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Bike fit and low back pain
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I'm looking to get a conversation started about good bike fit in conjunction with back pain. I went to pretty Great Lengths to have my physical therapist involved in my bike fit and was able to get extremely long and flat. I do suffer from some mild low back problems but is pretty easily controlled with daily stretching and strengthening. However riding in this position long and low with a very flat back is very difficult for me to hold because of shoulder pain and when the ride is over it is impossible for me to run out of that position. So I'm looking for some advice on finding a happy medium and what has worked for other people.
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Re: Bike fit and low back pain [Fishbum] [ In reply to ]
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Maybe not so low.
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Re: Bike fit and low back pain [jimatbeyond] [ In reply to ]
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jimatbeyond wrote:
Maybe not so low.


I have raised the front end 2 & a half centimeters. And tilted my pads and Aero bars six degrees. This has made the front end more comfortable for my shoulders however it has left me with more of an arch in my back which is what I was trying to get away from
Last edited by: Fishbum: Jun 18, 17 15:52
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Re: Bike fit and low back pain [Fishbum] [ In reply to ]
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Maybe raise it some more.
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Re: Bike fit and low back pain [Fishbum] [ In reply to ]
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I'm in a somewhat similar boat. What's the physical problem? I think the type of injury will maybe impact what to do. Second, can you post a pic? It may be any number of problems.

I switched saddles and extended+raised my cockpit to stretch my back out, but it wasn't until I lowered my saddle about 1cm that things clicked. And as slowman has pointed out, you can probably lose much more being too high than too low. Maybe not a panacea, but a good place to start (w/o any other info).

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Life is tough. But it's tougher when you're stupid. -John Wayne
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Re: Bike fit and low back pain [Fishbum] [ In reply to ]
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Pull the extensions off the bike and get on the trainer. Then with your arms resting on the pads,ask yourself where do your hands naturally fall/feel comfortable. Get extensions that match the hand position that does not create tension in your back.

Other tricks. Tilt the saddle forward a couple of degrees.

Bring the saddle down and back a couple mm
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Re: Bike fit and low back pain [grumpier.mike] [ In reply to ]
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Agree, the logical next step imho is to drop the saddle a little, and I would start with 1cm. Any mitigation of a dead flat and horizontal bac will be compensated by the ever so slightly lower position. This worked for me after trying several other changes. Of course I still don't run after a ride but my lower back is pretty degenerated (age related).
Last edited by: NealH: Jun 19, 17 1:14
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Re: Bike fit and low back pain [NealH] [ In reply to ]
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Having problems posting pictures.
Last edited by: Fishbum: Jun 19, 17 5:04
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Re: Bike fit and low back pain [Fishbum] [ In reply to ]
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Fishbum wrote:
I'm looking to get a conversation started about good bike fit in conjunction with back pain. I went to pretty Great Lengths to have my physical therapist involved in my bike fit and was able to get extremely long and flat. I do suffer from some mild low back problems but is pretty easily controlled with daily stretching and strengthening. However riding in this position long and low with a very flat back is very difficult for me to hold because of shoulder pain and when the ride is over it is impossible for me to run out of that position. So I'm looking for some advice on finding a happy medium and what has worked for other people.
saddle is probably too high.

If you're generally fit, shoulder discomfort can usually be alleviated with adjustments to the armpad position. If you're "too low", your neck (or your riding posture) is likely to blame.

Trent Nix
Tri Shop - Plano, Texas
http://www.trishop.com
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F.I.S.T. Advanced Certified Fitter | Retul Master Certified Fitter
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Re: Bike fit and low back pain [trentnix] [ In reply to ]
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trentnix wrote:
Fishbum wrote:
I'm looking to get a conversation started about good bike fit in conjunction with back pain. I went to pretty Great Lengths to have my physical therapist involved in my bike fit and was able to get extremely long and flat. I do suffer from some mild low back problems but is pretty easily controlled with daily stretching and strengthening. However riding in this position long and low with a very flat back is very difficult for me to hold because of shoulder pain and when the ride is over it is impossible for me to run out of that position. So I'm looking for some advice on finding a happy medium and what has worked for other people.
saddle is probably too high.

If you're generally fit, shoulder discomfort can usually be alleviated with adjustments to the armpad position. If you're "too low", your neck (or your riding posture) is likely to blame.

I'm a little confused as to what you are saying. How does this apply to my low back issue I've been able to correct the shoulder problem
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Re: Bike fit and low back pain [Fishbum] [ In reply to ]
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 Frequently when I hear of low back problems on a tri bike, the saddle will be too high causing a bit of rocking to reach for the pedals. I've also seen it when the saddle is too low and the rider is pushing away from the pedals to get an improved extension.

The lower back has to stabilize the torso while the pelvis rocks back and forth and that can cause muscle fatigue and tightening. If you could get some pictures or video from the side, it would be easier to assess as opposed to my attempt at blind speculation.

