At the time of writing, the defending Tour de France champion Egan Bernal has just abandoned the race with back pain. I may be twice his age, and barely champion of my own bike shed, but I know how he feels… sort of. Whether it’s a dull ache that sets in towards the end of a ride, the odd twinge getting in and out of the chair at the coffee stop, or a raging sciatica that prevents cycling altogether, many of us have experienced some form of back issue. And the sad truth is, these problems often seem to be brought on – or at least exacerbated – by riding a bike.
You might be frustrated; you might be in pain; but one thing you certainly won’t be is alone. The UK Health & Safety Executive put the number of work days lost to back pain at 2.8 million in 12 months across 2018-19. More seriously, it’s not unreasonable to estimate that the number of bike rides missed runs to seven figures, or at least not far off.
Cyclists seem to get a raw deal in the back pain stakes. A Norwegian study of 116 pro cyclists found low back pain (LBP) to be the most prevalent overuse injury in the group, with 49 cyclists reporting the issue. This was backed up by a study of 111 Swiss national team cyclists, which found one in three had some back pain and poor core strength.
These may be elite riders, but anecdotally most of us know someone who has had to take time off the bike now and then because of LBP. It stands to reason – if young professional sportspeople with multi-million-pound back-up structures are suffering with back pain, what chance do the rest of us stand? Going headbanging on Zwift or at the evening 10 on a regular basis – or even just upping your mileage a bit too far – with no health guidance and especially for riders in their 40s and beyond, seems like a recipe for a pain in the back.
So what’s going on?
“Number one is our lifestyle,” says Dan Boyd, a physiotherapist and bike-fitter at Complete Physio in London (complete-physio.co.uk) as to why backs seem so vulnerable to injury. “Unfortunately, we spend a lot of time at a desk and we weren’t particularly designed to sit at desks, which puts a lot of strain on our thoracic [mid] and lower back. That’s pretty unavoidable for most people, certainly recently.”
The posterior chain – the muscles in your back, bum and the backs of your legs – is king. Unfortunately, these muscles get ‘switched off’ by sitting for long periods. Studies have also shown that fatiguing other muscles in the posterior chain can lead to undesirable movement patterns in the back, and that maintaining a forward-flexed position for too long can compromise the extensor muscles we use to straighten up, and thus spinal stability.
“Number two,” Boyd adds, “is that the back is a crossover point in the body. Pretty much all the forces we have travel through our back, whether it’s rotational or position-based, and also it’s the bit that holds us together.”
It sounds like a recipe for disaster, but Boyd insists: “To be fair, the back is an exceptionally well designed bit of kit, but what we ask of it is probably quite a lot, particularly through cycling… Some of the endurance events people get injured doing are pretty extreme.” As an Ironman triathlete, he speaks from experience.
The blame, Boyd says, lies not so much with our backs, but with our expectations; as the movie line goes, our egos are writing cheques our bodies can’t cash.
“The expectations of cyclists and triathletes, in my experience,” Boyd hesitates trying to find diplomatic words. “The level of normality gets somewhat distorted.”
Some of us need to view our bodies a little more sympathetically.
“Cycling 100 miles is an awful lot to put on your body, but quite normal for a lot of people, particularly nowadays.”
So what if you enjoy riding long distances? If you’re a regular racer, club rider or Audax rider, rides of up to 100 miles are probably part of what you love about bike riding. Thankfully, Boyd says you don’t necessarily have to give these up to preserve back health. Much back pain seems to be preventable given a little attention, both on and off the bike.
My back pain struggle
As a sufferer of ongoing back problems myself, it’s an issue I’ve found myself occupied with a great deal over the last eight years, having been through a number of episodes which have kept me off the bike for several months at a time.
In my case, the culprit is the good old ‘slipped disc’ — more correctly known as a herniated disc. This has caused spasms and led to chronic deep, jangling nerve pain radiating down my leg, rendering riding a no-no. In fact, in the most recent flare-up, which began last summer and is still refusing to settle, even walking was painful and for months, I needed a walking stick just to get from the living room to the kitchen. Painkillers of all kinds layered extravagantly on top of each other and a steroid injection all helped, but only to take the edge off.
