I’ve heard some PTs say you shouldn’t ride in an aero position post lumbar herniation. I’ve had this discussion with friends and based upon a PT saying aero position would be really bad post lumbar herniation, I might have a hard time convincing my wife I should buy a new triathlon bike! My thought is, provided I can be in an aero position, but with a flat back, I should be ok… Wanted to see if others out there have some insight? Any physical therapists able to weigh in on this?
My surgeon was like 60 when he removed my lumbar herniation and said it was the biggest piece he’d ever removed. Going low is zero limiter for me and yes 10 years later I still have back issues. Rock that pelvis forward.
I had two herniated discs and surgery as I had foot drop and had no issue with tri position. I’ve been told by a fitter that aero is not an issue as it is all about the pelvis rotation not my back.
I’ve heard some PTs say you shouldn’t ride in an aero position post lumbar herniation.
Why ?
I herniated L5 and i find the aero position to be far easier on my back that riding a road bike on the hoods, can easily do 3hour plus on the aero bars with no soreness. But, i wouldn’t go out on my bike if the injury is fresh, i spent a year on painkillers and doing laps in the pool before i got adventurous with my exercise program, i didn’t do triathlon back then anyway.
Most of the pressure on aero bars is transferred to your shoulders, your lower back doesn’t really take a lot of strain.
The working theory is that repeated lumbar flexion causes disc herniations. So after you remove the herniation and stitch up the disc, that posterior wall is now weaker and easily subject to rein jury. So prolonged periods on a bike in a flexed position can create lower back symptoms exactly like prolonged sitting or driving. Stretching in the opposite direction (extension) can go a long way to reduce the accumulated increased forces of prolonged flexion. Your guiding principles should be how you feel. Start slow and if things go south, get off the bike and stretch into extension.
I have surgically repaired L3/L4 and a history of L4/L5 problems. Four straight years of IM racing and training without any issues other than occasional lower limb numbness toward the end of long rides. The only time I have any real problems is trying to hold over 90% FTP in aero, so I generally avoid that. My suggestions: (1) like others advised, rock or roll the pelvis forward on the saddle, (2) stretch and release the hip flexors and rotators on a regular basis after riding and (3) if you have a desk job, consider a standup desk for a couple hours/day to help offset.
Also keep in mind that a good aero position rotates you forward, it doesn’t fold you in half and the biggest change going “lower” will be the angle of your neck. I’m pretty low, but my hips are still fairly open and I’m really not folded forward all that much.
That being said, there may be a position compromise that reduces the curve or you back. But I’m not a PT or orthapedist.
This reminds me of a conversation after my spine fusion.
Me: Oh well, so much for me finally learning yoga.
Friend: Why? Maybe now you’ll keep your back flat during Downward Dog like you’re supposed to.
Agreed. I think this is why I often find riding my TT bike easier on my back than riding my road bike. My hip flexors generally feel more compressed on my road bike.
I can only speak for myself. Horrible sciatica and leg pain with radiculopathy after a long car ride a few years ago. Several weeks of no sleep, steroids, gabapentin. MRI performed. L5-S1 herniation with nerve root impingement. Doctor said worst he had seen in a while. Recommend surgery. I opted to try conservative care first. had a CT guided nerve root injection. Slowly improved. Back to running, biking within a few months. Triathlon bug bit me and since then have done a bunch of 70.3’s and a 140.6. Pretty aggressive position for a guy in his early 50’s. I have not had an issue since. Possibly slightly weakness right side but nothing that anyone but I can tell. I might go so far as to say that tri position with weight evenly distributed and relaxed is better than being aggressive on a road or mountain bike. I am rotated forward quite a bit and have good skeletal support of my upper body.
Thanks for the replies everyone!
The working theory is that repeated lumbar flexion causes disc herniations. So after you remove the herniation and stitch up the disc, that posterior wall is now weaker and easily subject to rein jury. So prolonged periods on a bike in a flexed position can create lower back symptoms exactly like prolonged sitting or driving.
I have the feeling that the PT that made the blanket statement that “aero position post lumbar herniation was bad” was basing it on this working theory and was also assuming that aero position always creates lumbar flexion. Unfortunately, this blanket statement and assumption I’m afraid might lead some triathletes to move towards a road bike that could ultimately lead to worse lumbar flexion as they attempt to get aero on a road bike! In reality, a person needs to work with a knowledgeable bike fitter and work to achieve as aero a position they can reach while keeping their lower back flat!
1 year after microdiscectomy l4 l5. Mtb worsens my symptoms a bit. Riding on the hoods and aero on tt greatly improves my condition. Basically a weekend ride of 4 hours gives me a break from symptoms until next tempo or long run. YMMV.
I had L4-L5-S1 laminectomy/discectomy almost 18 mos ago and don’t have any issues with aero position on the tri bike. I also agree with the previous post, it gives me some relief between runs.
Now 7 months post op from L4-L5 microdiscectomy. Been doing core exercises. Spoke to my physio who is Mackenzie trained. Encourages road biking. I personally ride in the hoods and try to keep my pelvis forward. Do get some mild sciatic pain at times. Am able to ride around 90 minutes at a time but do take breaks to do back extension exercise whilst riding. Also try contracting your Abdo muscles whilst you ride. It may give you more spinal stability