Recreational Cyclists: The Relationship Between Low Back Pain and Training Characteristics

Abstract

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.

Full text

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

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frequency of LBP in 20% of participants
(14). Burnett et al. (2) recruited 18 subjects
to participate in a pilot study examining
whether differences in spinal kinematics
exist in cyclists with and without chronic
LBP. Spinal kinematics was calculated
using an electromagnetic tracking system
and abdominal and back muscle activity
was recorded with electromyography.
Subjects were requested to ride in one of
two different riding positions; being on the
drops or on the aero bars (similar to the
brake position with arms stretched further
forward). The results of this study
identified a trend toward increased flexion
and axial rotation of the lower lumbar spine
with a loss of co-contraction of the
multifidus muscle in nine cyclists with non-
specific chronic LBP (2). Furthermore,
increased upper lumbar spine rotation and
flexion was reported to be associated with
no back pain (2). However, these findings
were not statistically significant, possibly
due to the various cycling positions and
small sample size.
Additionally, it is a belief in the cycling
community that intensity, frequency and
duration of training may influence the
prevalence of non-traumatic injuries in
cyclists including reports of LBP (4).
However, a search of the literature using a
systematic approach identified only three
papers investigating overuse injuries,
including LBP, and training characteristics
in recreational cyclists. Of these, two
studies reported low prevalence of LBP in
cyclists, 2.7% (17) and 16% (7), with no
conclusions available regarding training
characteristics and LBP. Wilber et al. (18)
investigated overuse injuries including LBP
and training characteristics in recreational
cyclists from northern and southern
California. They reported that male cyclists
who cycled 104.4 miles per week (168
kilometres (km)) were significantly more
likely to report LBP than cyclists who
cycled 77.1 miles (124 km) per week
(p<0.05) (10). In addition, cyclists who
reported less number of gears on the cycle
(13 gears compared to 15 gears; p<0.05)
were significantly more likely to report
LBP. However, no significant relationship
between diet, education, cycling equipment
and attire, and hazards encountered when
cycling and LBP was identified. Other
factors, which may contribute to LBP,
include age related degeneration of lumbar
joints and discs (5,12) and a history of
cigarette smoking (8).
In the last decade bike design has advanced
and cyclists have adopted more
aerodynamic riding positions. Further the
increase in popularity of recreational
cycling and no available information in the
Australian context warrants investigation
of training characteristics in relation to LBP
in recreational cyclists. The current study
modified the survey of Wilber et al. (18) to
specifically investigate the relationship
between LBP and training characteristics in
recreational cyclists.
METHODS
Participants
Ethics approval for this study was granted
by the Human Research Ethics Committee
of James Cook University, Townsville.
Cyclists aged 18 years and over belonging
to regional and metropolitan cycling clubs
in Queensland were recruited by invitation.
Survey
A survey was used to collect demographic
information. It included questions from the
survey of Wilber et al. (18) and other

