[Closed] Cycling and herniated discs - any medical consensus?

I have 3 herniated discs (MRI) and I think it's best just to ignore them. Most people have them and don't get any symptoms.

Rheumatologist suggested opiates, neuropathic pain killers and an epidural but I prefer swimming and cycling 🙂

Is sciatica the biggest problem? I'm currently also experiencing this but I have had a previous flare which went away for a few years. Mckenzie exercises and some nerve flossing should help with this (Google them).

I'm not sure that all that "weak core" stuff is real:

http://www.pain-ed.com/blog/2018/06/18/bullshit-about-posture-causes-pain-suffering/

Mick

You know my take on it. Road bike riding position puts your back under huge strain and you become adapted to it causing muscle imbalances that leads to these sorts of issues.

Road bike position flattens your lumbar curve and hyperflexes the neck curve.

Cycling is fine in the right sort of position. Dutch tourer for you my boy. No road bikes for a long time until its healed. It will not heal while you continue to ride a road bike

Normal spinal curvature then compare that to the position on a road bike

Edit - so on a road bike with the flattening of the lumbar curve the disc spaces chage from square to wedge and thats what damages the disc.

For me, movememnt helps 'repair' my lumbar disc and loading it in 'static' positions makes it worse. Canoe and kayak paddling helps, riding is just the wrong side of neutral (I'm aware that my mtb technique is not as dynamic as it should be), lifting heavy things can be bad. I don't ride a road bike but I'd expect it to be unhelpful.

Hmm... not what I want to read but hard to argue with. I just wondered how aggressive a road bike position had to be to be truly 'bad' for the back, and how much it was possible to counteract with strengthening.

I'd love to actually have my position on the road bike 'assessed' for back pain, I find it very easy to get into the drops and on the hoods is no strain at all.

I couldn't imagine a dutch tourer position for the sort of riding I want to do, even the commute would be purgatory as it's often a stiff headwind! I guess that's why e-bikes exist... Could replace the rest of my fleet with a basic full-sus 29er, but would really miss the freedom and expanded horizons of a road bike.

Actually found a useful article which sort of touches upon why I don't think my position on the road bike is so terrible, see below, I like to think I rotate from the hips rather than flexing the spine.

Guess I would need to confirm that with a mirror though.

The main issue with cycling is the effect it can have on hip mobility (loss of it mainly) and the transfer of forces into pelvic/lumbar flexion. Core strength is great and everything but if you can't move through your hips very well, you will still get back problems.

Don't let anyone tell you what you can and can't do (nobody actually knows). You will end up limiting yourself more and more and that won't help. Carefully find out for yourself.

https://trustme-ed.com/blog/back-pain-myths-posture-core-strength-bulging-discs

Google some Peter O Sulliven videos.

Indeed 13th. I was going to make the point about flexing at the hips. Myself I am very inflexible so a modern road bike position is difficult and involves a lot of back bend ie my pelvis does not tip forward much due to short hamstrings

Under normal situations can you touch your toes? I am inches short. that gives yo a good idea of hamstring length / flexibility. Hamstring stretching may help if yo are short of touching your toes

Keeping moving is certaily good advice - limiting your movement leads to more issues

Even in the pictures above tho the lumbar curve is still flattened

Please also note that on this I am only an informed amateur. sports physio for advice perhaps? GP? Have you seen a surgeon? if so ask them?

Oh - and the dutch tourer was a joke! Hows your riding position generally? slammed or touring? Maybe go to a more touring position? Bars level with seat?

Even in the pictures above tho the lumbar curve is still flattened

Agreed, I was just wondering about the degree of flex/flattening.

Funnily enough, the position which offers me most relief at the moment is flexion rather than extension! Had a physio indicate a long time ago that I suffered from anterior pelvic tilt, e.g. tilting forward (the opposite of you TJ by the sounds of it!) so I think if anything my lower back is under constant extension, maybe why McKenzie extension exercises don't offer any relief.

I was OK at touching toes, could certainly get more than just finger tips on floor, think possibly even knuckles (although that seems a long time ago! currently reaching knees is about all I can do).

