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Low back pain and bike setup

Old 03-30-17, 01:08 PM
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Low back pain and bike setup

At 51, I never thought I'd be posting this question but here goes. I was recently diagnosed with "severe stenosis" in my lower back at L4/L5 including minor bulging of two disks and nerve impingement resulting in sciatica (pain into the legs). I have played hard, riden hard and lifted heavy for many years and I guess it's catching up to me much sooner than expected.

I am still lifting weights but have changed many of the exercises to ones that aren't stressing the back as much or are done seated. I still like/want to ride and most of my bikes have been set up with a little longer stem for more agressive position because, as mentioned above, I like to ride hard. The last time out was just a moderate ride but the low back muscles went into enough spasms that I was pretty uncomfortable for three days.

Obviously, my bike set up is going to need to change (more upright) as well as my riding style. Riding on the indoor trainer has not been a problem so far but I don't want to limit my riding to that.

For those dealing with similar low back issues, what have you done to work through a bike setup that works? Stems are one area to address, what else?
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Old 03-30-17, 01:14 PM
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The Forward Lean on a road bike increased my core strength and worked fine for me.
Setting up straight Never worked for me.
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Old 03-30-17, 01:25 PM
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I have a mild scoliosis and a young adulthood of likewise playing hard and long time working on my feet have given me a troublesome back. I get back spasms pretty regularly on longer rides, but that has really been an issue for me for years. I haven't altered my bike setup that much except maybe raise my stem some and on my bikes with threadless stems, flip it to get more rise. That being said I'm often just as comfortable riding in the drops as on the top. I have developed a preference for shallower drop bars however.

I manage the back issue by popping 600 or 800 mg Motrin before a longer ride, stopping every hour or so to stretch out the back. There's an old adage that low back pain means tired legs and that makes sense to me as the main hip flexors are anchored in your lumbar spine. So simply getting in better riding condition might help. A good back stretch and exercise regimen is helpful also i.e. crunches, leg extensions, yoga stretches.
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Old 03-30-17, 01:33 PM
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I've gone through a couple periods with severe back pain, and the only relief I got was with laying on my back and raising my knees towards my chest. Thinking of how that relief position might apply to riding, it would mean allowing your knees to be brought further up (more bend in the knees at full stretch), so possibly lowering the seat a bit to get a little more bend in your knees might help. I know that if I stand straight up for long periods of time without bending my back, like walking around in a shopping center or at a flea market, my back tends to seize up. The same applies to my riding, so a more vertical position is much more painful for me. I almost never ride in the drops (by the way, I'm 62), and I've found that riding on the hoods is my comfort position.

Try lowering the saddle a tad, and riding less in the drops.
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Old 03-30-17, 01:38 PM
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Originally Posted by jj1091
I've gone through a couple periods with severe back pain, and the only relief I got was with laying on my back and raising my knees towards my chest. Thinking of how that relief position might apply to riding, it would mean allowing your knees to be brought further up (more bend in the knees at full stretch), so possibly lowering the seat a bit to get a little more bend in your knees might help. I know that if I stand straight up for long periods of time without bending my back, like walking around in a shopping center or at a flea market, my back tends to seize up. The same applies to my riding, so a more vertical position is much more painful for me. I almost never ride in the drops (by the way, I'm 62), and I've found that riding on the hoods is my comfort position.

Try lowering the saddle a tad, and riding less in the drops.
Thanks - I ride the hoods most of the time. Never get comfortable for longer periods in the drops unless it's a downhill or I'm drafting someone. I may try lowering the saddle a little - it's fine line there since I've had 3 knee surgeries too.
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Old 03-30-17, 01:44 PM
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I've got reduced flexibility in my lower back since ages(and I'm younger than you).
There really was no other cure for long rides and tolerably discomfort than going for a considerably shorter stem.
I've got good/excessive mobility higher up my back, so overall aero hasn't changed much.
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Old 03-30-17, 01:45 PM
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- it's fine line there since I've had 3 knee surgeries too.
Yeah, getting older requires a fine line. My "pushing myself" these days means pushing myself to accept more and more middle-of-the-road compromises.
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Old 03-30-17, 01:46 PM
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Sitting more upright can contribute to back pain because your weight is shifted rearward and put on your spine.
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Old 03-30-17, 01:55 PM
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When I first built up the Litespeed with a little extra drop than I was used to, it took a few hundred miles to really get used to it. Now it is fine.

