Biking Position and Low Back Pain

By: Dr. Laura Wenger, PT, OCS

It’s May in Durango, which means cycling season is officially in full throttle! With these month’s races such as 12 hours of Mesa Verde and the Iron Horse Bicycle Classic road and mountain bike races, there are a lot of locals hitting the pavement and the dirt to start getting their miles in. As PTs, we see a lot of folks whose main goal is to be able to bike without any issues. There are always discussions on bike posture and what is the “right” position for each body, for which there is not a carte blanche answer. That being said, there are some general guidelines that may be undertaken for cycling that may help you have a more successful season.

John showing off his bike position at 12 Hours of Mesa Verde

As it turns out, a slim majority (51.5%) of cycling-related injuries are related to overuse, and low back pain is the most common of these types of injuries.1 These injuries can cause lost time on the saddle and require medical intervention, so they are important to pay attention to and, more importantly, to figure out how to prevent. For road cyclists especially, a flexed (or bent over) spine position is used in an attempt to create proper aerodynamics which might translate toward increased speed and efficiency, which are both desired goals for racers and non-racers alike.1 A recent systematic review, which is an analysis of multiple studies, sought to determine if there is any relationship between body positioning and spine muscle activity in cyclists with low back pain that wasn’t brought on by trauma.1 The researchers also wanted to find out if bike fit affects these factors, so that cyclists can have more guidance on how they should be set up on their bike in order to feel their best.1

After reviewing eight studies, the researchers found that there is evidence that supports the idea that muscle activation imbalances in your core muscle group are risk factors for low back pain in cyclists.1 The studies also support the idea that there is some relation that sitting in a prolonged, flexed position during cycling is related to low back pain.1 Changes such as a well-balanced core muscle activation program as well as changing your positioning on your bike to one that is less bent-over may very well decrease your risk of developing low back pain.1 Specifically, a lower handlebar position that requires your back to flex more may set you up for further issues.1 Physical therapists are specially equipped to assess and help you refine your ability to activate the muscles in your body and especially in the core muscle group. We also love to assess bike positioning in order to find the best position for your body and recommend changes that will either prevent or reduce low back pain. If you are a cyclist and you are currently experiencing back pain or would like to know if you are at risk for developing back pain and what to do about it, call us to schedule an appointment with one of our specialized PTs.

  1. Streisfeld GM, Bartoszek C, et al. Relationship Between Body Positioning, Muscle Activity, and Spinal Kinematics in Cyclists With and Without Low Back Pain: A Systematic Review. Sports Health. 2016;9(1):75-79.