss of feeling – I very tentatively hauled myself to my feet. A few agonising steps later, I prostrated myself on my bed and lay motionless, fearing the next spasm. For the next few days, I could neither stand nor walk unsupported. Getting around meant a snail’s pace shuffle using my office chair like a Zimmer frame. I even needed to be propped up to go for a pee; ‘humiliating’ barely covers it.
While I was flat on my back distracting myself on Instagram as I tried to get comfortable, I stumbled upon a series of video posts by the sports physio Adam Meakins entitled ‘My Back Injury’. It turned out Meakins had injured his back, like me, in the gym just a couple of weeks earlier. Not only had he caught the moment on video but had thereafter posted daily updates detailing his rehab and recovery, drawing on his many years of clinical experience and knowledge of the science. For me, the series became a hugely reassuring and informative resource that genuinely helped me a) stop panicking and b) take sensible, evidence-based measures to help my back recover.
Though my mobility remained pitifully compromised for about a week and I doubted I would ever be able to cycle or run again, after three weeks I was pain-free, almost fully recovered and back to my usual activities. Given the initial agony, it was an astoundingly fast recovery. So many of my assumptions and fears about my back pain had proved false – many of them nipped in the bud by Meakins – that I was determined to arrange a call with the man himself, firstly to say thanks, and secondly, to further prise apart the myths and misunderstandings.
David Bradford: Many people assume that cycling causes back pain. Is there any truth in that?
Adam Meakins: An objective way to approach this is by looking at documented injury risk prevalence figures. Cycling is near the bottom of the table, with just three to five injuries per 1,000 hours. Bear in mind, most of those injuries are caused by falling off, suggesting that the riding itself is very low-risk.
That said, obviously being in a cycling position means you are bent over with sustained periods of spinal flexion – positions believed to be associated with back pain. But again, this relationship is not well supported. In fact, a 2019 study on high-volume road cyclists showed only beneficial adaptations to discs and psoas muscles, compared to a group of non-cyclists.
Of course cyclists do have episodes of back pain, but not at higher rates than in other sports that don’t involve spinal flexion such as running. Think of it like this: back pain is as common as headache, affecting most people from time to time, often for no apparent reason.
SECOND OPINION: Dr Graham Theobald (thebodyrehab.co.uk)
On cycling and back pain: Being a bike-fitter as well as a clinician, I do think that as health professionals we could do much better in assessing and advising on cycling position. We don’t think twice about asking runners about their footwear and training load, but when it comes to cyclists with back pain, I hear too often of clinicians not even asking about bike set-up. Again, following some simple principles around position and the demands on the lower back can help considerably.
DB: Like you, I hurt my back in the gym. My first thought was that my poor squatting form was to blame – that I’d caused the injury through carelessness. How likely is that?
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