Back pain is a common complaint from cyclists, and more common than knee problems according to some studies. It is important to distinguish between pre-existing back issues that are brought to the bike, and discomfort or pain issues that occur as a result of cycling.
Let’s just focus on pre-existing conditions for the moment.
Pre-existing conditions are surprisingly common among the cycling population, as the low impact nature of the exercise attracts people with a history of serious back injury. Typical issues relate to either the cervical or lumbar areas. People with broken backs, fused vertebrae and herniated discs are out riding bikes. When sizing or fitting a bike it is important to inquire about any existing back conditions, as this will influence bike choice and set up.
Cervical conditions usually mean the rider has less ability to tolerate neck flexion, meaning they can’t look forward while bent forward. The fit protocol is to have rider in a more upright position. That means a shorter reach, and higher bars. How upright depends on their personal situation and neck stability and mobility.
One cyclist I worked with had broken her neck in two place in a horse riding accident, and could not ride 5 miles without unreasonable discomfort. The only position she could tolerate was bolt upright. I fitted her mountain bike (used only on paved and gravel roads) with a stem extender and short, steep stem. It looked like a frankenbike, but she was delighted to then be able to ride 20+ miles without any pain.
Lumbar conditions vary more widely. Soft tissue only, or not? Fused or not fused? Off bike strength and flexibility vs on bike experience? A suitable bike position is likely going to require some experimentation. A more upright position with less shear stress along the spine will work for some people. However for others this will increase the loading, bump impact and back stress. They may be better with more weight supported through the handlebars. Rider feedback is important, and input and consultation with specialty health providers may be advised. Proceed carefully and with consideration.
I’ve had bike fit customers with fused lumbar vertebrae who didn’t seem to have any additional limitations regarding their fit position, and others who were much happier when their reach and drop were reduced.
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