Geomick, I'm starting to get a lot of similar advice from my physio about core strength/posture etc. not being especially relevant. Problem is, the alternative suggestion that it is all in your head and you 'think' yourself into having spasms/sciatica etc. is very hard for me to take, and even harder to do anything pro-active with! I would much rather do lots of core exercises and 'think' I'm doing something, rather than somehow trying to teach my brain not to over-react to minor stimuli in my lower back etc. Perhaps that's how core exercises work, you 'think' your core is strong and bulletproof and therefore your brain doesn't freak out when you bend down to help your toddler up some steps etc.

Hmmmm

I have nothing further to suggest other than perhaps you need an orthopeadic opinion

Its a difficult area with lots of conflicting advice, not a lot of clear science and everyone is different

TJ - see pic below, handlebars as high as steerer allows, in fact I think I'm voiding the warranty with that number of spacers... Typically they are about 2cm lower than saddle, I used some Hover bars to bring them up almost level on a recent holiday as my back was bothering me at that point (but not excessively). On my commuter they are pretty much level.

I had some bulged discs from weight lifting about 5 or more years ago. I stopped playing hockey / running for a bit and stuck to road commuting and upped my mileage there instead. Made it worse - stopping cycling eased things.

I did what the doc said - painkillers / ibuprofen then eventually had a cortisone injection to ease the aggravated nature of the nerves by the discs.

I then gradually eased back into some exercise - I found a cross trainer actually worked quite well along with physio and core strengthening exercises.

Now back to road commuting and mountain biking and hockey - I have to manage my back in terms of stretching and strengthening but it works ok most of the time. You get used to getting out of bed stiff (not morning glory kind of stiff) / inflexible and just easing into the day and getting things warmed up.

IM in exactly the same boat as you. Luckily i have a very senior physio in the family who specialised in sport recovery who helped me to get movement back.

When i first did my back, i did it "popping a wheelie", it was once of the most excruciatingly painful things I’ve felt, followed by an immediate lie down with my mates going WTF is wrong with you. I then rested for a few weeks, had a small amount of work done on it and i thought i was OK (far from perfect).

But then i decided to do some DIY, lifted a flitch plate and my back just popped and i literally fell to the ground -laid there for a while think you stupid prick. Couldn’t move at all, and being a stubborn bastid didn’t go to docs or hospital. thankfully sis popped round did the sh1t she takes great joy in, making me cry, and i actually got some movement back. Wasn't able to drive for about two weeks as being stationary for too long was a bad thing!

All that was 15-16 months ago and my back is still ballsed up, I’m constantly stretching it because it starts to seize with a lack of movement, whenever I stop on the bike, im off, stretching calves, back and hams. I have found that if i keep doing all over body stretches, especially my quads and hams, and drink lots of water it doesn’t affect me much to the point i can’t feel it.

However the SCIATICA - jeez, who else has been riding along and then all of a sudden gone "sh1t, i can't feel my leg", quite scary really all you can feel is pins and needles - it doesn't last too long, but do have to stop and have a shake about... this is now recurring a lot and is bloody annoying..

I dare say some of my back troubles were from time spent in the Army as well and this last couple of years was quite literally the straw that broke the camel’s back..

Not that radical a riding position. I thought you were a slam the stem type rider.

I thought you were a slam the stem type rider.

Haha, no I wish, I talk that sort of talk but my handlebar height is my guilty secret! In time I had hoped to mitigate my upright position by buying loads of really expensive aero kit, just to annoy Cynic_Al if nothing else.

This thread is sort of highlighting a lack of agreed medical consensus, but definitely a 'common sense' consensus...

This is also useful if you think you have pelvic tilt etc:

https://www.painscience.com/articles/structuralism.php

I was advised to stop trying to "fix yourself" (because you can't) and get on with doing things that you value.

And I don't think it is "all in your head" it's in your nervous system.

core strength/posture etc. not being especially relevant

That seems consistent with my experience.

the alternative suggestion that it is all in your head and you ‘think’ yourself into having spasms/sciatica etc

I haven't previously seen that as the alternative.

