Lower back pain is one of the most common complaint amongst cyclists. Pain emanating from the lumbar discs can occur due to the prolonged periods spent in a forward flexed position leading to pain across the lower back and often into the buttocks on either side.
What causes disc-related back pain?
There are varying degrees to which a disc in your lower back can become aggravated and painful. There does not necessarily need to be structural damage to the disc to cause pain and indeed there can often be disc bulges or herniation that produce little or no pain.
In a disc bulge there is stress or even small tears in the outer layers of the disc which can cause an inflammatory response and swelling (as you would experience if you sprained ligaments in your ankle).
In a disc prolapse or herniation the central contents of the disc push outwards through the outer layers of the disc. This can occur from a single forceful loading or more progressively over time.
In simple terms each disc consists of tough fibrous connective tissue (like ligaments) that wrap around in layers (annulus fibrosis) to a more fluid or gel-like centre (nucleus pulposus). The image below describes these key components.
Risk Factors
Previous back pain, back pain in childhood
Back muscle weakness
Poor bike fit
Significant changes in riding volume, especially if involving more uphill climbs
What are the symptoms?
Pain or limitation when bending forwards.
Pain in the centre of the lower back that can radiate out to either side or into the buttocks on either or both sides.
Struggling to reach down and take shoes or socks on / off or picking things up off the floor.
Having difficulty either getting into your usual riding position or not being able to reach down to the drops
It is common to have more pain and stiffness in the lower back first thing in the morning but this should ease over 20-30 minutes with some simple mobility exercises.
If you have acute low back pain with pain in both legs then please read about Cauda Equina Syndrome.
How can I manage Bulging disc?
Activity Modification
As noted above it tends to be forward bending (lumbar flexion) movements that irritate disc-related problems the most. So, where possible, minimise or avoid bending tasks in the short term.
Avoid sitting for prolonged periods of time, e.g at work. Try to take regular breaks to get up from your desk or sitting position. Ensure you sit back into your chair so the lower back is supported by the chair back. In addition a small cushion in the lower back may help to reduce the discomfort in sitting.
As is the case with most injuries, there is almost always a necessity, and benefit, to reducing your current ride volume and intensity.
Physiotherapy
In early more acute stages of low back pain it is vital to work on restoring movement with mobility exercises.
Once initial pain subsides it is important to work on challenging the core muscles, including the abdominals, obliques, back extensors, and gluteals.
Attention must then be paid to strengthening the global prime movement muscles with bigger more functional exercises such as squats, deadlifts, lunges etc.
Muscle spasm and tightness is common in those with lumbar disc injuries. This is mainly focused on the spinal extensors, quadratus lumborum, and gluteals. Sports massage can help significantly in easing this tension but it is best avoided in the most acute stages as it can often make matters worse.
Joint mobilisation and other manual therapy techniques can also be useful in the acute stages of low back pain.
There are a number of sports taping interventions that can be extremely helpful in acute stages of lower back pain to alleviate symptoms, allow muscle to relax and permit greater capacity to complete basic mobility exercises which in turn can expedite healing.
Bike Fit
As noted above, the forward bending motion is the main challenge for someone with disc related low back pain so the aim is to minimise this bending and distribute the weight more evenly so there is less strain on the back.
Long reach and a low drop to the handlebars will both contribute to increased loading on the lower back. Attempts to raise the front end and perhaps finding a shorter stem can be a useful short term measure.
If you have had recurrent episodes of lower back pain then it is paramount to have a full review of your bike fit and ideally combine this with a full physical screening assessment.
Acupuncture
Although no longer supported by the UK low back pain management guidelines (NICE) as a ‘best evidence-based practice’ treatment, acupuncture can still be safely used as an adjunct to a comprehensive rehabilitation programme.
Injection Therapy
In severe cases of unremitting disc related back pain there is good evidence to support the effects of a caudal epidural spinal injection of corticosteroid. Again, in the UK, this is no longer supported by the best practice guidelines but that is not to say that in some cases it might be helpful when other therapies or management are failing to assist.
Surgery
This is somewhat beyond the scope of this article but suffice to say that the greatest body of evidence supports that non-surgical means of managing back pain should be the mainstay and front line of all treatment. Microdiscectomy surgery does demonstrate good outcomes and return to activity in those where all other prior therapy has failed.
What else could it be?
Lumbar facet joint pain
Lumbar ligament sprain
Muscular spasm / referred pain
Referred pain from Sacroiliac joint (SIJ)
If you are having issues with your lower back and want to get in touch about booking a consultation or a bike fit then please email us: info@thebikethebody.com.