The worst thing about back pain—besides the actual pain—is the mystery surrounding it. It seemingly comes out of nowhere; one day, you’re fully functional, and the next morning, you’re struggling to stand up straight.
What happened? And, more importantly, how can you get some relief?
We asked physical therapists for a list of the common causes of back pain in cyclists and what they can do about it. While only a medical professional can provide an accurate diagnosis and customized treatment plan, this list includes information and recommendations cyclists can use to do some initial troubleshooting.
1. Weak Rotational Muscles
Humans have three planes of motion—the sagittal (forward and backward movement), frontal (side-to-side movement), and transverse (rotational movement). Cyclists tend to spend a disproportionate amount of time in the sagittal plane because you pedal forward. “We don’t use our rotating muscles much, and some of the really important rotating muscles in the trunk are the ones that support the spine,” Jessie Duppler, P.T., D.P.T., creator of the Chain Reaction Strength Revolution program for cyclists tells Bicycling.
As a result, the rotating muscles, particularly the multifidi, can get weak. “The spine doesn’t have as much support as it may need. That often results in pain on the bike,” Duppler explains, as the body is still trying to generate force without the requisite stability. “It’s like trying to shoot a cannon out of a canoe,” she says.
The Fix
Incorporate core and spine-strengthening exercises that target stabilizing muscles through small, rotational movements. Duppler’s go-to exercises are the hip hike, performed on all fours, and a specific version of the clamshell exercise in which the hips and knees are bent 90 degrees. Instead of just lifting the knee in the clamshell, it’s important to initiate the movement by rotating the thigh at the hip.
2. Core Instability
The core—specifically, the transverse abdominis, a deep core muscle that wraps around the trunk—is a critical stabilizing force for cyclists. When your core muscles are weak or dysfunctional, other muscles pick up the slack, which sets off a series of movement compensations that can generate back pain.
“The body says, ‘since I can’t use my abs, I’ll just use my hip flexors as a way to stabilize my spine,’” Duppler says. “Those [muscles] are supposed to just flex the hips, but they end up pulling on the spine too, causing back pain.”
The Fix
You need a stronger core, but don’t just crank out a bunch of crunches. Duppler recommends focusing on exercises that engage the deeper layers of the core musculature.
She’s a fan of the supine march, in which you lie on your back with your feet on the ground and alternately march your knees up and over your hips, making sure to keep your back flat against the mat. (To turn up that challenge, start with knees above hips, feet off the floor, and drop one foot to the floor at a time—still keeping back against the mat.)
The Pilates roll-down is also a good option for targeting the transverse abdominis, as well as the obliques—basically slow down the downward phase of a sit-up with legs straight.
3. Herniated or Bulging Disc
A herniated or bulging disc occurs when the inner part of the shock-absorbing cushion between two vertebrae is ruptured and protrudes abnormally. It’s a common condition that physical therapists see all the time, and not just in cyclists. (A sedentary lifestyle, heavy lifting, poor movement patterns, and aging can all be contributing factors.)
“Back pain could be a disc issue, which can compress a nerve and cause some numbness, tingling, or burning down the arms if it’s in the neck or down the legs if it’s in the back,” Grayson Wickham, P.T., D.P.T., C.S.C.S., doctor of physical therapy and founder of Movement Vault tells Bicycling.
The Fix
Potential disc issues should be evaluated by a healthcare professional, as they can give you a diagnosis and let you know if your condition requires medical intervention.
Often, a physical therapist can help you alleviate pain by addressing the root cause. “A disc bulge or herniation really is a symptom of movement patterns that aren’t working because discs don’t just bulge on their own,” Duppler explains. “Discs bulge when pressure is applied unevenly to them, and that typically comes from [poor] movement patterns and not recruiting the right muscles… We fix the pain through PT because we fix the movement patterns.”
4. Faulty Breathing Mechanics
When you don’t engage your primary breathing muscles—specifically, the diaphragm and external intercostals, which expand the chest and make room for the lungs—other muscles pick up the slack. “We breathe really hard on the bike. Sometimes, we end up utilizing a lot of back muscles to try to pull on our rib cage to breathe. Then the back muscles get tight because they’re not acting as back muscles, they’re acting as breathing muscles,” Duppler explains.
