Magic Number to Prevent Low Back Pain

By Kari Studley, PT, DPT, CYT

With the longer days and favorable weather, now is the time of year most amateur cyclists ride the majority of their miles and participate in their goal events. This also means more time spent on the bike, both in frequency and duration. In their research of overuse injuries in recreational cyclists, Wilber et al1 found that low back pain was the fifth most common area of injury. Furthermore, they found that males who rode more than 100 miles per week and had fewer gears on their bike (13 compared to 15) were significantly more likely to report the issue.

Schultz and Gordon2 further explored the relationship of contributing factors to low back pain in recreational cyclists based off of the research presented by Wilber et al. They compared training characteristics, history of back injury, and riding positions (upright, drop, brake and aero) as contributing factors. Interestingly, the only significant relationship factor for low back pain Schultz and Gordon found was also for those riding more than 100 miles per week — both males and females.

Low back pain is a common discomfort for cyclists. That said, based on both of these studies, should riding be limited to less than 100 miles per week?

The two studies were well-designed with good sample sizes. Wilber et al had more than 500 randomly selected recreational riders respond to their survey, whereas Schultz and Gordon utilized a local cycling club to voluntarily complete an online questionnaire. In the latter study, of the 66 eligible respondents, they divided equally into two groups that reported either low back pain or no low back pain in the past six months. Additionally, men and women were also similarly represented in each group. If only all studies were so lucky in their recruiting!

Despite the good sample sizes and group demographics in both studies, the use of surveys is a limitation. Participants are restricted to the available questions asked and it can be difficult to determine true cause and effect, as there is no formal control group. In this case, with both studies finding significant correlation between low back pain and riding over 100 miles per week, more information on how the weekly mileage was being achieved would be helpful; riding 100 miles in one day or over a weekend with minimal weekday cycling is a sure recipe for musculoskeletal injury, whereas riding 20 miles five days a week is generally better-tolerated physically.

Several factors can influence low back pain caused by cycling. This includes overall cycling position and posture, hamstring flexibility, strength, pedaling coordination, cycling experience, terrain, gearing and gear choice, and, of course, mileage consistency and progression. Those newer to road cycling and endurance activities need to be more diligent with stretching and regular riding to help their body successfully adapt to the repetitive demands of the sport.

In summary, if you are currently riding more than 100 miles per week, you may be at risk for increased low back pain. Following a general regular training plan and optimizing body adaptation through stretching and strengthening can help you achieve your goals and prevent overuse injuries. Use 100 miles per week as a general reminder to be attentive to your body and incorporate training preparation strategies, especially if your goal is to ride more than that each week on a regular basis.

References:

1. Wilber, C. A., Holland, G. J., Madison, R. E., & Loy, S. F. (1995). An epidemiological analysis of overuse injuries among recreational cyclists. International Journal of Sports Medicine, 16(3), 201-206.

2. Schulz, S. J., & Gordon, S. J. (2010). Recreational cyclists: The relationship between low back pain and training characteristics. International Journal of Exercise Science, 3(3), 3.

Kari Studley, PT, DPT is a 2013 Masters Cyclocross World Champion, a 3-time National Cyclocross Champion and one day STP rider. With over a decade of endurance cycling experience, she specializes in cycling biomechanics and injury prevention at Corpore Sano Physical Therapy (CorporeSanoPT.com) in Kenmore, Wash. Corpore Sano PT is an orthopedic and sports physical therapy practice specializing in treatment of overuse injuries and sports performance. Contact 425-482-2453 or Hello@CorporeSanoPT.com

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