Understanding your Lower Back Pain

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Understanding your Lower Back Pain

Lower Back Pain (LBP) is a very common symptom amongst triathletes but is not a diagnosis. In most cases, athletes with LBP do not have an anatomical abnormality. A study done on elite Japanese triathletes showed that LBP accounted for 28% of all injuries. Back pain is experienced by numerous athletes and the most common cause of lost playing time in professional sport. Every sport is unique and the way a physiotherapist evaluate different sports is crucial. For example the evaluation of a 15-year-old gymnast with back pain of 1-week duration would differ greatly from that of a 55-year-old professional golfer with a history of prostate cancer. Athletes in sports that require repeated hyperextension (eg,gymnastics, diving, volleyball) have a higher incidence of LBP.

Can physiotherapy help me with my LBP?
Most triathletes panic when they experience LBP. Being involved in triathlon for more than 10 years I have also been down that road before. Who do I seek for help? A chiropractor,physiotherapist , biokinetisist, sports physician, massage therapist or my GP? Everyone in the medical field has their part in treating your injury and ultimately getting you back on the start line.
A physiotherapist is equipped and skilled to do a thorough history of your symptoms. Your first appointment will also include a physical examination where the physiotherapist will make you do a series of movements and perform specific tests to determine a diagnosis and then establish a management plan. If necessary you can be referred for imaging studies (MRI scans , Xrays ect.) depending on your diagnosis. Physiotherapists that have a special interest in sport will most likely be able to refer you to the necessary specialists as they work hand in hand.
Main causes of LBP in triathlon
While most knee injuries in triathlon are caused by running, and the majority of shoulder injuries by swimming, there is not one clear cause of injury to the lower back, though cycling is suggested as a major contributing factor. When treating triathletes I have experienced that bike setup plays a huge role in treating pain.
The optimal position on the bike to minimize wind resistance is one of hip flexion, anterior pelvic tilt and reduced spinal flexion. This position may improve cycling speed and reduce the risk of spinal injury. Although this is the optimal position to maintain, cycling still place the body in an unnatural position. Unfortunately only a few triathletes can maintain this ideal position and most will maintain a position on the bike with varying degree of spinal flexion as well as varying angles of anterior/posterior tilt. Below I discuss two of the most common bike setup parameters that affect the upper body position of the triathlete and may be a cause of your LBP.
Reach distance - This is defined as the distance from the centre of the seat tube to the middle of the handlebars. It has been suggested by various studies that LBP may be related to an incorrect reach distance. If the reach distance is too short the lower back is placed in a position of increased flexion and your neck will have to compensate for this unnatural position of the spine. The increase in lower back flexion may result in a posterior pelvic tilt and place increased mechanical strain on the lower back.
If the reach distance is increased, allowing the pelvis to adopt an anterior pelvic tilt, a more natural position of the vertebral column is maintained, creating a stable posture.
Saddle angle - The angle of your saddle is a very important factor that can influence the position of the pelvis. A downward tilting saddle place the pelvis in an anterior pelvic tilt and result in less stress to the lower back muscles and ligaments.

Although running after a hard bike may have been the final factor producing marked lower back pain or symptoms, it is quite possible that the initial cause of low back pain originated from the cycling. Studies clearly indicate that triathletes are at risk of suffering LBP of a serious nature. Training related factors as well as weak core muscles is other strong indications with possible association with LBP in triathletes.
Triathlon is a fast growing sport and although most people are hooked on the sport after their first triathlon it is a sport that places huge demands on your body. Pain is an indicator that something is wrong and one lesson that I’ve learned this year is to LISTEN TO YOUR BODY! A physiotherapist can identify what is causing your LBP and help you to understand the nature of your pain.