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Original Research

Recreational cyclists: The relationship between low back pain and
training characteristics

SAMANTHA J. SCHULTZ* and SUSAN J. GORDON‡

School of Public Health, Tropical Medicine and Rehabilitation Sciences, James
Cook University, Townsville, Australia. susan.gordon2@jcu.edu.au

*Denotes undergraduate student author ‡Denotes professional author

ABSTRACT
Int J Exerc Sci 3(3): 79-85, 2010. This study investigated the relationship between low back pain
(LBP) and training characteristics in recreational cyclists. Purposive sampling was used to recruit
sixty-six recreational cyclists from nine cycling clubs. Participants completed a survey reporting
training characteristics and LBP behaviour during a usual week of cycling. This included percent
of time spent cycling in three common riding positions, cycling terrain, average cycling pace,
number of gears, days per week cycled and number of cycling events per year. Fifty percent
reported LBP during or after cycling or smoking and LBP. Cyclists who reported LBP cycled
significantly further in a usual week of cycling than cyclists who did not report LBP (p=0.022). An
odds ratio indicated that people who cycle 160 km or more per week are 3.6 times as likely to
experience LBP compared with people who cycle less than 160 km per week (OR=3.6, CI=1.29-
10.15). Preference for riding with the hands on the brakes approached significance with respect to
LBP reports (P=0.06). No other significant relationship between LBP and training characteristics
was identified. In order to reduce the risk of LBP recreational cyclists who report LBP should
consider decreasing cycling distance to less than 160 km per week.

KEY WORDS: Bicycling; injury prevention; cycling; low back pain.

INTRODUCTION however no published studies have
examined the relationship between
In Australia, cycling has increased in handlebar height, riding position and
popularity with approximately one million lumbar spine posture with respect to LBP.
people cycling for recreation, to work or to
destinations in inner cities (1). Although Research investigating lumbar posture and
cycling is a low impact activity, low back LBP in cyclists has provided two scenarios
pain (LBP) has been reported by 2.7-50% of in relation to symptom production. Salai et
recreational cyclists (3,14,17). al. (14) investigated pelvic tilt in cyclists
and found an inclination towards
It has been suggested that an extremely low hyperextension at the lumbo-pelvic
handlebar position (10) or riding in the junction in those who reported LBP.
drop position, with the hands positioned on Intervention (N=40) by inclining the saddle
the lowest part of the handlebars (14) anteriorly by 10-15°, for six months,
contributes to LBP in cyclists. Hence resulted in greater flexion of the lumbar
suggestions to prevent LBP have been spine on the pelvis and eradicated LBP in
made regarding handlebar height (15) 72% of participants and reduced the

2. (2) recruited 18 subjects kilometres (km)) were significantly more to participate in a pilot study examining likely to report LBP than cyclists who whether differences in spinal kinematics cycled 77. with a loss of co-contraction of the multifidus muscle in nine cyclists with non. (18) and other International Journal of Exercise Science 80 http://www. They reported that male cyclists survey of Wilber et al. Further the flexion was reported to be associated with increase in popularity of recreational no back pain (2). In the last decade bike design has advanced specific chronic LBP (2). which may contribute to LBP. (18) investigated overuse injuries including LBP Survey and training characteristics in recreational A survey was used to collect demographic cyclists from northern and southern information. It included questions from the California. Burnett et al.intjexersci. However.05) and abdominal and back muscle activity were significantly more likely to report was recorded with electromyography. METHODS However.7% (17) and 16% (7). these findings cycling and no available information in the were not statistically significant.4 miles per week (168 (14). Of these. being on the and attire. and cyclists have adopted more increased upper lumbar spine rotation and aerodynamic riding positions. and hazards encountered when drops or on the aero bars (similar to the cycling and LBP was identified. Wilber et al.1 miles (124 km) per week exist in cyclists with and without chronic (p<0. and training characteristics by the Human Research Ethics Committee in recreational cyclists.05) (10). In addition. LBP. p<0. Spinal kinematics was calculated reported less number of gears on the cycle using an electromagnetic tracking system (13 gears compared to 15 gears. education. two of James Cook University. Ethics approval for this study was granted including LBP.com . it is a belief in the cycling specifically investigate the relationship community that intensity. The results of this study include age related degeneration of lumbar identified a trend toward increased flexion joints and discs (5. However.12) and a history of and axial rotation of the lower lumbar spine cigarette smoking (8). no significant relationship Subjects were requested to ride in one of between diet. cycling equipment two different riding positions. characteristics and LBP. with no to regional and metropolitan cycling clubs conclusions available regarding training in Queensland were recruited by invitation. cyclists who LBP. prevalence of non-traumatic injuries in cyclists including reports of LBP (4). in recreational cyclists.CYCLING: LOW BACK PAIN AND TRAINING frequency of LBP in 20% of participants who cycled 104. The current study modified the survey of Wilber et al. Other brake position with arms stretched further factors. (18) to Additionally. forward). Furthermore. frequency and between LBP and training characteristics in duration of training may influence the recreational cyclists. Townsville. studies reported low prevalence of LBP in Cyclists aged 18 years and over belonging cyclists. a search of the literature using a systematic approach identified only three Participants papers investigating overuse injuries. possibly Australian context warrants investigation due to the various cycling positions and of training characteristics in relation to LBP small sample size.