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questions considered pertinent to the aims
of this study: 1) Individual and training
characteristics (smoking history, years
cycling, kilometres cycled per week, days
cycled per week, cycling pace and number
of cycling events per year), 2) Type of
handlebars on the bike, 3) Number of gears
on the bike, 4) History of traumatic injury
to the lumbar spine in the past two years, 5)
LBP during or after cycling within the past
three or the past six months, 6) Any
referred symptoms related to LBP the
cyclist had experienced in the past six
months, 7) An estimate of the percent of
time spent cycling in different riding
positions and 8) The type of cycling terrain.
The survey was piloted with a group of six
cyclists for clarity and appropriateness of
the questions before a final survey was
produced and employed in the study (13).
Procedures-Data collection
An information letter and online survey
were distributed to cycle club members via
the cycle club’s website and monthly on-
line newsletter. Reminder e-mails was sent
one month after the initial survey
distribution. Information sheets inviting
cyclists to participate in the study were also
distributed during cycling events.
Voluntary return of the completed survey
constituted participant consent. Participants
were instructed to complete the survey
questions individually. In many instances
the survey provided participants with a
number of possible responses and
participants were asked to choose the
response that best described their
circumstance. For example when asked to
report the terrain in which they mostly
cycled participants were asked to choose
between ‘mostly hilly’, ‘mostly flat’ and
‘flat with rolling hills’
Procedures-Data management
For the purpose of this study, a recreational
cyclist was defined as any individual who
cycled regularly (at least once a week) and
did not participate in more than 50
organised cycling events per year. Low
back pain was defined as one or more
episodes of pain or discomfort in the area of
the low back, experienced during or after
cycling within the last three to six months
(18). Survey questions 9, 14 and 15 (see
Appendix A) allowed confirmation of
recreational and LBP status according to
these definitions. Questions 13 and 16
allowed identification of those who had
sustained a traumatic injury in the previous
two years resulting in LBP and/or known
lumbar spine pathology.
Statistical Analysis
Statistical analysis was completed using
Statistical Package for the Social Sciences
(SPSS) Version 16.0 (16). As the numeric
variables were non-parametric, median
values and standard deviations have been
presented. Mann-Whitney or chi-square
tests were performed to determine
significant differences between the training
characteristics of cyclists with and without
LBP. The level of significance was set at
P<0.05.
When significant differences were
identified logistic regression was
performed to adjust for potentially
confounding variables. Odds ratios (OR)
and confidence intervals (CI) were
performed to provide meaningful
interpretation of significant findings. When
the lower 95% CI of the OR exceeded 1 the
odds were significantly elevated, whereas
when the upper CI of the OR was less than
1, the odds were significantly protective.

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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. Of the remaining 66
cyclists, 49 were male and 17 female.
Twenty-three male and 10 female cyclists
(Total N = 33) reported LBP during or after
cycling (non-traumatic) within the last six
months. Twenty-six males and seven
females (total = 33) reported no low back
pain (NLBP) during or after cycling.
Participant ages ranged from 18-61 y.
Initial analysis revealed no significant
relationship between LBP and NLBP
groups for age (P=0.967) and gender
(P=0.574). Further, as smoking has been
reported to contribute to LBP (8), analysis
was undertaken comparing smoking
history and those with and without LBP. Of
those participants with LBP, one cyclist
smoked, five had ceased and 27 had never
smoked. Similarly, in those with NLBP, one
cyclist was a smoker, six had ceased and 26
had never smoked. A Chi-square test
determined that there was no statistically
significant difference between LBP and
NLBP groups with respect to smoking
history (P=1.00).
As no statistical difference was identified
between age, gender and smoking history
in relation to LBP, further analysis of this
data set did not require stratification for
these variables. Response to questions
regarding training characteristics and LBP
and NLBP groups are summarized in
Tables 1 and 2. A significant difference was
found between the LBP and NLBP groups
for km cycled per week and riding with the
hands on the brakes approached
significance (P=0.06; Table 1).
Significant differences were identified in
the median km cycled per week for
participants with NLBP (150 ± 35 km, inter-
quartile range (IQR) =235) and for
participants with LBP (250 ± 131 km,
IQR=228) (P=0.02). Representation of self-
reported km cycled per week in Figure 1
indicates a change in LBP reports once
cyclists complete more than 160 km per
week. 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=3.6, CI =1.3-10.2). No
significant differences were evident
between LBP and NLBP groups for cycling
experience, cycling frequency, number of
gears on the cycle and riding position. A
post –hoc power calculation based on an
effect size of 0.63 (calculated according to
the presence or not of LBP) indicated that

