Lower back pain from cycling is a common discomfort for cyclists. Several scientific studies have shown a range of 10% to 60% occurrence of limiting lower back pain among cyclists. Whether it be among recreational cyclists, touring cyclists, professional cyclists, it doesn’t matter. It can be a hindrance for all who ride a bike up to the point where people even stop cycling altogether because of the lower back pain.
I must warn you when you start reading. The first half of the article is a bit technical and has nothing to do with cycling. I find it important to let you know in detail what we know about lower back pain and what we don’t know. It is a crucial aspect for self-recovery and cannot be skipped. Thereafter I’ll explain how cycling can cause lower back pain. And ultimately, I’ll show you what you can do about lower back pain from cycling.
Lower back pain explained
To know what you can do about lower back pain, it is important to have some theoretical knowledge on lower back pain. I can tell you now, in 95% of the cases it is something you DO NOT have to worry about. And I’ll tell you why.
Lower back pain is as common as catching a cold. The World Health Organization have researched that 60% to 70% of the world population will get lower back pain somewhere in their lives. It is common among children, adults and elderly people. Lower back pain is most prevalent at the age of 35-55.
The pathophysiology, or physiological mechanism causing lower back pain, is to this day still unknown. With the current knowledge health professionals can not determine the source of the pain in the back. For many this will come as a surprise. In this day and age, you’d expect we would know exactly what lower back pain is. Wrong! None of the existing theories and tests for locating the source of pain have held up in scientific studies.
Is this important? No, it actually is not, because in 95% of the cases it is known what has to be done to ‘cure’ lower back pain. In other words, we know the behavior of lower back pain, what factors can negatively influence the natural course and how to address these without knowing the pathophysiological cause of lower back pain.
Cycling can be a cause as well, however, cycling is not a pathophysiological cause. It’s the activity during which the onset of pain presents itself. What precisely happens at cellular, neurological or physiological level is, again, unknown. Before I get to how to address lower back pain from cycling, I’ll tell you exactly how lower back pain in general behaves.
In 95% of the cases, lower back pain is not more than a discomfort. Meaning, there is no pathology, illness or disease as a cause for it. If there is a suspicion of any kind of pathology, a doctor must be consulted. Usually, pathological lower back pain presents itself in such an a-typical way, that most people visit a doctor anyway. In this article, when I speak of ‘lower back pain’, I mean the 95% discomforting lower back pain, otherwise known as ‘a-specific lower back pain’.
Discomfort and a-specific may sound a little bit demeaning, but in my work as a manual therapist I understand, and have seen many times, how incredibly negatively affecting it can be on the quality of life op people. I merely try to emphasize, for the sake of this article, that lower back pain from cycling is not something to worry about. It is a discomfort, not a disease.
A-specific lower back pain is generally divided into three categories: acute, subacute and chronic. These categories are defined by time. Acute lower back pain will generally heal within six weeks, subacute in twelve and chronic lower back pain lasts longer than three months. Funny thing is, that only when the pain is gone that you know in which category you belonged.
Circumstances where you are at higher risk of getting lower back pain, called risk factors, for acute and subacute low back pain are depression, anxiety, stress, and some professions.
Of the people with lower back pain, 90% will notice a decrease in pain within a few weeks after onset. They will be free of pain without any intervention from a health professional. The pain will just go away by itself. 5-10% will eventually experience prolonged pain for many months which is called chronic lower back pain. Most often, socioeconomic and psychosomatic factors are the cause of pain becoming chronic in general. Same is the case with lower back pain.
Chronic lower back pain is complex because of the many factors at play. Often, the solution goes beyond the typical advice and exercises. There is a need to investigate if for instance any emotional, personal or social factors are hindering recovery.
Lower back pain demystified
This section is a juicy one and might raise some eyebrows. Some of you reading this will disagree in what I’m about to explain. This explanation is not one of my own, but the status of current scientific research about lower back pain.
