Preventing back pain caused by cycling

CyclingHere are some top tips to prevent back and neck pain caused by cycling. How you position yourself, how you set your bike up for you and even what clothing and equipment you use can have a massive impact.

When most of us begin cycling – either just to work, on odd weekends or as a pleasurable sport – we are largely under the impression that the hardest aspect is building up our fitness to a level that is sufficient to cycle to the top of the notorious local steep hill (or just to make it to our destination without collapsing from an angina attack). However there is a lot more to the cycling than just having balance enough to stay on or a steely determination to keep pedalling.


Bike set up to prevent back and neck pain

The most important aspect which needs to be sorted out before you even begin, and is a must for any type of bike and any number of hours spent on it; the set up.

Whether you have a road bike or a mountain bike it should be set up so that it fits you, not the other way around. As with a pair of shoes one size does not fit all and your gender as well as your whole body measurements will affect your set up. Why bother to get it right? Because not doing will undoubtedly lead to poor performance as well as opening you up to the risk of all manner of possible injuries and aches, especially back pain.

Even those who train religiously on their bike to a high standard are exposed to back pain. A study looking at a group of Japanese tri-athletes found that the most common complaint was back pain and of all three disciplines, cycling was the highest causative risk factor (1.). In fact one article even found that anything from 30-70% of cyclists suffered with some kind of back pain. In the study they found that even just by angling the saddle it reduced back pain in more than 70% of participants (2.)

Once you have ensured that your bike is actually roughly the right size for you the best plan is to then take it to a reputable bike shop which offers a check service and get them to assess and measure the two of you. But in the meantime here is a general overview, broken down to make it more user-friendly.

1. Picking the right bike.

Deciding if a bike is right for you is not as easy as meeting someone on a dating site and reading that they have a GSOH, or noticing that they have kind eyes’ as you would with a horse, or even going to see them with their mum and the rest of the litter. Bike shops will usually take one look at you and bring you out bikes that are suited to your height and build, but if you are a little unsure the easiest way is to check the bike frame against your height and the length of the crank (the metal part attached to the pedal) against your leg. Standing astride the bike there should be a 2 inch distance between the cross tube and your groin with a road bike, or 3 inch distance with a mountain bike. There are exact figures but as a rule of thumb the crank should measure approximately 20% of the length of your inside leg (3.).

2. Handlebars.

The distance from the seat to the handlebar stem and the height of the handlebars should allow you to ride in a relaxed position through the upper body without adopting tension through the neck and shoulders. Handlebars are often lowered when racing to favour aerodynamics but unless you are heading out of the shop and straight to the local time trial it is wise to always be sensible with these things. Excessively lowered bars can cause flexion or rounding of the thoracic spine, more stress through the shoulders and onto the wrists, and therefore leave you needing to raise the head up higher to avoid riding into obstacles, putting undue stress on your lower neck region and giving you tension through the neck and shoulders. Never a great combination.

So the best position is to bring the handlebars down so that when sitting on the bike and resting on them you reach a position of 40-60 degrees flexed from sitting up straight.

A good rule of thumb is to stand beside the bike and place your elbow against the tip of the saddle. Your fingertips should be approximately 70mm short of reaching the handlebars. Any more and you will struggle to reach the bars, causing you to lock your arms out and overstretch (4).

When looking from the side at a pedal position of 3 o’clock the front of the kneecap should line up with the middle of the pedal. If not move the saddle forwards or backwards, raise or lower it and alter the position of your shoe cleat (if using them).

3. Saddle type, height and angle.

The saddle itself is important and should feel comfortable. Just like a mattress there are different sizes and styles with different degrees of cushioning and it is important to decide which you prefer. As a rule, women will require wider seats as their pelvis is wider than men’s but generally most people favour one with additional gel for cushioning. But try out a few.

Ideally the saddle should not be angled unless you are experienced and racing as tilting it down at the front will only drive your weight forwards onto the handlebars and shoulders. This posture can help with increasing the lordosis in your lumbar spine and so reduce back pain in some cyclists but unless you are conditioned to this increase in force it will create all sorts of problems through the shoulders. And of course tilting it backwards only causes you to round through the lower back and flex more at the hips, increasing the pressure in the area and reducing the power generated at the hip flexors for pedalling, which doesn’t benefit anyone.
The height of the saddle is critical and one of the key causes of injuries if not assessed correctly. A seat too high will strain your lower back and hamstrings. Too low and you are likely to round your back, overwork your quadriceps muscles and strain your knees. The seat post that is moved to raise and lower the saddle will come in different lengths so it is worth checking that yours can accommodate the correct saddle height without stressing the frame. The easiest way to check the height for you is to sit on the bike against a wall, holding onto the wall for balance. Letting your legs hang free you should find that your feet can sit in the pedals with only the slightest bend in the knees. If you find that you rock when you later ride out then you are likely to have your seat a little too high so it needs to be lowered (5).

With the foot at 6 o’clock the knee should be bent around 30-35 degrees. If it is not then the height of the seat needs to be changed.

4. Brakes.

These should be easily reached with the fingers when the hands are on the handles in a cycling position. The wrist should not flex in any way.

5. Accessories.

Aside from the obvious helmet it is hopefully pretty transparent that avoiding riding with heavy bags on your back or even dangling from the handlebars can save you twisting forces through your spine or heavy loading around your neck and shoulder region so it is wise to invest in panniers fitted to your bike on either side of the back wheel. It may not look cool but it will save you aches and pains.

6. Cleats.

Not adopted by all who ride a bike, these little devices screw onto the sole of cycling shoes and allow you to clip onto the pedals of your bike, allowing greater control of the bike as well as power deliverance through the legs and pedals. It also reduces all those problems of friction between the shoe and pedal and of course twisting at the ankle joint due to the foot sliding around. To release your foot you simply turn it with some downward pressure onto the pedal and your foot is released. These do require experience on the bike however, as they take a degree of getting used to. No longer can the foot simply lift off from the pedal and initially this can result in falls and injuries (I have a great deal of painful experiences myself!) and so this can cause a number of injuries itself unless care is taken. Not to mention that they must be aligned correctly so as not to cause strain to the inner or outer knee and hip and as they are sprung loaded, if this is not set correctly for the rider it can stress the ankle joint.

References

1. Manninen, J.S., & Kallinen, M. (1996). Low back pain and other overuse injuries in a group of Japanese tri-athletes. British Journal of Sports Medicine. Vol.30. pp.134-9.

2. Salai, M., Brosh, T., Blankstein, A., Oran, A., & Chechik, A. (1999). Effect of changing the saddle angle on the incidence of low back pain in recreational bicyclists. British Journal of Sports Medicine. Vol.33. pp.398-400.

3. Whiteley, A. (2009). Basic bike set-up: 5 tips to set up your bike so as to avoid injury. www.physiobench.com

4. Beer, J. Technique: How to set up your bike.www.bikeradar.com.

5. How to set up a mountain bike. www.snowbikers.com/articles/mtb_setup.html

6. Usabiaga, J; Crespo, R; Iza, I; Aramendi, J; Terrados, N; & Poza, J.J (1997). Adaptation of the Lumbar Spine to Different Positions in Bicycle Racing. Spine. Vol.22. No.17. pp.1965-9.


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