Information sheets inviting significant differences between the training cyclists to participate in the study were also characteristics of cyclists with and without distributed during cycling events. LBP. Questions 13 and 16 time spent cycling in different riding allowed identification of those who had positions and 8) The type of cycling terrain. Low handlebars on the bike. In many instances identified logistic regression was the survey provided participants with a performed to adjust for potentially number of possible responses and confounding variables.com . Survey questions 9.05. When report the terrain in which they mostly the lower 95% CI of the OR exceeded 1 the cycled participants were asked to choose odds were significantly elevated. Reminder e-mails was sent presented. For example when asked to interpretation of significant findings. the odds were significantly protective. cycling pace and number did not participate in more than 50 of cycling events per year).CYCLING: LOW BACK PAIN AND TRAINING questions considered pertinent to the aims Procedures-Data management of this study: 1) Individual and training For the purpose of this study. kilometres cycled per week. ‘mostly flat’ and when the upper CI of the OR was less than ‘flat with rolling hills’ 1. As the numeric were distributed to cycle club members via variables were non-parametric. Mann-Whitney or chi-square one month after the initial survey tests were performed to determine distribution. experienced during or after LBP during or after cycling within the past cycling within the last three to six months three or the past six months. constituted participant consent. the questions before a final survey was produced and employed in the study (13). International Journal of Exercise Science 81 http://www. Odds ratios (OR) participants were asked to choose the and confidence intervals (CI) were response that best described their performed to provide meaningful circumstance. a recreational characteristics (smoking history. 14 and 15 (see referred symptoms related to LBP the Appendix A) allowed confirmation of cyclist had experienced in the past six recreational and LBP status according to months. 2) Type of organised cycling events per year. 3) Number of gears back pain was defined as one or more on the bike. 7) An estimate of the percent of these definitions. 6) Any (18). 5) the low back. values and standard deviations have been line newsletter. years cyclist was defined as any individual who cycling. median the cycle club’s website and monthly on. Statistical Analysis Statistical analysis was completed using Procedures-Data collection Statistical Package for the Social Sciences An information letter and online survey (SPSS) Version 16.0 (16).intjexersci. The level of significance was set at Voluntary return of the completed survey P<0. Participants were instructed to complete the survey When significant differences were questions individually. 4) History of traumatic injury episodes of pain or discomfort in the area of to the lumbar spine in the past two years. days cycled regularly (at least once a week) and cycled per week. whereas between ‘mostly hilly’. sustained a traumatic injury in the previous The survey was piloted with a group of six two years resulting in LBP and/or known cyclists for clarity and appropriateness of lumbar spine pathology.

Twenty-three male and 10 female cyclists (Total N = 33) reported LBP during or after cycling (non-traumatic) within the last six As no statistical difference was identified months. these variables. further analysis of this pain (NLBP) during or after cycling. gender and smoking history females (total = 33) reported no low back in relation to LBP.574). Similarly.06. CI =1. inter- cyclist was a smoker. as smoking has been for km cycled per week and riding with the reported to contribute to LBP (8).3-10. one cyclist Significant differences were identified in smoked.02). Table 1). An odds ratio indicated that people who cycle 160 km or more per week are significantly more likely to experience LBP compared with people who cycle less than 160 km per week (OR=3.2). cycling frequency. A significant difference was groups for age (P=0.63 (calculated according to the presence or not of LBP) indicated that International Journal of Exercise Science 82 http://www.6. No significant differences were evident between LBP and NLBP groups for cycling experience. cyclists complete more than 160 km per week.com . number of gears on the cycle and riding position.CYCLING: LOW BACK PAIN AND TRAINING RESULTS A total of 70 cyclists responded to the survey (response rate of 20%). Four cyclists were ineligible and therefore were excluded from the study due to experiencing LBP as a result of a traumatic accident in the previous two years. six had ceased and 26 quartile range (IQR) =235) and for had never smoked. determined that there was no statistically IQR=228) (P=0. one participants with NLBP (150 ± 35 km. history and those with and without LBP. Twenty-six males and seven between age. Representation of self- significant difference between LBP and reported km cycled per week in Figure 1 NLBP groups with respect to smoking indicates a change in LBP reports once history (P=1. analysis hands on the brakes approached was undertaken comparing smoking significance (P=0. A Chi-square test participants with LBP (250 ± 131 km.00). data set did not require stratification for Participant ages ranged from 18-61 y. Further.intjexersci. Of those participants with LBP. 49 were male and 17 female. five had ceased and 27 had never the median km cycled per week for smoked. Of the remaining 66 cyclists.967) and gender found between the LBP and NLBP groups (P=0. in those with NLBP. A post –hoc power calculation based on an effect size of 0. Response to questions regarding training characteristics and LBP Initial analysis revealed no significant and NLBP groups are summarized in relationship between LBP and NLBP Tables 1 and 2.

