Cycling as exercise with back problems

If the vertebrae shift laterally and really trap the nerve you will be in trouble - so based on my experience get a referral to get an MRI - you are London ish based so get the London Upright MRI Centre in Newman Street and get a MRI taken with the spine vertical and hence under load. Pay for it yourself to cut out the waiting time - it will cost about £800 and your consultant will get the results within days.

Then you think about the future.

Hi Rod.

I suspect it's probably not a disc herniation that's the problem but facet joint arthropathy. Basically that's wear and tear in the spinal joints and fits better with your history of intermittent bouts of discomfort with pain localised to the back. As the episodes are recurring, and obviously bothering you, I would advise you see your GP for advise and possible investigation. The availability of MRI to GP practice is widespread and he'll probably refer you and you probably won't have to wait long. It's his call on where to refer you from there.

If it is the facet joints that are the problem CT guided injections do work well, I do a lot and have many happy patients, but, and more importantly, addressing posture and improving core strength can be more beneficial. Your GP will advise.

From a fellow sufferer, good luck.

Steve

Thanks both.

I'm in France, and last time my doctor did not refer me for MRI, and I don't think they do unless the pain continues for four weeks or so. But I'll go see her again I suppose.

But, notwithstanding that, assuming I feel fine on Thursday/Friday, which I am sure I will, is it going to make any difference if I use the bike for transport, versus, say, the car, in terms of making the problem worse/better or more or less likely to reoccur?  It's the lack of exercise that bothers me far more than the pain.

Rod

Rod - I think it's difficult as back's are a mystery wrapped in a conundrum when it comes to diagnoses and therapy. For me, I had a badly herniated disc L4/5 that needed surgery as the resultant profusion had almost severed the nerve.

Post surgery I had to do a lot of exercises that focused on the cyclist's core - stomach, back and hamstrings. As a result of the enhanced core, I found that cycling was the best overall exercise that did not aggravate the spine and also seemed to relax tense muscles in my lumbar spine (weather or posture related). 

I think cycling on its own might not be so good, but ymmv. My experience suggests that a combination of exercises that build and maintain core strength together with low impact exercise like cycling and swimming are the way to go.

The more knowledge you have the less comfortable you generally feel giving specific advice. I will therefore be a bit vague and include all sorts of caveats about not having the chance to see you, examine you and know your records etc

Your symptoms sound mechanical-not a herniated disc 'again'. Just based on your brief description. Discs don't tend to 'go' repeatedly. Most of what was called a 'slipped disc' in the past is acute mechanical pain-muscles bones and joints. Disc=sciatica and leg pain, and many months to resolve. Generally. Mechanical pain= days or weeks. generally.

Regarding exercise. In broad terms low impact is good, and good core strength is good-both plus points for cycling

On the flipisde lots of cycling does not always means good flexibility and can also mean tight hamstrings-a factor in some back pain. Also rough roads and hard tyres can cause vibration and back stress, as can a poorly set up position on the bike.

For me back pain has been very effectively managed by a great deal of cycling-swimming bores me too much. I have a custom frame with a moderately upright 'stance' that suits me. 2 weeks off the bike and I can tell my back is stiffer. I had sciatica for 18 months before getting serious on the bike. I also bought cars with better seats-for me Volvo every time now!

So in conclusion-get a regime of exercise tailored to you. Base it on common sense, what you enjoy (crucially) and maybe with the guidance of a physio or similar who can tailor it to you. Get a good bike fit. Little and often to start. Don't ignore simple things like losing weight if that is an issue and adressing posture, seating and gait problems if relevant

Re scans and surgery etc. Be wary of having scans that reveal problems that are radiologically enticing to surgeons. The vast majority of back problems do not require intervention. A significant portion of surgical procedures have disapointing outcomes. Surgeons love to operate/inject and generally do stuff. Make sure it is really needed-and not just treating a scan but treating your best interests. I'm afraid I don't share Steve J's enthusiasm for facet joint injections myself-and neither do a lot of doctors. They are not comissioned in many areas due to the lack of evidence to support their routine use.

Best wishes

Bruce

Hello Rod

The resident Docs on this M/B will no doubt sort out your back problems,but if i may make a suggestion.

When SHMBO first slept in my bed many years ago she told me the mattress on the bed was crapp and she wanted it changed. You spend a third of your life in bed and i have to say its the best thing i did.

I remember some years back we hired a Gite in the south of France for a week. The bed and Mattress were cheap and nasty and each morning i woke up in agony. Got home and the first night back in our own bed......Paradise.