So, if you've been off of the bike for a while, or making changes, don't give up immediately. As mentioned above, the roadie posture may help strengthen the back, especially if you don't put too much weight on the hands.

I've had chronic low back pain for as long as I can remember (especially morning stiffness). What has really helped it, oddly enough, is sleeping in a lazy-boy chair.
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Old 03-30-17, 02:15 PM
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Originally Posted by CliffordK

I've had chronic low back pain for as long as I can remember (especially morning stiffness). What has really helped it, oddly enough, is sleeping in a lazy-boy chair.
Funny you mention that, most days I wake up pretty stiff between 2 and 4 am and walk over to my shop, get situated in my old wing back recliner and go back to sleep for a few hours.
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Old 03-30-17, 02:16 PM
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I had a bulging disk injury, L4 to L5, about 20 years ago. Since then, I periodically get related lower back pain and/or pain/tightness down through my right thigh. I've only had 3 or 4 really bad incidents with back spasms since. I also lift, with varying degrees of interest. Since the injury, I've gone to doing circuit training with lower weights and being especially cautious with my ergonomics. When I do re-injure my back, it's usually doing something minor like picking up a dropped pencil from the floor.

I've done nothing with changing my riding setup, without any issue. However, I've always been more accustomed to riding the top of the bar or hoods. I actually find riding to be therapeutic for my back and seem to have issues during the periods when I'm not riding (like over the winter).

To echo jj1091, stretching the hamstrings and glutes is very helpful to me. In particular I try to do these before bed and in the morning.

This one stretches the muscles straight back.



This one stretches the outside area of the muscles, out towards the hip, and helps me when I get sciatic pain radiating to the hip.



This one is like the reverse of standing and touching your toes, but it is great for isolating the glutes and hams. I usually use a 2" leather belt to pull on.



Same stretch with help is even more effective. Either way you do it, try to keep the knee locked straight.



Additionally, when I'm in the shower I'll stretch by trying to touch my toes, with my knees locked, and hold that position with the hot water hitting my lower back.

There are other stretches you can research online as well. Finally, when you're picking something up, or bending over for some reason, ALWAYS bend your knees so your lower back doesn't bear all the strain of that motion.
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Old 03-30-17, 02:26 PM
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I've had back problems for about 15 years(L5-S1 disk). A neurologist even suggested surgery. When I told him "NO". His reply was: "You'll be back". Stretching, stretching, stretching. It works. I've had no surgery and can ride pretty much all day with no pain. I still get stiffness after the ride, but it's not bad.

Edit: And don't sleep on your stomach.

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Old 03-30-17, 02:29 PM
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Subbed. I need help, too!

Nothing to suggest as I've not found any solutions for my similar issue. PT is on the horizon, tho (Monday), so fingers crossed

Hopefully you find something that works, too, Scott!

DD
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Old 03-30-17, 02:36 PM
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Originally Posted by Drillium Dude
Subbed. I need help, too!

Nothing to suggest as I've not found any solutions for my similar issue. PT is on the horizon, tho (Monday), so fingers crossed

Hopefully you find something that works, too, Scott!

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When I first injured my back, my doctor prescribed several weeks of PT which consisted of:
1. Rubbing the lower back area.
2. Heat therapy.
3. TENS stimulation.
4. The above stretches.

and...

drumroll...

5. Riding a stationary bicycle.
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Old 03-30-17, 02:55 PM
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All the suggestions here are good. Another very helpful thing is to walk. Walking can loosen you up in a good way. Having a dog has improved my health, and we don't even walk that much. She's a greyhound, and greyhounds need less walking than any other breed.
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Old 03-30-17, 03:16 PM
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I have L4/5 trouble as well, mainly manifest as sciatica. I feel it a lot in the right glute and hamstring. If I try to push too big a gear that can set it off. If I am riding and it gets bad, a couple minutes off the bike walking around generally takes care of it.
I have also gone to a shorter stem and shallow drop bar. Where I used to have a slammed 100mm stem and Cinelli 66 bars, I now have an 80mm stem at full extension and Nitto Randos. The difference is considerable.
You might also check around the >50 subforum. Probably lots of back discussion there.
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Old 03-30-17, 05:40 PM
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Originally Posted by scozim
At 51, I never thought I'd be posting this question but here goes. I was recently diagnosed with "severe stenosis" in my lower back at L4/L5 including minor bulging of two disks and nerve impingement resulting in sciatica (pain into the legs). I have played hard, riden hard and lifted heavy for many years and I guess it's catching up to me much sooner than expected.