The reason for demystifying lower back pain is a simple one. Certain ideas about lower back pain taught by professionals are actually causes of lower back pain. It will make people unnecessarily dependent on these professionals and will delay or prolong recovery. Likewise will a lot of (false) information found on the internet do more harm than good.
People have told me many things for what they believed were the cause of their back pain. The following quotes are the ones I hear most often and I can tell you, they are not true! I will explain this in the next paragraph.
‘Lower back pain is caused by a weak core’
‘My lower back pain is caused by misalignment of my spine and a slipped disc’
‘I’m in pain so something must be damaged and moving my back is bad for me’
‘I’m not flexible so I have back pain’
‘I have bone to bone arthritis in my lower back and will end up in a wheelchair’.
The reason why these quotes are not true is mentioned earlier in this article. With all the research that has been done, with all the knowledge we have, to this date THE mechanical, or pathophysiological, cause for a-specific lower back pain has never been found. And all these quotes have been at the basis for scientific research and to everyone’s surprise have been answered by ‘not enough evidence to support this hypothesis’.
So why pretend that it exists when all that it does is stigmatize and does not add to recovery. These quotes are all from a viewpoint that something is wrong, weak, shifted or diseased in your lower back. When in fact there is just pain without a known pathophysiological cause. Your back is absolutely healthy, strong and the vertebrae are in the right place.
I conclude this section by repeating the most important message and advice:
Although your lower back is in pain, it is still very strong, healthy and resilient. The pain is no more than a discomfort, which in most cases will subside within a few weeks. Your body and lower back will adapt and you’ll be pain free within a certain amount of time!
Lower back pain from cycling
With the theoretical part done, we can get to the point. Which can be a bit confusing, because I said earlier that it is still unknown what the cause of lower back pain is. But cycling can be a cause. Well, there is a difference between the two.
The pathophysiological cause is unknown. Meaning, the physiological and/or neurological mechanisms that causes lower back pain have yet to be determined.
In the situation of lower back pain from cycling, the activity is known and maybe other contributing factors as well. It doesn’t say anything about the pathophysiological mechanisms. Logically, there is no need to start therapy or looking for a ‘cure’ from the viewpoint of pathophysiological mechanisms. What is more useful is to see if there are variables, like an activity, which contribute to the lower back pain and you can actually change for the better.
These variables can be divided into two categories. External and internal factors. The best examples of an external factor is bike fit. Internal factors are factors within a person itself for example fitness, stress, sleep deprivation, fatigue and so on.
External factors causing lower back pain from cycling
Let’s start with the external factor first and the most apparent one. Bike fit. There are three elements of bike fit which have been proven to be a cause for lower back pain from cycling: Saddle angle or inclination, reach and saddle height.
I do have to place a footnote for bike fitting. Bike fit is a personal affair. For some a certain position is comfortable, for others a nightmare. There are some basics in relation to lower back pain from cycling that apply for most people though.
Bike fit: Saddle angle or inclination
The saddle angle or inclination is the angle at which the saddle is placed. When the saddle is placed with the nose pointing downwards, the lower back and pelvic region respectively extend and tilt forward. This is not a problem on its own. However, should the saddle position be that your lower back and pelvis are too extended and/or tilted forward, thus the saddle inclination be too steep, it might cause lower back pain.
The theory for this phenomenon is quite simple. If you sit for prolonged time in any position near or at the end of the range of motion of a joint in general, protest of tissues like ligaments will occur. The best example for this phenomenon is known to everyone. Imagine yourself sitting on the couch and watching television. Your feet are on the salon table, your knees are fully extended and unsupported between couch and table. After a while you notice an ache and unpleasant stretch in the knees. You get your feet off the table but the knees keep hurting for a little while after. Only once you get them moving again will this feeling subside.
Now imagine yourself with a near fully extended lower back and forward tilted pelvis. No wonder protest will occur after a while on the bike. No harm done, but it is very uncomfortable. Once you are off the bike and move around a bit, will this uncomfortable feeling pass.