Please excuse if this reads abrupt - I'm posting from my phone.

Trent Nix
Tri Shop - Plano, Texas
http://www.trishop.com
Facebook | Twitter | Instagram | Youtube
F.I.S.T. Advanced Certified Fitter | Retul Master Certified Fitter
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Re: Bike fit and low back pain [Fishbum] [ In reply to ]
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And you had mentioned not being able to sustain aero due to shoulder discomfort. Raising the cockpit is often the solution my clients self-prescribe, but it's not always the best solution. I'd say I raise the cockpit with only one out of every 20 clients reporting shoulder discomfort in aero.

Trent Nix
Tri Shop - Plano, Texas
http://www.trishop.com
Facebook | Twitter | Instagram | Youtube
F.I.S.T. Advanced Certified Fitter | Retul Master Certified Fitter
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Re: Bike fit and low back pain [Fishbum] [ In reply to ]
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Fishbum wrote:
I'm looking to get a conversation started about good bike fit in conjunction with back pain. I went to pretty Great Lengths to have my physical therapist involved in my bike fit and was able to get extremely long and flat. I do suffer from some mild low back problems but is pretty easily controlled with daily stretching and strengthening. However riding in this position long and low with a very flat back is very difficult for me to hold because of shoulder pain and when the ride is over it is impossible for me to run out of that position. So I'm looking for some advice on finding a happy medium and what has worked for other people.

Here is the problem with 98% of the positions that I see at races. They are cool on paper, non sustainable in practice (and when I say non sustainable, I mean not just for getting through the bike fast, but getting to the finish line the fastest way possible).

Too many of you look at a certain factor of tri in isolation, when you really should be focused on the clock at the finish line. Now to get to the finish line "faster" what should you do. Without looking at you, I'd instantly start with pads and extensions a few cm closer (x axis), pads a few cm higher (y axis), maybe saddle a cm forward and saddle height a cm lower. I'm not saying this is the final recommendation, but just move x and y axis tighter all around so your body is more compact. You might feel this is a ridiculous "comfort position" but starting from that you can experiment and gradually move things out a few mm at a time on each adjustment until you get something that is sustainable that you can hold for your entire bike split without leaving the aero position and get off from and run instantly.

Start with that and move outwards gradually. All of this may also be race duration dependent.

here is Jurgen "mr. lower back pain"....fastest bike split almost every year he showed up in Kona and Roth





And here is Thomas Hellriegel during his 1997 Kona win in a full tourist set up:


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Re: Bike fit and low back pain [devashish_paul] [ In reply to ]
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Thanks for your responses guys. I'm having problems posting pictures and videos to slowtwitch from my phone. I'm going to try a little later in the day after my wife is home from work on her phone. When I say I raised my cockpit I should say that I put it back to wear my FIT originally had it as I had tried to go lower to get flatter in the back at the recommendation of my physical therapist. He is warning me not to ride for long periods of time with the large arch in my back that you get from having a shorter reach and a constantly flexed back. However riding extremely aggressive with the very flat back is obviously not sustainable as I posted before. So I put my cockpit back to the original height which is what I should have said rather than saying I raised it two and a half centimeters. And I'm going to lower the saddle however this will give me a flexed back so I feel like I'm in a little bit of a conundrum
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Re: Bike fit and low back pain [Fishbum] [ In reply to ]
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Are you actually getting back pain while riding or are you trying to avoid it? Treat the back pain fully and you will definitely tolerate a flexed back position. Don't forget to ease into it, there is something to be said for gradual accommodation.
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Re: Bike fit and low back pain [Fishbum] [ In reply to ]
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Hey guys I just wanted to take a second to thank you for all your help. I had a conversation with Trent a few hours ago and he was extremely helpful and Paul you've answered several of my questions over the past couple years and also been extremely forthcoming with good information. And many other people on here that I can't recall
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Re: Bike fit and low back pain [Calvinbal6] [ In reply to ]
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Calvinbal6 wrote:
Are you actually getting back pain while riding or are you trying to avoid it? Treat the back pain fully and you will definitely tolerate a flexed back position. Don't forget to ease into it, there is something to be said for gradual accommodation.

