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Cyclists' low back pain usually isn't coming from the back

You stretched it. You foam rolled it. You got the bike refitted, twice, and the second fitter contradicted the first. It helped for a few weeks, then the ache came back exactly where it was. Brief relief, reliable return — that's the signature of treating a symptom where it's felt rather than where it's generated.

“I picked up my daughter and my neck went numb”

— Monique

Your results may vary.

Client testimonial — Monique, 4 weeks of neck pain rated 7/10 Play video: Client testimonial — Monique, 4 weeks of neck pain rated 7/10

“I tried a new move in yoga. I woke up the next morning and couldn't move my neck”

— Danielle

Your results may vary.

Client testimonial — Danielle, 6 weeks of neck pain rated 7/10 Play video: Client testimonial — Danielle, 6 weeks of neck pain rated 7/10

“After 3 years I didn't think anyone could help me fix my neck”

— Sandy

Your results may vary.

Client testimonial — Sandy, 3 years of neck pain rated 8/10 Play video: Client testimonial — Sandy, 3 years of neck pain rated 8/10

“My office job means my neck is in constant pain — nothing seems to help”

— Natasha

Your results may vary.

Client testimonial — Natasha, 4 weeks of neck pain rated 7/10 Play video: Client testimonial — Natasha, 4 weeks of neck pain rated 7/10

“It's too hard to get in shape when I've had knee pain ever since I can remember”

— Cindy

Your results may vary.

Client testimonial — Cindy, a lifetime of knee pain rated 6/10 Play video: Client testimonial — Cindy, a lifetime of knee pain rated 6/10

“I tore my ACL in an MMA match and haven't been able to train since”

— Meghan

Your results may vary.

Client testimonial — Meghan, knee pain after an ACL tear, 4 out of 10 down to 0 Play video: Client testimonial — Meghan, knee pain after an ACL tear, 4 out of 10 down to 0

“After my fall my knee was in pain and I couldn't stand on one leg”

— Brad

Your results may vary.

Client testimonial — Brad, 6 months of knee pain rated 6/10 Play video: Client testimonial — Brad, 6 months of knee pain rated 6/10

“I got surgery on my shoulder 2 years ago and have been getting rolfing and PT”

— Samantha

Your results may vary.

Client testimonial — Samantha, 5 years of shoulder pain rated 7/10 Play video: Client testimonial — Samantha, 5 years of shoulder pain rated 7/10

“My shoulder numbness and tingling was so bad I drove 2 hours to see Jamie Atlas”

— Heather

Your results may vary.

Client testimonial — Heather, 6 weeks of shoulder nerve pain rated 10/10 Play video: Client testimonial — Heather, 6 weeks of shoulder nerve pain rated 10/10

“I've been in physical therapy for 6 months and I'm stalled on my results”

— Judy

Your results may vary.

Client testimonial — Judy, 6 months of shoulder pain rated 10/10 Play video: Client testimonial — Judy, 6 months of shoulder pain rated 10/10

“My shoulder pain meant I couldn't take my shirt on or off without hurting”

— Sharon

Your results may vary.

Client testimonial — Sharon, 4 months of shoulder pain rated 6/10 Play video: Client testimonial — Sharon, 4 months of shoulder pain rated 6/10

“3 surgeries over 10 years and I still can't get my shoulder above my head”

— Clay

Your results may vary.

Client testimonial — Clay, 10 years of shoulder pain rated 7/10 Play video: Client testimonial — Clay, 10 years of shoulder pain rated 7/10

“Taking my dog for a walk he pulled on my shoulder and now it hurts to move”

— Kendall

Your results may vary.

Client testimonial — Kendall, 2 weeks of shoulder pain rated 6/10 Play video: Client testimonial — Kendall, 2 weeks of shoulder pain rated 6/10

“I was squatting at the gym when I felt a pop and my leg went numb”

— Kelly

Your results may vary.

Client testimonial — Kelly, 12 months of back pain rated 8/10 Play video: Client testimonial — Kelly, 12 months of back pain rated 8/10

“After the car accident the hospital said I was fine but my back pain says otherwise”

— Dax

Your results may vary.

Client testimonial — Dax, 5 days of back pain rated 10/10 Play video: Client testimonial — Dax, 5 days of back pain rated 10/10

“Playing football has left me with constant back pain that I can't get rid of”

— Matthew

Your results may vary.

Client testimonial — Matthew, 7 weeks of back pain rated 7/10 Play video: Client testimonial — Matthew, 7 weeks of back pain rated 7/10

“I went to Pilates to fix my back but it ended up making it worse”

— Colleen

Your results may vary.

Client testimonial — Colleen, 8 weeks of back pain rated 7/10 Play video: Client testimonial — Colleen, 8 weeks of back pain rated 7/10

“I was thrown from a horse and couldn't bend over without pain”

— Katrina

Your results may vary.

