BACK AND PELVIC PAIN WITH CYCLING

Cyclists who ride with the trunk leaning forward are likely to trigger or worsen any malalignment-related back or pelvic pain as a result of:

INCREASING THE STRESS ON THE BASE OF THE NECK
The rider either constantly or intermittently bends backward at the neck in order to bring the head up into a position that allows them to see the road ahead. This increases the angle and, with it, the stress, at the junction of the cervical and thoracic part of the spine at the base of the neck, a stress that is further increased by the usual reversal of any compensatory curves at this junction (Fig. 5: upper “x”; for figures other then 17 to 21 see Cycling & Alignment part 1 & 3).

FURTHER INCREASING TENSION IN THE BACK MUSCLES AND LIGAMENTS
A number of the muscles in the neck and along the back of the spine and rib cage are already tense, and often tender, as a result of the malalignment (Fig. 12). Holding the trunk in a forward-bent position and bringing the head upward when cycling requires an ongoing contraction of back muscles from the neck down to the pelvis to maintain this posture and prevent the trunk from falling forward (Fig. 17A). Bending forward also puts the ligaments at the back of the spine and pelvis under increased tension (Fig. 18). A number of these are already being stressed by the malalignment, especially those spanning the back of the sacroiliac or SI joint that may present as abnormal sensations and/or pain in the right or left buttock region.

Certain structures are often already tender because of the malalignment and may become painful with sitting. In particular:

  • Any ligaments and tendons in the buttock and pelvic region that are being pressed on; they are vulnerable, given that they tend to be rich in nerve fibres but lacking in blood supply and are, therefore, more likely to be irritated
  • The parts of the hipbone that the cyclist sits on (the sitting bones), which also serve as an attachment point for the sacrotuberous ligament and origin of the hamstrings on each side (Figs. 2, 19)
  • The tailbone itself (Figs. 18, 19)
  • The pubic joint and the displaced bones to either side (Figs. 1, 3, 4)

THE SADDLE PUTTING DIRECT PRESSURE ON TENDER SITES

Fig 17A

Fig 17B

Fig 17C

Fig 18

Fig 19

Fig 20

Fig 21A
Before

Fig 21B
After

Realignment of horse and rider

UNEVEN PRESSURE DISTRIBUTION ON THE SADDLE

In addition to the problem of sitting on or otherwise stressing a painful structure, seating problems can also be caused by the uneven weight-bearing that results from the malalignment. For example, with a right upslip or when the right hipbone is stuck in a forward rotated position, its lowest part—the sitting bone—will have moved upward relative to the left one. As a result, the left sitting bone is now lower than the right (Fig. 20) and, as is the case with the horseback rider in (Fig. 21A), ends up bearing more weight.

Cyclists may be aware that they are bearing more weight on the left buttock and may try to counter this feeling of not being balanced and get some relief of any discomfort by:

  • Deliberately shifting more toward the centre or on to the right buttock to decrease this side-to-side difference
  • Filling in the gap between the right buttock and seat by putting a hand in between them intermittently (i.e., sitting on the hand), placing a thin pillow underneath that side, or stuffing some padding inside the training shorts to lie under the right sitting bone

MEASURES TO CONSIDER IF CYCLISTS DEVELOP ANY OF THESE PROBLEMS

CHANGING THE BICYCLE SETUP WHEN OUT ON THE ROAD
Riders can decrease how far the trunk leans forward simply by raising the handlebars until the forearms are positioned closer to horizontal, or at least raising them as high as is tolerated and still feels comfortable. Additional seat padding in the form of a pillow or viscoelastic gel cover will increase shock absorption and decrease pressure on a tender structure. Accommodative seats that are elevated on each side increase the amount of weight borne by the sitting bones, and the groove formed in between decreases the pressure exerted on the tailbone, genitals, and pubic joint/bones which are particularly vulnerable, especially when leaning forward for longer periods of time (Figs. 1, 3, 4, 17B,C). The increased ability of mountain bikes to absorb shock makes them preferable to standard bikes even for riding on regular roads.

TEMPORARILY TRAINING ON A STATIONARY BICYCLE
In comparison to having to lean forward to hold on to drop-bars (Fig. 17A), the raised handlebars allow for sitting with the trunk fairly upright and intermittently riding with the arms hanging by the side, thereby minimizing tension in the muscles and ligaments of the neck, shoulder girdle, back, buttock, and tailbone regions. It also helps to maintain the normal hollow of the lumbar spine, which effectively decreases tension in structures along the length of the back. Weight-bearing is more effectively shifted onto the sitting bones and may, in fact, avoid putting any pressure on the tailbone, depending on the seat construction (see “Impaired Seating” below; Fig. 17B,C).

TRAINING ON A RECUMBENT BICYCLE
This allows for relaxation of the back muscles and ligaments by getting some support from the back rest and bearing more weight on the thighs, minimizing direct pressure on the sacrum/tailbone area.
TAKING A BREAK FROM CYCLING TO ALLOW FOR RECOVERY
If cycling repeatedly stirs up tailbone symptoms or other musculoskeletal pains, it may be best to avoid this activity temporarily. Riding on a recumbent bike instead is worth a try, as it sometimes gets around triggering or aggravating any symptoms until these problems finally start to respond to a treatment program aimed at achieving and maintaining realignment.