Yes the back pain gets progressively worse as the ride goes on. Starts to feel like I'm going to have a spasm. I do treat my back problem through Physical Therapy stretching and exercises almost daily. As I've transition into a full try bike I'm struggling with finding a position that does not cause me back problems yet is not ridiculously up right
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Re: Bike fit and low back pain [Fishbum] [ In reply to ]
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If your pain is getting worse as you ride and you continue to do it, you won't get better. You need relative rest- do less than what is provoking the back pain. The position is obviously too taxing for you. However, it might be perfectly fine once your active back symptoms are under control. Avoid knee to chest stretching, touching your toes, hamstring stretching, prolong sitting. These all reproduce the flexed lumbar spine. It seems that you are likely to achieve the most benefit from extension stretching- press ups. Even so, you need some rest and cannot push through and expect it to get better. A position change will not fully solve this.
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Re: Bike fit and low back pain [Calvinbal6] [ In reply to ]
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Well I just got back from a ride not long 10 miles. But I was able to hold the position much better with the changes that were made. I lower the saddle just under a centimeter. As I stated before I had brought the front end up two and a half centimeters and pitched the pads and Aero bars up six degrees. Also pushed the Saddleback another centimeter. Much less back pain. Much less shoulder pain. Feeling more confident about it now even though I'm nowhere near as Aero.
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Re: Bike fit and low back pain [Fishbum] [ In reply to ]
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The first rule of fit club...never judge a fit until you see the rider on the bike. But, it's Slowtwitch so:


To quote the great Dan Empfield....I'm the fitter, not the coach. You should politely appropriate that quote for your PT. So, saddle up? Saddle down? Fore? Aft? What nobody has mentioned is the saddle itself. Does it support you? Does it provide channel relief? Does it allow proper anterior rotation of the pelvis - if no to any of those. Scratch the entire fit and start over.
Why?
Because the saddle is, watch this, the most important thing.
It also determines the entire fit. So, you can move it around, you can raise it or lower it. You can kick it down the street. Same with bar position. But if you can't meet the 3 criteria, you're going to have pain and try to find the cause somewhere else. A saddle that doesn't do those things is gonna hurt. How you compensate for that will determine where that expresses itself. Back pain is an output not an input.

Now to quote Eric Thomas The Hip Preacher. I can't explain it to you any better than that, so you just gotta feel me on this...
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Re: Bike fit and low back pain [Fishbum] [ In reply to ]
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Fishbum wrote:
Well I just got back from a ride not long 10 miles. But I was able to hold the position much better with the changes that were made. I lower the saddle just under a centimeter. As I stated before I had brought the front end up two and a half centimeters and pitched the pads and Aero bars up six degrees. Also pushed the Saddleback another centimeter. Much less back pain. Much less shoulder pain. Feeling more confident about it now even though I'm nowhere near as Aero.

As an experiment I'd be interested in seeing you try using what's called a Trochanter belt during your ride. This belt is an aid to the SI joint(s) by providing compression, and it also works on the hip flexors with a bit of ART action. I got one off Ebay 2" Bodysport. I used it all day today actually from ride to swim back to riding then running.

If you have a compromised SI joint for any reason that forward-bent pedalling position will eventually start to gnaw or pull at it no matter how good your fit is. It's because biking is inherently an imbalanced activity front <> back (it is symmetrical side <> side of course). The SI seems to be ground zero or the intersection point for all things hip-related. So short fronts, tight sides = pulling and pain

One of the most complex areas to re-hab & strengthen is the SI/ Lower lumbar region. I think current PT protocols are close, but go at it with a bit of a shot-gun approach. Therefore it's very difficult to find the actual problem "fix".

I believe the rehab solution is in taking 3D approach by working rotationally around a blocked or held pelvis. Which inverts the activities that got you there in the first place. Again a bit too complicated to outline in a few sentences.

Training Tweets: https://twitter.com/Jagersport_com
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Re: Bike fit and low back pain [Fishbum] [ In reply to ]
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Fishbum wrote:
Feeling more confident about it now even though I'm nowhere near as Aero.


Comfortable and sustainable is fast especially when you have to run.

I herniated l5 and run a fairly compact low drop set up and can't complain about the speed I get out of the set up. If I tried to go long and low I'd get crazy sciatica down my hamstring.
Last edited by: TriguyBlue: Jun 20, 17 22:50
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Re: Bike fit and low back pain [Fishbum] [ In reply to ]
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Fishbum wrote:
I'm looking to get a conversation started about good bike fit in conjunction with back pain. I went to pretty Great Lengths to have my physical therapist involved in my bike fit and was able to get extremely long and flat. I do suffer from some mild low back problems but is pretty easily controlled with daily stretching and strengthening. However riding in this position long and low with a very flat back is very difficult for me to hold because of shoulder pain and when the ride is over it is impossible for me to run out of that position. So I'm looking for some advice on finding a happy medium and what has worked for other people.

What kind of strength work are you doing. I have had some shoulder issues as well in the last year or so. I have found that doing squats with a bar + about 30-40kg has helped loosen things up and release some some tension I was holding on one side. I only had the pain in the aerobars in one shoulder and doing squats at first was challenging but day by day it got better.


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Re: Bike fit and low back pain [Thomas Gerlach] [ In reply to ]
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Squats???? For shoulder pain? Did I read this wrong?
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Re: Bike fit and low back pain [Fishbum] [ In reply to ]
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