The Fix
Doing basic diaphragmatic breathing exercises, which focus on expanding your midsection as you inhale, can help break bad breathing habits and better engage the correct muscles.
To strengthen your breathing muscles and improve their efficiency, you have to train them like any other muscle. As part of your cross-training, perform breathing exercises like the bellows breath, crocodile breathing, and exhale pulsations.
5. Poor Bike Fit
Back pain may be a clue that your bike fit is off. For example, a saddle that is too high can cause you to pedal harder, increasing side-to-side motion, a.k.a. “bobbing and weaving.” This kind of back-and-forth rocking puts “undue stress on the hips and back. It can also ask the hamstrings to lengthen too much, which will result in them pulling on the pelvis and the low back,” Duppler says.
Also, if your saddle is set too far back, you have to reach further to grip the bars, which can strain your back, restrict your breathing, and put extra stress on your hips.
The Fix
Get fit by a certified pro with a background in movement and physiology. A bike fitter who is also a physical therapist, for example, will have a comprehensive understanding of the human body and how it communicates with the bike. And if a bike fitter is trying to fix your back pain issues with new, expensive gear, find another person to work with. (“That’s always a bit of a warning,” Duppler says.)
6. Training Mistakes
Your training should be intentional, rooted in exercise science, and geared to your levels of fitness and experience. So, if you’re going off-book or just winging it, don’t be surprised when your body starts to revolt.
Wickham highlights training volume and intensity; suddenly ramping up either variable can lead to injuries. Progress should always be gradual and progressive.
Adequate recovery (and not just in terms of taking days off) is equally important, he adds. “If you’re not getting good sleep and adequate nutrition—not only replacing the calories, because endurance burns a lot of calories, but also the micronutrients, the vitamins and minerals—that will definitely increase your chances of injury,” he says. “Modulating stress outside of your training, in your work and relationships, as well as getting deep, restful sleep, is also super important.”
The Fix
“A coach is one of the best investments you can make,” Duppler says. Not only will they work with you to create an appropriate training plan, but they can also help you stay on track, avoid overtraining, and troubleshoot issues, like pain and injuries, as they arise.
7. Tight or Unstable Hips
Chances are, your time in the saddle represents just a fraction of your time sitting. Between work, commuting, and relaxing on the couch, you’re likely spending most of your time in a flexed position, which is bad news for your hips and, therefore, your back.
“That’s going to lead to tight and/or weak hip flexors, which is going to pull the pelvis forward and increase pelvic tilt, which is going to pull on the lower back,” Wickham says. This “suboptimal position,” as Wickham describes it, can trigger feelings of tightness or pain in the posterior chain, including the back.
The Fix
Do your best to vary your position throughout the day. Swap your traditional desk for an adjustable one so that you can stand more (try standing normally, balancing on one foot, and widening your stance).
If you can, ditch your chair altogether. “Sitting on the ground is better than sitting in a chair,” Wickham says, noting that you can switch up your positioning (legs crossed, straight out, one leg bent, etc.), which will engage different muscles in the core and hips, especially because you don’t have the back rest to lean back on.
If you do sit in a chair, keep your core activated by not using the backrest, and schedule “stretching snacks” throughout the day.
8. Your Posture on the Bike
Time to address the elephant in the room: The best, most aerodynamic, and aggressive posture for a cyclist on a bike is “actually a pretty poor position from a functional anatomy perspective,” Wickham says. “Your hands are on the handlebars and you’re flexed over… the neck is actually arched and extended because you need to see where you’re going.” It’s what the sport demands, but it’s not surprising that, over time, this form often causes back pain.
The Fix
While you can’t change your position on the bike, you can offset its negative effects with what you do off the bike. Wickham recommends incorporating regular mobility work, active stretching, and strength training into your routine. And, as noted above, reducing your overall sitting time and varying your postures and movement patterns can help.
“I never want to dissuade anyone from any type of exercise or movement that they enjoy,” Wickham says. “Just because you’re sitting for work and cycling a lot doesn’t mean that you’re automatically going to have back pain…The question is are you going to do the things outside of cycling to prevent it?”