My experience, as posted above, is that movement is good and static muscle tension is bad. My two worst episodes of lower back pain and sciatica have been 'cleared' (although only when partially recovered) by a week of skiing, ie, frequent movement, well relaxed, low load on the spine, rotating chest and hips in opposite directions. My physio said "take as much Naproxen or Ibuprofen as you need to allow you to move, and keep moving" - he explained this on the basis that static pressure flattens the discs and exposes the nerves, while movement keeps the discs massaged and hence fully hydrated and expanded. Once you've got pain, you tense the muscles and that makes it worse, so it does take a while to break out of that. I'm not a medic so have no idea whether that's correct, but it worked for me.

Greybeard, that does sort of tally with my experience recently. The picture above was taken on top of the Rococorba climb in Girona. Three weeks before we flew out I had a back spasm which at the time was extremely sore. I worked through it with painkillers and staying active, and after three weeks was able to go out to Girona and had an amazing week's riding, back pain almost forgotten.

It was returning to the office that brought it all back on, despite trying to keep going with my riding and commuting. Maybe the periods of static sitting and/or standing brought it back on.

Will start experimenting, have already fitted touring/butterfly bars to my 29er so it's pretty relaxed!

This is also useful if you think you have pelvic tilt etc:
https://www.painscience.com/articles/structuralism.php < I was advised to stop trying to “fix yourself” (because you can’t) and get on with doing things that you value.

That is all interesting, but he doesn't really offer any alternative which is frustrating.

I could believe that my so-called spasms etc. are caused by by nervous system being over-sensitised to certain movements or injuries, but how do you prevent this? I have no conscious input, one minute you're fine, next you're on the floor in pain.

I did think that doing yoga etc. might help as it would get the body used to doing certain movements, stopping it from 'freaking out' when it experiences those movements in the wild.

That article also offers no useful advice for recovering, I suppose the take-away could just be MTFU, get on with your daily life and ignore the pain signals, but that's just not realistic.

I guess just trying to ease yourself back into the activities you love is the way to do it. Still not sure how this new 'anti-structuralism' can help prevent future injuries though.

I don't know if this is of any use to you at all, but I'll tell you my story.

Ten years ago, I suffered a double prolapse so bad that I could no longer move my legs. In the run-up, I had done everything wrong: I didn't even know what core muscles were; I didn't know there were different types of back pain, so when I went online to figure out why I was suffering and read somewhere that it was good to carry on with everything as best I could, I did; I now know that I have naturally short hamstrings anyway, and that I was doing everything wrong in terms of stretching and exercising.

Anyway, I ended up in hospital where they MRI'd me, gave me a few nerve injections, and sent me home after ten days.

Since then, I have had periodic relapses where I have thought, "Oh shit...", but which I have managed to stave off - not least in part by cycling. The moment I have felt the "tingle" of discomfort, I have slept on a heating pad, made sure to take my NSAIDs, and gone for long, gentle rides.

I don't know what the science says should happen, but while I feel like I am always on the brink, I do know that I have managed to get through the last decade without another major problem. So cycling doesn't seem to add to whatever the harm is, and may actually help. Touch wood.

That does help Saxon, all contributes to my little plan of action.

I was very conscious of my back stiffening up over time prior to my latest episode, thought I was stretching enough etc but obviously not, ignored this stiffening up and BAM, off it went.

Could be that muscles in my lower back were being over-worked and just spasmed from fatigue, could explain previous physio's determination to have me working glutes...

Just to add to everyone else's posts, I had a similar experience to SaxonRider 14 blinking years ago. A cluster bomb of completely wrong diagnoses for 4 years left me at the end of my tether and blootered on pain killers.

Then a competent doctor finally diagnosed a huge pro lapse in one of my discs and I had surgery to "fix" it. Incredibly sore and taxing with a long recovery period and I thought I was doing all the right things when, ping, it went again (falling off my bike funnily enough).

From then, I just have to accept I've got a back that will let me down occasionally and I have to be nice to it and not over stress it. Pilates every day to maintain some sort of mobility and some very specific nerve stretches get me by plus a back brace for cycling.