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with this sample size the study achieved
greater than 74% power (13).
DISCUSSION
Australian recreational cyclists who report
cycling 160 or more km per week are
significantly more likely to report LBP. This
concurs with the findings of Wilber et
al. (18) that American recreational cyclists
who cycled an average of 104.4 miles per
week (168 km) were significantly more
likely to report LBP.
It has been suggested that sustaining one
riding position over a long duration,
pushing hard with big gears on the bike for
prolonged periods and prolonged climbing
of hills, gluteal, hamstring and back muscle
fatigue contributes to LBP in cyclists (11).
However, this study did not find a
statistically significant difference between
the number of gears on the cycle, riding
terrain or riding position and LBP reports.
Females are reported to be at greater risk of
spinal injury than males due to anatomical
differences in trunk muscle size as well as a
combination of trunk coactivity patterns (9).
This study did not find any significant
difference in training characteristics
between genders with respect to LBP
reports. 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. However, this study did not
find any significant relationship between
age and LBP. Future studies with a larger
sample may identify significant findings
between age, gender and LBP and training
characteristics of recreational cyclists.
However there are a number of the
variables, which were not considered in this
study or the study by Wilber et al. (18)
which may be potential confounders to the
findings regarding mileage cycled and
should be included in future research.
These include intensity of training,
anthropometric variables especially with
respect to bike set-up and favoured cycling
position at onset of LBP, which would be
best, investigated using a prospective
design.
Professional cyclists vary their training
frequency and intensity when preparing for
events. However, there is no evidence to
suggest that during an increased training
phase cyclists alter the proportion of time
they spend in each riding position. The
recreational cyclist may also vary training
frequency and intensity. It is possible that
some participants in this survey may have
experienced LBP within the last three
months while undergoing an intense
training period or they may have been in a
light training phase when survey data was
collected. While no relationship was
identified between frequency of cycling and
LBP, the speed and gear setting may
contribute to LBP and hence future studies

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should consider these parameters related to
intensity of cycling as possible confounders.
Recreational cyclists with LBP reported
more time riding on the brake levers (50%)
than those with NLBP (36.7%). In
comparison to upright and drops cycling
positions, riding on the brake levers results
in a mid position of the lumbar spine. It has
previously been suggested that end range
lumbar positions are the cause of LBP in
cyclists (2, 14) hence cyclists with LBP may
report a preference for the mid-position
brake lever position to unload the lumbar
spine and reduce their LBP. This study did
not set out to account for changes in riding
position as a consequence of developing
LBP while cycling. It is therefore unclear
from the survey data which cycling
position may have been linked to the initial
onset of LBP.
Geographic location did not allow the
investigators to measure the height and
weight of all survey respondents and self-
reports may be unreliable. Collection of
anthropometric data would have provided
further detail regarding the general health
of the cyclist. It would also have allowed
derivation of an indicator of obesity, such
as body mass index, and consideration of
the relationship between obesity and LBP
(6) in recreational cyclists. Additionally,
clarification of riding position related to
LBP would identify if cyclists who reported
experiencing LBP during or after cycling
had altered their riding position to relieve
their LBP. This additional information
should be collected in future studies
regarding risk factors for LBP in
recreational cyclists. A prospective study
investigating the riding positions of people
who commence cycling and subsequently
develop LBP may provide more
information on the relationship between
training characteristics and LBP in
recreational cyclists.
In summary, this study identified a
significant difference between self-reported
km cycled per week and LBP in recreational
cyclists. Those cyclists who reported riding
an average of 160 km or more per week
were significantly more likely, in fact 3.6
times more likely to report LBP than those
who rode less km. Agreement between this
study and that of Wilber et al. (18) indicate
that 160 km per week is a critical value in
preventing LBP in recreational cyclists.
Future research regarding the relationship
between LBP and training characteristics in
recreational cyclists should include
information about bike set-up, the training
phase of the cyclist and the cyclists’
anthropometric measurements.
ACKNOWLEDGEMENTS
No external funding or research contract was
involved in this study. The project was funded by
the Discipline of Physiotherapy, James Cook
University, Australia.
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