Physio Bike Fit Case Study, Lower Back & Hip Pain

# Bike Fit Case Study: Lower Back and Hip Pain When Cycling

Pre Bike Fit Discussion

A 45 year-old cyclist, reported 2 years of worsening lower back and hip pain. Now he can only ride 1 hour before he has to stop and stretch. He used to take part in amateur road racing but now his lower back pain limits him pushing beyond Zone 2 Efforts.

He did seek advise from his GP who referred him to the Musculoskeletal Interface Team who offered X-rays of his hip and back, finding moderate arthritis throughout with a minimal joint space between L4 and L5 of his lumbar spine. if the pain and movement in his hip gets worse then a referral to an Ortho Surgeon for a total hip replacement could be made. His lumbar spine pain was only on the bike so he decided to try a bike fit first before seeking a surgical opinion.

The Physio Assessment

Firstly I carried out an in-depth biomechanical assessment focusing on the hips, lower back, sacroiliac joints, and associated muscles relating to his core and legs.

During the evaluation, I discovered limited range of movement in his lumbar spine and hips which confirmed the findings in his X-ray. Additionally, there was a noticeable leg length difference of 6mm. Fortunately, no issues were found with their sacroiliac joints.

He had limited core strength including his gluts and deep abdominal muscles.

There was also excessive over-pronation in his feet with low arches. Otherwise his feet were of equal length.

Bike Fit Adjustments

To address the leg length discrepancy, I fitted cleat shims. This adjustment resolved an asymmetrical pedal stroke. I also moved his saddle forward to flatten his back and relieve pressure on his already limited lumbar spine.

For his left hip arthritis and limited range of movement I fitted 165mm cranks which stopped the hip impinging at the top of the pedal stroke his left knee from tracking out.

Using the handle bar and stem jig I determined a longer stem was needed, which reduced the weight in his hands whilst keeping his spine in a neutral position.

Saddle Pressure Mapping

Saddle pressure mapping revealed that his stability in the saddle improved significantly with a saddle that suited his sit bone width and lumbar flexibility. This adjustment was crucial for enhancing his overall comfort during rides but also stabilising his pelvis to reduce the risk of lower back pain.

Conclusion

8 Weeks later he reported his lower back pain and hip pain had resolved when cycling. He is now able to train properly for his next cycling event which requires averaging 40kmph for 1 hour.

I also retested his core strength and he is now able hold a stable posture on the bike whilst in Zone 3 for 20 minutes which compared with 8 weeks ago he he would lose core stability in Zone 2 after 5 minutes. Proving an exercise programme in addition to the bike fit was required to resolve his symptoms but also improve his performance on the bike.

Get In Touch

Contact Jake at Physio Fit Bristol to find out how I can help you ride pain free with a bike fit tailored to your symptoms and cycling goals.