When confronted with back pain, the only way forward is to go back to basics, finds Iain Treloar.
For the first hour or two of a ride, all seems well. Then, like a thread unraveling from a jumper, the first ache appears and soon enough I’m undone. The early twinge spreads from the mid-back and down the spine, and after another hour or so I’m numb and aching through the entire lower half of the back. Power output is affected—it’s like there’s a lock on my legs, preventing them from pushing out higher power—and I plod to the completion of the ride, stretching every half-hour, frustrated and aching.
Back pain is an unfortunate reality of life for many riders, particularly in the more aggressive position of a road bike. It has the ability to turn a happy spin into a disheartening slog and leave residual pain for days. At its most acute, it can be cause enough for expensive bike and componentry purchases, medical appointments and bike fits. I’ve previously outlined my recent foray into bike fitting, and documented an earlier investigation as well.
However, despite the significant improvements in physical comfort that all of the above can bring, the treatment of the root cause of discomfort, as well as management of pain post-injury, can play an even more vital role.
Dr Andrew Daff, a Sports and Exercise Medicine Physician at the Epworth in Melbourne, treats both obvious injuries, like “broken bones from falls and other more acute issues”, as well as overuse injuries, such as knee pain, groin pain and back pain. Daff describes the overuse issues that may affect riders as coming from two sources, “Extrinsic, that is, equipment, position on the bike and the like; and intrinsic, pre-existing structural issues or asymmetries with the individual.”
Extrinsic issues can be resolved with bike fitting and changes in equipment, but the intrinsic issues may often require medical intervention.
Conditioning is key—core strengthening and stretching is critical as a preventative step,” Daff says. “I talk about it as a kinetic chain—everything’s linked.
The key to management of such issues—particularly with back pain—is not just a matter of treating symptoms when they occur, Daff argues, but ensuring that there is a solid foundation to start with. “Conditioning is key—core strengthening and stretching is critical as a preventative step,” Daff says. “I talk about it as a kinetic chain—everything’s linked. So if your core gives out, the back goes, then it spreads into the glutes, the hips come out of balance… by concentrating on conditioning, building the strength of your glutes and core, using rollers, massage and myotherapy, this can be delayed.”
Andrew Sargent, director of Pure Physio, agrees with this assessment; his practice is based not just around management of existing pain, but prevention of its onset. When I presented for physio treatment, he quickly identified that there was a disparity in my back flexibility. In essence, although my lower back was limber enough, the rest of it certainly wasn’t; as soon as my core strength gave out, my back hinged, flaring up from the thoraco-lumbar junction and spreading from there. A bit of forceful prodding at the tight muscles along my upper back had me winded and gurning into the bench. “You’re pretty tight there,” Sargent muses. I wheeze a self-pitying acknowledgment.
At the conclusion of the session, I’m prescribed a set of exercises that I need to complete at least once a day, and booked in for follow-up sessions with Sargent (the proddy stuff) and a ‘rehab’ physio (retraining my body to activate the core on the bike).
Dutifully, I go through the daily exercises that it turns out I should have been doing all along. I grow used to the clickity clack of vertebrae and shoulder blades on the foam roller; my girlfriend and cat grow used to me rolling around on the living room floor like an overturned turtle, and the pathetic whimpers as I work on my ITBs.
Within a week, it’s time for my last big training ride before the SCODY 3 Peaks Challenge. I map out a 205km route, with over 3,500 metres of vertical gain, wondering at which point my back will give out and when the legs will follow suit. As I set out, there’s a new fluency to my pedal stroke and a new freeness in my spine, and it’s not until the base of Mt Donna Buang that I take the time to get off my bike and stretch. After nine hours in the saddle, I arrive home, lie on the floor and get stuck into my stretching again. My spine stretches and nerves fire, but for the first time I understand that for me, all this is every bit as vital as going out and flogging myself on the bike. Although there’s a way to go, a less painful future is finally in sight.
Looking for stretches and core strength exercises to do? Try these:
Stretches: a post-ride treat for your muscles
Warm up with dynamic stretches
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