Healthy Cycling: Preventing Back Injury

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Over recent years, there has been significant growth in cycling as a hobby and sport.  Inevitably, this has resulted in increased injuries, including back and neck pain issues. BackCare, the national charity for supporting people in managing and avoiding back and neck pain, is keen to raise awareness of the many factors that contribute to the frequency and severity of cyclists’ injuries as it has been estimated that between 30-70 percent of cyclists will get back pain when carrying out the activity.  Many of these injuries can be prevented with careful management, which can contribute to ensuring that cyclists have an enjoyable and healthy experience whether or not they are taking the sport up on a competitive basis or as a leisure activity.

Back pain from cycling can be caused by a number of issues such as a poor riding position; the wrong size or type of bike; wrongly positioned handle bars or saddle; weak muscles; prolonged cycling; or riding rough terrain. 

The simplest of things can have a large impact on performance levels and avoiding injuries.  The factors that contribute to both injury and the effects of over-training can be body type or size, the use of inappropriate equipment or a combination of both. Within the cycling population, big sprinters experience very different complaints compared with small hill climbers purely due to their body type, hereditary conditions and the type of discipline-specific training they undertake.  On the other hand, poor equipment choice will have an impact on back or neck pain.  For example, we commonly see very small female cyclists using frame sizes designed for much larger people, with some extremely detrimental results not only regarding injury level, but also on performance.

There are a number of simple measures that can be taken to avoid injuries from cycling through education and in respect of the more complex and long-standing issues, interventions from professional experts, such as physiotherapists, osteopaths and chiropractors are desirable. 

Pedalling technique can be a significant factor in the development of the most common cycling injuries. The motion of the pedal stroke needs to look and sound smooth and continuous. When the cyclist tries to create an up-stroke this can become injurious.  The use of cleats on the pedals will aid proprioception, stopping the foot falling off the pedal. The up-stroke phase of pedalling will bring the psoas and hamstring muscles into play, while in a less-than-optimal length-tension ratio, creating the effect of destabilising the pelvis, reducing the rider’s ability to efficiently produce power.

On Bike Posture’, showing the need for the cyclist to disassociate their hips to generate leg power.

While cycling, a sustained, flexed posture can lead to mechanical low back pain.  Many cyclists are prone to this as the position places pressure on the front of the spinal discs and keeps posterior sacral ligaments in a lengthened position. It has been shown that adjusting the inclination of the seat as an anterior tilt of between 10 and 15 degrees reduces low back pain in cyclists.  Changes to the set up of bikes, along with advice from professional practitioners to identify early signs of low back pain, can help manage this condition.  The adoption of pre-habilitation and post-habilitation plans developed by your physiotherapist, osteopath or chiropractor can be effective in preventing mechanical low back pain becoming an acute or chronic issue.  Furthermore, practitioners can advise on how to develop a pedal stroke that is more gluteal dominant during the drive phase, which leads to better performance and injury prevention than the more common ‘hamstring drag’ pedal stroke.

A number of cyclists tend to develop pain on the outside aspect of their knee around the knee cap and over the joint line.  This is caused by a friction effect of the iliotibial band (a strong connective tissue) rubbing the bursal structures (small fluid-filled sacs) that sit between the iliotibial band and the bone. The pain is the result of the knee being at the wrong angle.  The knee needs to be positioned with no less than 30 degrees of knee flexion at bottom dead centre (pedal position). It is important to measure your joint position and adjust your seat height and cleat position to ensure the correct angle. Most riders find it comfortable to have their cleat rotated to a natural toe-out position, normally with their heel just clipping the crank on each pedal stroke.

Mid-back and shoulder pain can result from cycling.  Postural fatigue through the thoracic (mid-back) region arises as a consequence of the ‘on-bike’ posture of the shoulder and hips being at 90 degrees in relation to the trunk. Sustaining this posture requires both flexibility and stability as in order for cyclists to produce power in this position they are required to be able to dissociate their hips while maintaining a stable core through pelvis and trunk.  Again, your professional practitioner can advise on core stability training and strengthening exercises to prevent neck and mid-back pain, while helping to maximise performance by producing a strong trunk to drive the hips from:

Gluteal strengthening to ease low back pain and to enhance cycling performance.