I am still lifting weights but have changed many of the exercises to ones that aren't stressing the back as much or are done seated. I still like/want to ride and most of my bikes have been set up with a little longer stem for more agressive position because, as mentioned above, I like to ride hard. The last time out was just a moderate ride but the low back muscles went into enough spasms that I was pretty uncomfortable for three days.

Obviously, my bike set up is going to need to change (more upright) as well as my riding style. Riding on the indoor trainer has not been a problem so far but I don't want to limit my riding to that.

For those dealing with similar low back issues, what have you done to work through a bike setup that works? Stems are one area to address, what else?
I had a L5-S1 fusion in 2014 and decided to start riding again because walking was just not cuttin' it for me due to permanent spinal cord damage. I had to start out upright just to relearn how not to fall over. I have now gone back to drop bars and for me it was just a matter of a taller quill stem that I can slide up or down as necessary for my progress. If your bike fit is dialed in regards to everything else you should be fine. All previous is good advice regarding PT, conditioning, flexibility etc.
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Old 03-30-17, 06:14 PM
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Old 03-30-17, 06:40 PM
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I cracked 3 lower vertebrae sledding with my kids in 2008. I was misdiagnosed by a "country" hospital and did not get the correct diagnosis until 3 weeks later. Lots of pain. Everything started healing in that time and I was told by an orthopedic surgeon that surgery was a greater risk than letting it heal "as is" and working with it as best I could. I will be 50 this year.

It became apparent to me pretty quickly that I needed to start some kind of regular exercise program. It had to be one that would allow me to progress at a pace that would not re-injure the area. My mobility was diminishing and the pain was increasing.

I took a chance on a hot yoga class out of desperation. At first, it was really strange to me. That said, it was challenging enough that it kept my interest but I could progress at a pace that I did not re-injure myself.

Regular attendance allowed me to build flexibility, core strength and stamina. Now about 5 years in, I go once a week to yoga and do weight work outs with kettle bells, push ups, planking etc. to maintain core strength. Yoga got me back in the game.

I don't think the yoga was "magic". I just think it gave me something to work at on a regular basis and it was and still is challenging. You compete with yourself. Kind of like randonneuring.

Bars level with saddle for me:

[IMG][/IMG]

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Old 03-30-17, 06:42 PM
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I'm right there with you BG. Here is my most comfortable set up.
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Old 03-30-17, 06:54 PM
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Sit ups. Lots of sit ups. Proper ones. Strengthen the back and stomach using machines , not free weights. No wallet in your rear pocket, ever. I herniated those discs long ago in life. You learn to sit right, proper shoes, proper standing positions. Some bikes just hurt. Road Vibration. I had an Aluminum Trek that just plain killed me. My Cannondale, with big tires seems fine.
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Old 03-31-17, 12:42 AM
  #22  
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A few additional thoughts.

For "normal" body parts, a little stress isn't bad. Stress is what tells the body it needs to change to get stronger. If you have pathology, that may change the equation somewhat, but you still don't want to ignore strength.

I wear a backpack a lot for errands and commuting. It is handy. But, a pannier setup might be a bit more back friendly, especially with awkward loads.

Slow cadence (mashing) also puts strain on the back muscles, whether that is good or bad is up to the person.