I also tried electrical stimulation, courtesy of a device called Mibody, made by British company Nurokor (£99, nurokor.co.uk). A neat little device housed in two small pads applied to the skin, it delivers electrical pulsing patterns designed to be painkilling and therapeutic. I found the sensations – adjustable from an unobtrusive ‘hum’ to a fairly hefty buzz, which I couldn’t tolerate – worked quite well at blocking out the pain, and in the case of my leg, the painkilling effect lasted well. But like all of the above, it was no silver bullet.
Thankfully, most back sufferers won’t experience this sort of discomfort, with muscle aches being relatively straightforward healers, and even troublesome disc and nerve issues often healing in around three months. But back pain, particularly where discs are concerned, is a pretty capricious sparring partner — you really don’t know what you’re going to get.
For example: a 2015 review in the American Journal of Neuroradiology looked at more than 3,000 people of all ages, and found that 30 per cent of 20-year-olds, rising to 84 per cent of 80-year-olds, had some sort of disc bulge – the classic slipped disc, often associated with pain. Yet none of the people in the review had symptoms. So, though attempting to protect yourself from a slipped disc might be futile – seeing as you may well have one already without knowing it – there are some guidelines that will help you stay mobile and back pain-free, which let’s face it, is what matters.
Put in the work off the bike, urges Boyd: “Just hopping on, say, twice a week to do a 50km and 100km ride, is certainly not uncommon among your readers, I’m sure,” he says, “while not putting any work in the gym, or at home, in terms of simple push-ups, planks, any sort of mobility work at all.”
The time commitment does not need to be huge.
“Literally 20 minutes of yoga will do the job. Appreciating the effort you have to put in off the bike to manage those sorts of distances is key.”
And if you’re at all unsure about your set-up, get a bike-fit – or at least do a little research and get some benchmark advice.
“I see a lot of people in pain who want a bike-fit, but bike position is one of the things that can cause back pain just as easily as it can solve it,” Boyd says. “One of the silliest things I see is people riding with their saddle on an upward tilt. That’s frankly bonkers. Then there are other things like not even having a saddle on straight. Honestly — decent-level riders coming in with their saddle on wonky… Over six hours, it’ll have an effect.”
So much for keeping yourself pain-free. But best-laid plans and all that — what do you do if you do find yourself one of the many bike riders troubled by LBP? The NHS UK website states that most back pain is not serious and usually gets better over time, and suggests keeping active, taking ibuprofen if it’s safe for you to do so, and trying hot or cold packs. It adds that if it doesn’t start to improve within a few weeks, stops you from doing day to day things, or is severe, “it’s a good idea to get help.”
Patience is key
A GP can refer you to a physiotherapist or musculoskeletal consultant or, in order to be seen straight away, you can opt to go privately to a physio, chiropractor (not widely endorsed by the NHS) or osteopath. If at this point you are diagnosed with a disc problem, be prepared to make two new friends: patience and light exercise.
“Unfortunately, once we know it’s a disc or a nerve impingement, you’re coming off the bike,” Boyd says, “because they’re very difficult to manage during sport.”
Out with cycling, then, but in with lighter forms of exercise.
“‘Activity modification’ is the phrase used in the literature,” Boyd continues. “Walking certainly is one of the best things you can do for back pain. So keeping active sensibly, I think – basically limiting impact exercise and not putting too much load… usually guided by someone who’s had a look at your scans and whatever pathology you’ve got.”
In my case – at least in this most recent episode – it was regular sessions with a physiotherapist that put me back on track. She helped me mobilise my spine and ironed out some of the tension in my lower back muscles. Things quickly dialled down from ‘very bad’ to simply ‘bad’ on the ‘How messed up is my back-o-meter’, which I was eternally grateful for. (It’s worth adding that in the past I have had good results with both a chiropractor and an osteopath).