Scapula setting and mid-back strengthening

Stretching exercises performed between three and five times a week can help prevent or reverse injuries from cycling.

Piriformis:

Start in a press up position, and then pass one leg diagonally

underneath you. Rest your weight down onto your elbows and down through the knee under your stomach, trying to get as flat to the floor as you can. You should feel the stretch deep inside

the gluteal region of your bent leg. Hold this for 30 seconds

and repeat three times.

Hamstrings:

It is possible to stretch your hamstrings in several positions, but seated will allow you to progress to standing positions, as cyclist’s hamstrings are generally shortened due to riding postures.

Sitting on the floor, keep one leg straight (which will be stretched) and bend the other up to your chest (for stability). Keeping the knee of your straight leg locked out reach as far down your shin towards your toes as you can and hold for 30 seconds. Repeat three times.

Lumber Spine Rolls:

It is important to stretch your lower back to minimise the mechanical lower back pain brought about through cycling postures.

Laying flat on your back, bring one leg over by rotating your hips, while keeping your shoulders flat on the floor. Pull this leg towards your shoulder with your arm and hold the stretch for 30 seconds, repeating this three times on each leg.

Iliotibial Band (ITB):

Maintaining the length of the ITB can help reduce the friction around the knee while cycling.

Stand with your weight on one leg, while passing the other leg behind and across your midline. With the same arm take it above and over your head. Hold the stretch for 30 seconds and repeat three times on each side.

There are a number of activation exercises you can do before training or a race situation to reduce the risk of injury and increase performance. These will produce increased blood flow and flexibility leading to more efficient muscle activity.

Gluteals:

Kneeling on all fours, push heel up towards the ceiling, keeping your hips square and your back flat, pausing for three seconds at the top of the movement. Slowly lower your knee back to the ground and repeat the movement. Perform this 10 times on each leg.

Hamstrings:

Laying on your front, dynamically flick your leg from one side over the other, lifting your foot towards the opposite shoulder. Return your leg to the starting position and repeat the movement with the other leg. Complete 10 repetitions on each leg.

Laying with your back flat on the floor, keep one leg straight, and have a partner hold the other at 45 degrees. Gently push your heel into your partner’s hands with ten percent of your strength, while your partner pushes it away from them, back towards your head. Once your leg has been pushed away, use your hamstrings and glutes to ‘throw’ it back into your partner’s hands. Repeat 10 times on each leg

Quads:

Sit into a half squat position with your elbows in line with your ribs. Keeping your elbows still, pull your shoulder blades back and together. Hold for five seconds and repeat 10 times.

In order to avoid injury, every effort should be made to ensure that you do not over-train.  There is a fine balance between training to elicit a physiological response, and overstressing metabolic and skeletal systems.  Overtraining is not confined to physiological responses – it is also an emotional and behavioural condition that occurs when the volume of exercise an athlete undertakes exceeds their capacity to recover.

Overtraining is the umbrella term used to describe negative responses within the body leading to a plateau or decrease in performance, that often results in some physiological manifestation.  From a soft tissue viewpoint, repetitive micro trauma within a musculo-tendinous unit without appropriate rest can lead to more pronounced muscle trauma and damage.  At a cellular level, prolonged maladaptive exercise can lead to raised cortisol levels which have been shown to decrease wound healing and immune responses. Amino acid [building blocks of protein] uptake can also be affected, with both protein synthesis and energy production decreased.  Psychological effects of overtraining can include decreased sleep, depression, low mood and loss of appetite.

To avoid overtraining you need to ensure you incorporate regular rest days and recovery weeks into your schedule, and keep a close eye on diet – with your calorie intake matching or exceeding your daily energy usage [including resting metabolic rate, training and daily activities] depending on your training goals.

For further advice and information join as a member of BackCare: www.backcare.org.uk , info@backcare.org.uk

or telephone: 020 8977 5474.

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