Wiggling, and changing positions while riding (standing, sitting, bar tops, drops, hoods), flexing the back up and down, is all probably good for the back.
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Old 03-31-17, 05:24 AM
  #23  
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I am hesitant to post this but.... My advice, for what it's worth? Don't accept advice on what therapies to do from folks on a forum. Saddle and bars set up? Yes. Lower back therapies? No.
In my opinion, the first step is finding out just which nerves are affected. Most insurance companies don't want to pay for it, and doctors knows this. But MRI's and/or CAT scans are probably called for , if you haven't had one yet.
And a visit(s) to a specialist. Insist on it.
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Old 03-31-17, 05:26 AM
  #24  
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Originally Posted by Vintage_Cyclist
.......I've gone to doing circuit training with lower weights and being especially cautious with my ergonomics. When I do re-injure my back, it's usually doing something minor like picking up a dropped pencil from the floor.
I've had lower back pain for about 50 years now (from yard work in my early teens) and had real bad sciatica a few years ago. I'll +1 the stretches that VC showed in his post - all worked well for me on my sciatica, though regular cycling really banished it for me. I still need to be careful picking up pencils.....

I do a workout routine through the winter. The rest of the year yard work is adequate. The winter routine starts with around 45 minutes on either the stationary or the rollers then a combination of stretching and dumb bells, though only 10lbs each and much care about how that is done. My skinny body gave up on strength building ages ago so I'm now just focused on flexibility, core strength and conditioning. My routine is a cycle of about 20 exercises, three sets. Real boring. Tunes help.

As to cycling, I'm convinced that it has been the greatest contributor to my minimal back pain and the elimination of my sciatica issue. As others have said, good core strength, flexible hamstrings and the basic pedaling benefit to the nerves tracking through the butt and down the legs. My bars are an inch or so lower than my saddles and I actually spend quite a bit of time in the drops. When I'm on my stationary trainer I'm always in the drops. I've said before - "I ride the drops so I can when I need to". This recent winter is an example: several rides straight into a 20mph headwind where I was able to stay in the drops for an hour.

One tip that has not been mentioned but has been helpful for me - I've developed the habit of ALWAYS standing up off the saddle when I approach an intersection, watching for traffic, even track standing the bike. I find that those few moments of straightening my back is very helpful and, I assume, any drivers that see me will see me better. I started this when I had much back trouble and have kept it up.

I'm now going on 66 yrs and am in the best shape I've been in in decades. Good luck finding your solution.

Edit: I agree with Rootboy, sound medical advice is best. I first went to my GP then a PT. I'm only passing on what has been beneficial to me and those things I eased carefully into, testing to see what helped vs hurt. We each need to find a unique solution.

Last edited by Prowler; 03-31-17 at 05:30 AM. Reason: added perspective
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Old 03-31-17, 05:35 AM
  #25  
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Sco, sorry to hear of your back troubles. You are not alone.

Of course what works for one person may not be right for another because no two of us are exactly alike. So I always take advice with a grain or two of salt. Or a grain of Ibuprofen if necessary. Nevertheless I'll toss in my two cents.

I'm 68. I have moderate scoliosis, inherited. Decades ago I was told it might be a problem one day. Also apparently developing stenosis. My doctor says I'm 2" shorter than I used to be. (And my thick black hair turned silver and then transparent, but that's a different problem.) No bulging disks but x-rays show bone-bone contact in my lower back. So yeah, it bothers me sometimes, especially right after I wake up. I've never been an athlete but have always tried to stay active. Decades ago my sweetie and I used to run, have also done aerobics, yoga, and weight workouts. No super-heavy free weights though.

So what now? I've been through a few episodes of back and buttock muscle spasms, even developing knots that stayed around for a month or more. PT was a huge help in eliminating the knots and in teaching me how to treat them. Some stretching, some trigger-point pressure, some strengthening exercises. Mostly I make the effort to stay active as if nothing bothers me. One helpful but trivial exercise is getting down on all fours, raising one arm and the opposite leg to horizontal, hold it for 30sec. Do opposite side. Trivial to do but it makes those muscles fire instead of getting lazy. I still do other weight work too, mostly for upper body and abdomen, for example elbow plank held for at least 1 min or as long as 3 min.

As for the bike, riding seems to help my back (and my knees). I've never been able to stretch out on the drops for more than a few seconds. (With German and Italian ancestors I have a Mediterranean build and northern European flexibility, the best of both worlds!) But some forward bend helps the back as long as I don't overstretch the muscles. My handlebars are generally even with my saddles, or a bit lower if the reach is less. I mostly ride the hoods or bends.

As I've told my nephews, the day I stop doing something is the day I start not being able to. So unless there is a tangible medical issue, consider PT and keep doing what you like.
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jimmuller
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