Mista H

Thanks again

Mista H, you're right. It 'went' on Saturday after a night on a sofa at my parent's house, and I think every other time my back has 'gone' has been either bending down badly or after a night on a strange bed or bed equivalent.

In fact this morning, the pain has almost completely vanished (two nights in my own bed on an expensive and quite hard mattress). So this episode has lasted all of 60 hours (joy). The first time it happened I was travelling in Africa, and after 10 days it was better before I could get to a doctor. The second time I did visit my doctor (in France, but not a prescribe-the-whole-pharmacy-French-style doctor [actually a get-on-with-it Dutch lady]). She gave me some painkillers and said to come back if it hadn't cleared up within a week, which it did, so I didn't. 

It's happened three times since (over the course of three years) and each time it's got better more quickly after being less debilitating in the first place.

I bow to Bruce's at-a-distance diagnosis (thank you). I had assumed it was a 'slipped disc' because that was what I was bought up to believe back pain usually was, and the symptoms sounded consistent. But this mechanical thing sounds more believable. 

I neither want to waste the time of others, nor take the risk of an operation unless it was absolutely necessary (and I feel unnecessary treatments happen far more often in France than in the UK, because everyone here revels in time off work, and there's money to be made for someone).

So, the pain has gone, and I feel fine. (It still aches a bit, as though I slept awkwardly [which I probably did]). Anyway, fine enough to ride the bike to work tomorrow, I think. It sounds as though this is not a bad idea (unless it causes pain). Should I?

I might leave off running for a while though.

Cheers

Better already? The healing power of t'internet!

Cheers

Bruce

Just don't ride anywhere near this idiot...

http://www.standard.net.au/sto...driver-hits-cyclist/

A 9-month driving ban seems very lenient, particularly given that from the report the offender doesn't even seem to acknowledge what she was doing was unlawful and very dangerous. 

You're not kidding. I'd have banned the stupid cow for life.

Should be an immediate life ban plus custodial sentence. The sense of entitlement such people have to wantonly putting others at risk is quite stunning.

It is amazing how the act of getting behind the wheels confers so many entitlements in the common psyche. No amount of asking nicely is going to change the resulting behaviour across the board.

Worse still, when you look out for it, this behaviour is going on absolutely everywhere and all the time now. It puts not just cyclists but other car drivers and pedestrians at risk too of course.

This driver got a 4-year sentence for crashing into a car and killing another motorist whilst on his mobile. Better than a 9 month ban but impossibly lenient still. The basic action and risk it causes are the same.

www.theguardian.com/uk/2006/au...phones.jeevanvasagar

Yikes.  A professional driver with the extended proficiency training to acquire an HGV licence, too.  Awful.

Oh dear, those bad boys are back dragging you way off topic. 

Please do us a favour and leave it out or go start another thread.

I suffered a pretty severe disc problem several years ago.  On the advice of my osteopath, that marked the end of my running days - the impact he advised to be too great to take the risk of the problem recurring (it was with me in a nasty way for the best part of 9 months).  So I suspect that my problem is not related to yours.

I do however, recognise the symptoms of sleeping in a bad bed.  When I visit my homeland I can no longer stay in my mother's house - two days there and my back is guaranteed to lock up completely leaving me walking like a bent over penguin!  Not good!  I found when I bought a decent pocket sprung mattress that life improved dramatically.

I also maintain a trip to the osteopath every 6 weeks for a general tune up - it may be verging on placebo effect however, I think it works for me.

My thoughts are that if my back is feeling stiff, going out for a long or fast ride is one of the last things i should be doing - guaranteed to increase muscle guarding and overall discomfort.

Having given up running, which I used to do a lot of, I was encouraged to take up cycling.  Whilst I don't think it does much for the upper body, it does provide plenty of sustained cardio vascular work outs and I'm told there is not much impact on the back.  I do concentrate on maintaining a very straight balanced posture on the bike - no swinging of bike and hips when climbing for me!  As an earlier post mentioned, cycling tends to tighten the hamstrings, which can load up the lower back, so it is important to do plenty of stretching exercises to take that load off.

If you can, core strengthening exercises such as those from pilates are meant to be great for helping support the spine/ spreading load.  I have been very poor at implementing this - the key for me is to avoid twisting exercises.

I'm having a new bike built hopefully next week and, for the first time, I'm also arranging for a proper retul bike fit - some may argue a bit late in the day for that but it's something I've meant to do for ages with my existing bikes. 

Pumping tyres up at the road side is not good for your back - so I trust by now that you've bought yourself a decent pair of tyres to help avoid such instances!!