The same principal goes with a saddle with the nose pointing upward. In contrast to an extended lower back and forward tilted pelvis, the region will be flexed and tilted backwards. There is one addition in this situation in comparison to the extended back. If a lower back is flexed for a prolonged time there occurs something called ‘flexion relaxation’. The extensors, muscles along the length of your spine, relax completely. The effect is simple; strain on ligaments and soft tissue with the already described discomfort as a result. Getting off the bike and moving around will relieve the discomfort.
Bike fit: Reach
In this context, reach is the term used for the distance from your seating position on the saddle to the center of your handlebar.
Several factors have an influence on your reach. The size of your bicycle, horizontal position of your saddle, stem length and type of handlebars. If this distance is too long and you have to overreach, again your lower back will be overextended and your pelvis tilted to far forward with a possible discomfort as a result. Should the reach be too short, your lower back will be over flexed and pelvis tilted backward with the same possible discomfort as a result.
Bike fit: Saddle height
Imagine a saddle positioned too low and someone sitting on it. A flexed lower back is the result of this position. Then we apply the same principle for an over flexed lower back and backward tilted pelvis. Discomfort or pain can be a result when this person rides for a longer time in that flexed position.
Internal factors causing lower back pain from cycling
Too fast, too far
One of the most common causes for any discomfort or overuse injuries from cycling is you go too fast, too far or a combination of the two. The body with all its systems like musculoskeletal, neurological, visceral (organs) and senses need time to adjust to new stimuli. If time is not given, one or more systems can overload with overuse injury or other symptoms as a result. Overuse injury doesn’t imply damage, disease or inflammation of any sorts. It is more a protest of the system, rather than actual injury.
For example. Let’s say you are reasonably fit. You ride three times a week of which one is a ride of at least a hundred kilometers. You decide to start training for a cycling event of two hundred kilometers or multi week bicycle touring trip and you extend your riding times. At the same time you incorporate some interval or HIIT blocks as strength training during your rides as well. After a few weeks you feel you are getting stronger but are slowly developing some aches and pains. For instance in your lower back. You have no idea where this comes from because you feel you are getting stronger. You start fiddling with your bike fitting but the pain is getting worse, because you keep training at the same intensity. At one point, the lower back pain is hindering you in your training to the point it’s no fun anymore.
This is a typical example of overuse injury or system overload. Recovery and gradual buildup of administered load is key in preventing this from happening.
Other internal factors like fatigue, stress and worries about lower back pain
In the former paragraph I spoke about ‘the systems’. I call it the system, with which I mean the sum of body and mind. They operate as one and affect each other in positive and sometimes negative way. Especially with low back pain where physiological mechanism alone don’t seem to be the cause. When the mind is occupied by any negative thoughts, feelings or otherwise negative phenomena, the body is at risk of displaying all sorts of symptoms. Pain and discomfort being two of them.
To explain this in more detail, I’ll use the previous example again with one difference. Instead of extra training you keep doing what you’ve always done, three times a week on the bicycle with at least one time a ride of hundred kilometers. But in this case, you’re having problems at work. The last few weeks you haven’t been sleeping that well and you feel stressed. You notice you can’t generate the strength and haven’t the stamina you usually have on the bike. You’re struggling to keep up with friends. After a few weeks, for no reason, your lower back starts to ache. First on the bike, later during the day at the office and even when you are relaxing on the couch watching a movie. It seems like cycling is the cause, because the onset of pain, the first moment it started, was while cycling.
In this case, it has nothing to do with cycling. There are many, many factors at play when it comes to lower back pain. Stress, anxiety, depression, lack of sleep, unhealthy diet, alcohol consumption, cigarettes, a cold or the flu can all cause a system overload with lower back pain as a result.
What to do about lower back pain from cycling
First off, there isn’t one solution, unfortunately. But there are some basic things you can do yourself, without the aid of a health professional. Here is a step by step guide what you could do. The steps are ordered in three chronological steps following the first few weeks of lower back pain, the period after the first few weeks and the prolonged or chronic period.
