Cycling Lower Back Pain Has Little to Do with Back Strength…

By Chris Centeno, MD /

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cycling lower back pain

Many people believe their cycling lower back pain is caused by having weak back muscles. However, they’ve never heard of the most important back muscles for cycling endurance-which aren’t the ones that you can strengthen easily in the gym. Now a new study confirms that atrophy of the deep abdominal muscles and multifidus are associated with cycling back pain, but paradoxically the overall strength of the big muscles we can see and feel has nothing to do with pain.

Multifidus is the name of a muscle group that 99.9% of patients with low back pain have never heard mentioned in their care. In fact, 99% of their doctors have never heard of this muscle or read the more than 100 research studies showing it’s a key muscle in preventing back pain when it’s healthy and causing back pain when it’s atrophied. This multifidus muscle lives close to the spine and stabilizes the segments of the spine as one bone sits on another. It can quickly atrophy after a first episode of low back pain, leaving the low back vulnerable to further injury.

The deepest abdominal muscle is another structure that most low back pain patients have never heard of before. It’s called the transversus abdominus and it lives under your obliques. It’s the abdominal muscle that protects your low back, but it isn’t strengthened by doing power sit ups. It actually contracts more easily when you bear down or perform a Kegel maneuver.

recent study looked at 14 professional competitive off-road cyclists with low back pain and 24 control subjects without back pain. The interesting finding was that when it came to the overall strength of the back muscles, the cyclists with low back pain had no deficits. However, the endurance of their low back muscles was impacted. More importantly, the multifidus and transversus abdominus muscles were physically smaller on ultrasound imaging.

The upshot? We’ve known for a very long time that the multifidus and transversus abdominus muscles are key players in the maintenance of long-term low back pain. Despite this, few physical therapists have any clue about how to strengthen them or even access them if they’re weak. Even fewer physicians or radiologists bother to look on the patient”s low back MRI to see if they’re atrophied. This is despite these being very easy measurements. So if you’ve got low back pain and love cycling and have never heard either of these muscle terms, it may be time to find new medical providers! To start, you need an MRI or ultrasound assessment where the size of these muscles are measured!

Chris Centeno, MD

Regenexx Founder

Chris Centeno, MD is a specialist in regenerative medicine and the new field of Interventional Orthopedics. Centeno pioneered orthopedic stem cell procedures in 2005 and is responsible for a large amount of the published research on stem cell use for orthopedic applications.
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