Peter

Spinal manipulation can be very beneficial for athletics - were it not for that I would never have competed in weightlifting as long as I did.  I also saw a number of athletes in my practice, including Olympians, NHL, NBA, & NFL players, and worked extensively with the traveling Broadway shows; dancers are every bit of athletes.  I doubt they were all looking at placebo effect. 

As Bruce said, much of it is mechanical, and when mechanical pain arises, it is usually multi-factorial.  Bio-mechanics, the bed, posture, flexibility and tone of muscles, weight, activity or lack thereof, and sometimes, for whatever reason, joints just are not moving as they were designed.  Correcting factors in your life (e.g., the bed), medication as needed, manipulation, deep tissue massage, stretching, etc. are all useful to keep your "in the game."  And of course, as one ages, one must concede certain things; I still lift weights, but I no longer do 400-500+ lb squats or deadlifts.

Left long enough, it can lead to more rapid onset of degenerative joint disease (osteo arthritis) and on occasion disc issues.  However, as stated above, the "slipped disc" is basically a layman's misnomer.  A disc is a fibrous ring within which is contained a gelatinous material.  The "slipped disc" is actually when the ring tears and the gelatin starts to protrude.  If it does so near a spinal nerve, lots of symptoms; pain, radiating pain down an extremity, loss of deep tendon reflexes, and numbness following prescribed patterns.  Sometimes these can be treated conservatively, other times a micro-discectomy is in order.  I personally would only use a neurosurgeon for such a procedure, although I imagine more orthopedists are getting better at them.  (I have not practiced full time since 2000, prior to which time it was a fairly new procedure.)  Done properly, I had patients return to basically full activity post surgery...but we also did much of the rehab afterward.  And they could even eventually have manipulation performed on the surgically addressed disc.  But those were the most severe injuries, and very much the minority.

I have recently tried and since purchased for myself a device called a "Rumble Roller" - I have found it to be very beneficial for address myofascial issues on my own.  I don't know if they are available in the EU or not, but a search should reveal.  I got the blue one, which is stiff, but not as stiff as the black one, and is typically the choice for most.  Highly recommended.

I found that Pilates was very very helpful. I realise that you will have to find a 'good' teacher, one who understand the problems you are having. I would suggest you find one who is familiar with dance injuries. I can suggest someone in south east London, depending on where you are? I found that it strengthened my core, the rest of my back and in tern eased my lower back and periformis syndrome. I am a cyclist, well I ride a bike most days, and at my age I now try to go to the gym once a week and do Pilates at least once a fortnight just to keep my body supple enough and fit. I realise that many might consider this a bit much but i certainly feel much more capable to cope with life doing this. But Pilates is well worth exploring and i find it essential now.

At slight risk of upsetting the medical contingent here (to who I am grateful) I was encouraged to try a session with an osteopath who came highly recommended. I've always regarded osteopathy (in my ignorance) as being a bit 'alternative' and probably not therefore based in science, and had ignored it. But such was the recommendation, and upon checking that in France osteopaths need to be licenced AND qualified in physiotherapy too, and that it is recommended for lower back pain by, amongst others, the NHS, I gave it a go. She was very good and helpful and while some of the rhetoric sounded a bit, er, frothy, a lot of what she said made perfect sense. Most importantly, it appears to have worked, as the dull ache that had replaced the pain has now vanished.

I cycled to and from work yesterday and felt great. 

As a side note, this last week has been the first time I have driven to the office four times for a long time. On only one of the eight car journeys did I get there quicker than I did on the bike yesterday!

No offence taken whatsoever Rod. Physiotherapy/Osteopathy is very important in the treatment of mechanical back pain. The physio is the first person I look to when I have similar problems. I'm delighted you're now pain free and long may it remain so.

Good news on the back pain issue. Did she recommend further sessions ? It sometimes takes more than one session to provide long term relief.

On the "side note" issue, you'll be giving cyclists a bad name. Cycling to work is meant to be theraputic, environmentally friendly, relaxing, genteel exercising. Not a race against motorists. You don't want another accident !

Osteopathy (and other physical therapies) have a decent evidence base and despite what can sound like some rather dodgy terminology and associated fluff at times IMHO I'd see an osteopath way, way before an orthopod in almost all situations...and have indeed done so. They don't work for all, and it does seem rather 'operator dependent' but a good one is well worth a try.

The key message is that no treatment works for all and the main asset is a 'fit' back which means being slim, active, flexible and strong if you can. Magic cures for back ache are likely to be snake oil; wether advised by a conventionally trained doctor or a reflexologist with a magnet.

Managing back pain is generally a lifelong, and often up and down, process. Whatever you do don't slacken the exercise.

Bruce (who just played his first cricket match of the season, and will be utterly unable to move in the morning. I will need a crane not an osteopath)