First few weeks after onset of pain
- Do not worry!!! This is the most important thing to start with. Most likely there is absolutely nothing wrong with your back. It is strong, healthy, resilient and adaptable. Trust your body, keep your mind at ease, and relax.
- Give it a little bit of time. By far the most cases of lower back pain will reside within a few weeks. It will probably not be solved within a day. The body and mind need time to adapt to new stimuli, or recover from an overload.
- Adjust the load if you are in training or in the midst of touring. Try and lower the intensity of training or touring. Less kilometers per day, reduce the average speed, increase your cadence, maybe do some alternative activities like general exercise.
- Take care of your body and mind. Pay extra attention to your diet and make sure you get enough of everything like vitamins, minerals, proteins, amino acids, and so on. Make sure you get enough sleep and you feel rested when you wake up. Don’t passively rest too much. Go for an easy hike or swim for instance. And very important, do what you know and feel is good for you. Yoga, stretching, Pilatus, general exercise, swimming, it really doesn’t matter as long as it feels good. Movement is our own natural painkiller.
If the pain persists after the first few weeks
- Check the external factors: Try and think if anything has changed in the last few months in relation to your bicycle. Did you adjust your saddle, did you mount a new stem, did you get new bibs with thicker or thinner cushioning and so on. The slightest change could be an answer to your lower back pain. And of course, if you think you have found the answer, act accordingly and change it back or adjust your bike fit to the new situation.
- Check your bike fitting:
- In case of an overreaching position and over extending the lower back:
- Check the saddle angle. The nose of the saddle might be pointing too far downward. Correct the angle to slightly under the ninety degrees angle. Don’t go over ninety degrees angle.
- Check the horizontal position of the saddle. The saddle might be positioned too far backward. Correct the position by less than a centimeter at first. Don’t position the saddle too far forward or you will be at risk of causing knee pain from cycling.
- If step 1 and 2 didn’t make a difference, check the length of your stem. It might be useful to try a shorter stem.
- In case of a cramped position and over flexing the lower back
- Check the saddle angle. The nose of the saddle might be pointing upward. Position the saddle in the ninety degrees angle or slightly less.
- Check the horizontal position. The saddle might be placed too far forward. Correct the position by less than one centimeter at first.
- Check the saddle height. Your saddle might be positioned too low. Correct the height in such a way that while you sit on the saddle you can fully extend your knee, with the heel on the six o’clock positioned pedal. This an easy way of determining the correct saddle height.
- If steps 1 to 3 didn’t make a difference, check the length of your stem. It might be useful to try a longer stem.
- Check the internal factors: Try and think if anything occupies your mind for a long time, which could negatively influence the lower back pain. Stress, anxiety and depression are examples. These are things you can’t change that easily, but knowing it plays a role, can be reassuring and a start to change your situation for the good.
- Exercise in any way you want and what feels good. For some people, stretching might work, for others Pilatus, yoga, general exercise, as long as you are moving and exercising your lower back and pelvic region. You can find an abundance of exercises by using these search terms on Google: lower back pain exercises. Try to exercise every day, even multiple times per day, for example 15 minutes at a time, for several weeks.
If the pain persists even after you have done all the above
- Get a professional bike fit. You might have missed a detail. A professional will most likely be able to put you on the right path.
- Get help from a qualified physical therapist, chiropractor, sports masseur or – masseuse, or any other qualified health professional. It can definitely help to get some therapy or treatment. It might relieve some lower back pain from cycling and so you’ll be able to move better. Once you can move better with less pain, you can rely on movement as your natural painkiller again.
Lower back pain from cycling is very common and nothing to worry about. Most likely the pain will be gone within the first few weeks. If by any chance this is not the case there are some steps to go through which can help in self-recovery. To give it some time, a proper bike fitting and exercise in any form are the three actions with the best result for lower back pain from cycling.
This article should be read as an expert advice and not a medical advice. I am a licensed physical therapist, however this is written on a personal note as a touring cyclist, an experience expert in knee pain from cycling and a physical therapy enthusiast. If the reader is seeking professional advice or care, he or she should visit a doctor or physical therapist.