Two steps forward, one step back
It was around this point, after nearly four months off the bike, that I first turned the pedals again: six minutes on Zwift averaging 85 watts. But it was a start. Six weeks later, I was up to an hour outside, but that proved a bridge too far and necessitated a further month off the bike.
As Boyd says: “It’s about expectation alteration. When someone’s expectation is not aligned with the underlying physiology [of the issue], that’s where it goes wrong.”
Thankfully, more small steps, more physio, daily stretching and a good
deal of core work saw me reach the 60-mile benchmark this month, and painkillers are a thing of the past, bar the occasional paracetamol.
The last key healer in the equation has undoubtedly been time. Sadly, without going under the knife (and even that is no guarantee), nerve and disc issues like sciatica require patience. I’m still waiting for it to resolve itself completely, but as it’s still improving, I’m confident that one day I’ll be pain-free. Now, if you’ll excuse me, I have some core exercises to do.
There are many different types of back pain but the headlines are ‘muscles’ and ‘discs’.
Muscles suffer as a result of poor posture and a weak core, and combined with going a bit too far or hard on the bike – or even lifting something too heavy – is a recipe for a strain. A strain can cause painful spasms, your body’s way of ‘freezing’ your back to stop you doing any more damage, and can take weeks to heal. The good news, as Boyd says, is that exercise and movement can help the healing process.
Discs issues, as we have seen, are extremely common – though many such cases involve no pain, and the effects are difficult to predict. The classic cause of pain is a damaged disc that bulges outwards from the spinal column (a so-called slipped disc) and impedes the sciatic nerve, resulting in pain, often down the leg, that can vary from mild to severe. Disc issues can also cause spasming.
One last brief, but important, point that will be among the first raised by any medical practitioner – if your back pain is accompanied by any bladder or bowel issues, do not delay but go straight to hospital. Impeded nerves in this area are a medical emergency and, without urgent care, can leave the sufferer with permanent damage.
One rider who knows all about the frustrations of a disc injury is Team GB trackie Kian Emadi. Originally a sprinter, Emadi was lifting weights in the gym when the injury came on in 2014.
“It was a herniated disc, which I got from deadlifting in the gym,” says the 28-year-old from Stoke. He was able to get back into training after a couple of months, but: “I just kept having recurring issues related to that.”
By late 2015, Emadi realised that being selected for the sprint events at Rio the following August was going to be a big ask. “I decided I couldn’t really couldn’t really continue training hard enough to hope to make the Olympics, so I decided to give endurance a go.”
Moving away from the heavy gym work required as a sprinter showed that a bad back doesn’t need to be catastrophic — and that sometimes a change of focus can help: Emadi helped the team pursuiters to two World Cup golds and a rainbow jersey in 2018. Unfortunately last summer Emadi’s back issues returned; after suffering more and more on the bike, he eventually had to take a month out, but was able to return to ride the individual pursuit in November’s Track World Cup.
As anyone with ongoing back issues will want to do, Emadi, with the help of specialists, eventually established what sorts of treatment and exercises helped most in keeping him mobile and pain-free.
“The thing we find works for me is leaving the lower back alone and just working on keeping the hip muscles loose,” he explains. “Plus a bit of massage in the upper back, and it keeps both sides of things around the lower back loose.”
As to what caused the original issue, it wasn’t due to deadlifting per se. “I wasn’t moving properly and there’d been issues that had been niggling for a while, and the deadlift set those off,” Emadi says. “But I think if you’re lifting with good form and good control, the gym can be a great way to strengthen your back.” Off-bike work, provided it’s done with correct technique, is an effective preventative measure.
“The bike is good for training your legs, but puts hardly any load on your core and back, so anything you can do in the gym to give you some balance is useful.”
For any readers who do find themselves suffering with a back issue, Emadi advises our old friend patience: “Just be patient. It can take time. And when you are getting back into it, remember you can’t get back straight away. It takes a bit of patience just to build back up.”
This feature originally appeared in the print edition of Cycling Weekly, on sale in newsagents and supermarkets, priced £3.25.