Client testimonial — Katrina, 4 weeks of back pain rated 6/10 Play video: Client testimonial — Katrina, 4 weeks of back pain rated 6/10

“This 9/10 back pain is stopping me from sleeping at night”

— Alexis

Your results may vary.

Client testimonial — Alexis, 2 months of back pain rated 10/10 Play video: Client testimonial — Alexis, 2 months of back pain rated 10/10

“My back pain is so bad I can't put on my shoes”

— Penelope

Your results may vary.

Client testimonial — Penelope, 5 weeks of back pain rated 7/10 Play video: Client testimonial — Penelope, 5 weeks of back pain rated 7/10

“Living with back pain has me living at a 7/10 pain that I can't find relief from”

— Chris

Your results may vary.

Client testimonial — Chris, 8 weeks of back pain rated 7/10 Play video: Client testimonial — Chris, 8 weeks of back pain rated 7/10

“I have a herniated L4/L5 and my sciatic pain feels like a screwdriver in my back”

— Kendra

Your results may vary.

Client testimonial — Kendra, two years of shooting sciatic pain resolved Play video: Client testimonial — Kendra, two years of shooting sciatic pain resolved

“The doctor told me my spondylolisthesis back pain could only be cured with surgery”

— Tony

Your results may vary.

Client testimonial — Tony, two weeks of severe back pain down to 1 out of 10 Play video: Client testimonial — Tony, two weeks of severe back pain down to 1 out of 10
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What hours in the saddle do to a hip

A riding position holds the hip in deep flexion for hours. The muscles at the front of the hip sit short the entire time. The adductors on the inside of the thigh work continuously to stabilize the leg through the stroke, and they also sit short.

Muscle held short and working hard for long periods adapts to that length. It gets strong in a narrow range and stiff outside it.

Then you stand up off the bike, and the pelvis is asked to return to neutral by tissue that has spent four hours deciding it lives somewhere else. The pelvis tilts forward. The lumbar spine takes up the extra range, because something has to. Your back isn't the problem. Your back is the part that moved because the hip wouldn't.

Test it off the bike

Kneel on one knee, other foot forward, knee bent to about 90 degrees. Keep your ribs down and your pelvis tucked under — this is the part everyone skips, and skipping it lets you fake the whole test with your lower back. Now gently push your hips forward.

You should feel a clear pull across the front of your kneeling-side hip. If you feel it in your low back instead, or you feel almost nothing until you let your ribs flare, your hip extension is limited and your spine has been covering for it.

Add the second layer: reach the same-side arm overhead and tilt away. That should produce a deep stretch through the inner thigh and groin. If it doesn't, and you're a rider, that's the adductor stiffness that has been quietly tilting your pelvis.

What actually changes it

Not passive stretching alone. Range you can't control is range your nervous system won't let you use under load — it will simply guard it back.

What works is range plus load. Get into the position, then work actively in it: shift the hips side to side while holding the overhead reach, hold the end position and gently push into it. Then load the hip through that new range with strength work — split-stance hinges, single-leg work, the same pattern that fills in the dead spot in your pedal stroke — so the range becomes something your body trusts at 40rpm on a climb.

Three sets, twenty seconds a side, then load it. Daily through a heavy riding block. The glute work belongs here too — a hip that can't extend and a glute that isn't contributing are usually the same story told twice.

The part that needs a real assessment

Back pain that radiates below the knee, comes with numbness, pins and needles, or weakness in the leg, or that wakes you at night, is a different category and should be assessed properly.

So should back pain you have had for more than three months. Persistent pain changes how the nervous system processes load, and at that point the useful work is as much about how you move and what you believe about your back as it is about tissue. That is the specific thing Cognitive Functional Therapy is built for, and it is why I trained in it. More on that on the chronic back pain page.

Common questions

Why does my bike fit keep not fixing my back pain?

A fit changes the geometry you're placed into, and a genuinely bad fit is worth correcting. But a fit cannot change what your hip is capable of. If your hip extension is limited before you get on the bike, adjusting the saddle just changes which structure compensates. That's why fits so often produce a few good weeks — a new position redistributes load, the irritated tissue calms down, then the new arrangement finds its own weak link. The better question isn't whether your position is right; it's whether your hip has the range that position requires.

Is stretching enough to fix a cyclist’s tight hips?

Rarely on its own. Range you can't control is range your nervous system won't let you use under load — it will simply guard it back within hours. What works is range plus load: get into the position, work actively in it, then load the hip through that new range with split-stance hinges and single-leg work so the range becomes something your body trusts at 40rpm on a climb.

When should cycling back pain be properly assessed?

If it radiates below the knee, comes with numbness, pins and needles, or weakness in the leg, or wakes you at night — those warrant assessment rather than self-management. So does back pain you have had for more than three months. Persistent pain changes how the nervous system processes load, and at that point the useful work is as much about how you move and what you believe about your back as it is about tissue.

I first covered the cyclist's hip and groin work in The Denver Post, May 2011. See the full Denver Post series.

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