Pain in Middle of Back While Riding

author : AMSSM
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I have been having pain slightly to the right side of my back for the past month. I am worried about my upcoming IM and having to climb hills and be on the bike for 7+ hours!

Member Question

I have pain in the middle of my back (near the lower part of the rib cage) while riding.  I have been having pain slightly to the right side for the past month. I went in for a massage, because I was having issues with my right quad as well. That seemed to help a bit and I survived my 100 mile bike ride a few days later, but the pain is back and has slowly gotten worse. I saw my chiro last week but that didn't seem to help much at all.  I felt pretty good on my bike ride this weekend, until I had to stop at a 4-way stop about 3 1/2 hours into my ride. When I started to pedal again, I had an excruciating pain in my back for several minutes. The pain subsided, but I am worried about my upcoming IM and having to climb hills and be on the bike for 7+ hours!  I'm not sure if I should continue with the chiro, go in for a massage again or just stretch on my own and hope that it has time to heal a bit during taper.

Answer from Tobi Gopon MD and Nathan Dowling PT
Member AMSSM 

Dear Triathlete,

Thank you for your question. First and foremost, let me emphasize that the advice given in my response should not replace a detailed evaluation by a health care professional, which should include a thorough physical examination. In addition, please keep in mind that my response is limited without further history or a physical exam. Ok…. Now that we have gotten that out of the way here are my thoughts:

In brief, I feel that your symptoms are the result of a postural issue that should be correctible with changes in bike fit and physical therapy. Based on your description of the pain, I feel that the most likely cause is muscular dysfunction and instability at the thoraco-lumbar (T/L) junction. This has most likely resulted from multiple hours on the bike and countless pedal strokes with increased stress at the T/L junction. The T/L junction is the area of the spine where the curvature changes from kyphosis (convex) in the thoracic spine to lordosis (concave) in the lumbar spine. The vertebrae in this area, like the rest of the spine, are supported by paraspinal muscles, which can become overused if prolonged stresses are placed on these segments.

I had a discussion about your case with the director of our cycling clinic within the University of Utah Orthopedic Clinic. We both feel that with a proper bike fit and physical therapy your pain should improve. A possible explanation for your issue is that your pelvis is tilted vertical as you are reaching forward to the bars. We feel that the chiropractor did not help as your issue is not a vertebral hypomobility issue. We also feel that the massage did help you as it worked on the paraspinal muscles which are being overused in the attempt to stabilize the thoraco-lumbar junction.

Further treatment options would include physical therapy focused on core stabilization, which would offload the paraspinal muscles. A quicker fix would be undergoing a professional bike fit aimed at achieving a more anterior pelvic tilt on the bike. This would allow a more neutral spine and allow for more core engagement. This could be done with adjustments to the handlebar position, seat post position, or different saddle type. For instance, raising the handle bars up would decrease the amount of forward tilt required. This change would have to be balanced with achieving the most aerodynamic position for a more efficient pedal stroke and position on the bike. Another idea would be moving the saddle forward, which can facilitate the pelvic tilt and is a good tri-specific fit as we want to keep the hips open for a smoother transition to the run.

I hope that this offers helpful insight into your issue and possible treatment options. Again, I would consult with a health care professional for a thorough evaluation and at the very least undergo a bike fit ideally with a physical therapist that specializes in bike position and kinesiology.

Sincerely,

Tobi Gopon MD and Nathan Dowling PT

University of Utah

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date: August 31, 2015

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The American Medical Society for Sports Medicine (AMSSM) was formed in 1991 to fill a void that has existed in sports medicine from its earliest beginnings. The founders most recognized and expert sports medicine specialists realized that while there are several physician organizations which support sports medicine, there has not been a forum specific for primary care non-surgical sports medicine physicians.

FIND A SPORTS MEDICINE DOCTOR

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