Lower back pain is the most common complaint in cyclists after knee pain. While it can cause time off the bike, many riders continue to cycle / train / race in spite of low back pain.
What causes Facet joint syndrome?
Facet joint pain emanates from stress and strain to the joints that run down on either side of the back at each vertebrae. The pain may come from the joint surfaces themselves, the capsule that surrounds the joint, stress on the underlying bone or the overlying ligaments and nerves that innervate these joints.
The sustained posture required for cycling involves varying degrees of forward bend in the hips, pelvis and lower back. This can progressively have an effect on lower back muscle strength, length, muscle control, and on the soft tissues such as ligaments around the joints.
Previous / childhood back pain
Disc bulge or prolapse
Back muscle weakness
Poor bike fit leading to excessive rotational instability at the pelvis
Rheumatoid Arthritis, Ankylosing Spondylitis
What are the symptoms?
Imaging in the form of MRI or x-ray is often advocated as the gold-standard for diagnosing back-related problems however there is substantial evidence that demonstrates that many suffering with lower back pain have no obvious changes in their imaging that reliably accounts for their symptoms. As such, the term, Non-Specific Low Back Pain (NS-LBP) is often used in these cases.
Pain will often be felt centrally in the low back or just off to one side and often with some radiation of pain into the upper part of the buttock muscles on either or both sides.
Presentations of different types of back pain may exhibit what is known as a ‘directional preference’. In the case of facet joint related pain it is more common to see pain with backward bending, side bending, and rotation movements.
If you have acute low back pain with pain in both legs then please read about Cauda Equina Syndrome.
How can I manage Facet joint syndrome?
Reducing ride duration and intensity while allowing for more recovery time between rides is a sensible first step.
Away from the bike, consider other factors that are currently aggravating your pain - as noted above, movements that involve backward bending and rotation will often be triggers - standing for long periods and lying on your front in bed are common aggravating factors for facet joint pain.
Consider other sports / exercise that you are undertaking and assess how your back feels during of after to decide if this also needs to be avoided or reduced in the short term.
Work related posture and activities must also be addressed, particularly if you have a sedentary / desk based job as the postural adaptations from sitting will be duplicated from cycling and can make things more difficult to resolve.
Seeing a physio for a full screening assessment will allow for any restrictions or imbalances to be identified and work on for your specifically.
Encouraging movement and mobility in the lower back is a key first step to regaining full functional movement.
Stretching exercises may be useful for the gluteal, hamstring and hip flexor muscles if their range of motion is restricted. Be sure not to push stretches into painful or provocative positions. Yoga can be helpful but it is important to move within your comfort tolerance when you are recovering from injury.
Manual therapy techniques such as mobilisation, massage, acupuncture can also be applied to alleviate some of the early pain symptoms.
Building core strength, co-ordination and control is vital - this may be done with some simple exercises or with some well taught pilates programmes.
The deadlift exercise, when done with correct form and appropriately graded weight, is one of the most important exercises in a strength training programme for back pain. There are many different variations that can be used - barbells, dumbbells, kettlebells, olympic-style etc. I tend to favour the Romanian Deadlift, pictured below.
In any lower back pain presentation there is some degree of weakness in the muscles of the lower back, gluteals or core / abdominals. As such, strength training will always form a vital part of any comprehensive rehabilitation strategy, particularly for longer term health, performance and reduction of repeat episodes of back pain.
Saddle height is the primary positional fault in bike set up that can act as a trigger to low back pain. In most cases this will be a saddle that is too high causing instability excessive rotation over the saddle as the feet try to reach the pedals.
A saddle that is placed too far backward will also lead to increased weight and pressure through the lower back and increase the reach needed to get your hands on the bars / controls comfortably.
In severe cases of facet joint pain / inflammation it can cause sciatica from irritating the nerve root beside the joint. In these instances there can be a role for a steroid injection either to the joint or as a caudal epidural. Please see the article on Nerve Root Pain and Sciatica for more information.
What else could it be?
Muscle spasm, referred muscular pain
Referred pain from the sacroiliac joint (SIJ)
Lumbar ligament sprain
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: firstname.lastname@example.org.