Degeneration of the lumbar spine in people aged 40 y and over has been reported (5) and may possibly contribute to the cyclists LBP as opposed to their training characteristics. (18) which may be potential confounders to the DISCUSSION findings regarding mileage cycled and should be included in future research. It is possible that However. While no relationship was spinal injury than males due to anatomical identified between frequency of cycling and differences in trunk muscle size as well as a LBP. between genders with respect to LBP reports.CYCLING: LOW BACK PAIN AND TRAINING with this sample size the study achieved difference in training characteristics greater than 74% power (13). However.4 miles per design. gluteal. cycling 160 or more km per week are anthropometric variables especially with significantly more likely to report LBP. However. However there are a number of the variables. this study did not find a some participants in this survey may have statistically significant difference between experienced LBP within the last three the number of gears on the cycle. contribute to LBP and hence future studies This study did not find any significant International Journal of Exercise Science 83 http://www. the speed and gear setting may combination of trunk coactivity patterns (9). training period or they may have been in a light training phase when survey data was Females are reported to be at greater risk of collected. Professional cyclists vary their training frequency and intensity when preparing for It has been suggested that sustaining one events. (18) that American recreational cyclists best. frequency and intensity. The of hills. gender and LBP and training characteristics of recreational cyclists. Australian recreational cyclists who report These include intensity of training. suggest that during an increased training pushing hard with big gears on the bike for phase cyclists alter the proportion of time prolonged periods and prolonged climbing they spend in each riding position. investigated using a prospective who cycled an average of 104. Future studies with a larger sample may identify significant findings between age. week (168 km) were significantly more likely to report LBP. hamstring and back muscle recreational cyclist may also vary training fatigue contributes to LBP in cyclists (11). This respect to bike set-up and favoured cycling concurs with the findings of Wilber et position at onset of LBP.com . which would be al. there is no evidence to riding position over a long duration. which were not considered in this study or the study by Wilber et al. riding months while undergoing an intense terrain or riding position and LBP reports.intjexersci. this study did not find any significant relationship between age and LBP.

such 1. anthropometric measurements.gov. Collection of the Discipline of Physiotherapy.au clarification of riding position related to /Ausstats/abs. Geographic location did not allow the ACKNOWLEDGEMENTS investigators to measure the height and No external funding or research contract was weight of all survey respondents and self. experiencing LBP during or after cycling O’Sullivan PB. Dannenberg AL. involved in this study.CYCLING: LOW BACK PAIN AND TRAINING should consider these parameters related to information on the relationship between intensity of cycling as possible confounders. Cornelius MW. riding on the brake levers results cyclists. further detail regarding the general health of the cyclist. Available from: http://www. Am J Sports Med 24(6): 747- develop LBP may provide more 753. It is therefore unclear recreational cyclists should include from the survey data which cycling information about bike set-up. International Journal of Exercise Science 84 http://www. Australia: the relationship between obesity and LBP Australian Bureau of Statistics. Kolodner investigating the riding positions of people KB. Predictors of injury among 1638 riders in a who commence cycling and subsequently recreational long-distance bicycle tour: cycle across Maryland. (18) indicate brake lever position to unload the lumbar that 160 km per week is a critical value in spine and reduce their LBP. cited 2008 Jun 10. The project was funded by reports may be unreliable. Spinal kinematics and trunk had altered their riding position to relieve muscle activity in cyclists: a comparison their LBP. 2004. Recreational cyclists with LBP reported more time riding on the brake levers (50%) In summary.abs. not set out to account for changes in riding Future research regarding the relationship position as a consequence of developing between LBP and training characteristics in LBP while cycling. Needle S. Dankaerts W. regarding risk factors for LBP in recreational cyclists. This study did preventing LBP in recreational cyclists. in fact 3. the training position may have been linked to the initial phase of the cyclist and the cyclists’ onset of LBP. training characteristics and LBP in recreational cyclists. 1996. Those cyclists who reported riding in a mid position of the lumbar spine.intjexersci.7%). this study identified a than those with NLBP (36. (6) in recreational cyclists. James Cook anthropometric data would have provided University. In significant difference between self-reported comparison to upright and drops cycling km cycled per week and LBP in recreational positions. This additional information between healthy controls and non-specific should be collected in future studies chronic low back pain subjects – a pilot investigation. and consideration of physical recreation (Internet). LBP would identify if cyclists who reported 2. A prospective study 3. 14) hence cyclists with LBP may who rode less km. 2008. Australia.6 lumbar positions are the cause of LBP in times more likely to report LBP than those cyclists (2. Mullady D. Burnett AF. Additionally. Agreement between this report a preference for the mid-position study and that of Wilber et al. It would also have allowed REFERENCES derivation of an indicator of obesity. ABS: 2008 year book Australia: sports and as body mass index. Man Ther 9(1): 211-219. It has an average of 160 km or more per week previously been suggested that end range were significantly more likely.com .

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