It sounds like you are still in the mildly ok area. My advice is to shop around with physios and try to find one who lucks onto stretches and exercises that help then stick to a regular regime of maintaining mobility. At the same time, think about dropping a gear or two on climbs to limit the strain you put through your back and recognise that you are a bit more limited than you were.

Once you've herniated a disc and damaged the surrounding tissue, it is never really going to heal back to what it was.

This is also useful if you think you have pelvic tilt etc:
https://www.painscience.com/articles/structuralism.php < I was advised to stop trying to “fix yourself” (because you can’t) and get on with doing things that you value. And I don’t think it is “all in your head” it’s in your nervous system.

Thanks for posting that link geomickb - has to be a lot of truth there. I thought similar after physio for a frozen shoulder a couple of years back - loads on posture and biomechanics which was sensible enough, but the degree of emphasis struck me at the time as ridiculous. Like you wouldn't see a person over 60 being able to walk upright if what the physio was telling me was true, and these defects were not corrected.

Guy I see (minor sports stuff in my case) is all about strength first and everything else a distant second. Any muscle or joint issue is tackled by exercises that load it and make it stronger - (not sure how this would relate to the lower back or even if it can). It's not that he thinks this approach is the one true way, as that doesn't exist, more that it delivers the most benefit in the limited time we all have available in seeing the physio and actually doing rehab exercises.

Re: strengthening and lower back, I've gradually been led to believe that my glutes are weak, and that this is significant for lower back issues.

I'd like to see someone who could explain the mechanics to me, but I'm guessing that if your glutes can't control the movement of the hips, then maybe the lower back muscles take over, and get fatigued with time resulting in spasm? Doesn't explain all the herniated disc type symptoms though, wonder if a spasming muscle can cause a herniated disc!

MRI appointment came through, 2 week wait on NHS is pretty good!

I was in your predicament about 18 mths ago (bulge/herniated disk at L5). I've been riding for a year now with so far no repeat.

I think the main thing that got me going again was the 1-1 sessions I had with a pilates instructor. She gave me all sorts of movements and general hints and tips, and told me cycling should be fine. My drop-bar MTB looks quite similar to yours in its high bar set up by the way.

Also other things, like making sure my office set up is good, and adjusting my car seat so that my hips are higher than my knees, and thinking about posture generally, has helped a lot.

So don't give up hope! Get some pilates and stick to it.

I’d like to see someone who could explain the mechanics to me

The pilates lady was the best person I found for this - way better than my physio, back specialist or GP (obviously). But I suppose it depends on who you see - if you're anywhere near Stonehenge I'll give you her details if you like?

(But I didn't start pilates until the initial swelling had gone down, which took about 3 months, helped by max ibuprofen dosage)

Highly recommended for pilates

Mrs RM is in hospital atm, op tomorrow to repair a collapsed C5 disc. X-rays, MRI and stuff show it clearly and its giving intense nerve pain in one shoulder down the arm to the fingers. Lack of power and control picking stuff up. Opiates dulls this but they cant be a long term solution...massage etc hasn't addressed the root cause of the problem.

Op includes removing the disc, enlarging the place where the nerves exit the spine, replace with a prosthetic disc and some titanium mesh. Prognosis is good with full control and power to the arm and fingers restored. Lets see...

I did wonder what the market was for synthetic discs, seems like a no-brainer but I guess putting them in place could be difficult at the base of the spine!

Dorset_Knob, thanks, but I'm in Edinburgh. Have access to a bike fitter who also has a trained physio on staff, seems like an ideal way to have a physio look at me on a Retul setup and give me cycling specific advice. They also run cyclist-specific strength and flexibility classes, but unfortunately just too far away and too late in the evening for me to attend.

Meanwhile I have the 'Core Advantage' book recommended on another thread which has some very relevant looking exercises, although according to yet another physio, I pretty much just need to be doing squats!

13thfloormonk

Member
I did wonder what the market was for synthetic discs, seems like a no-brainer but I guess putting them in place could be difficult at the base of the spine!

Depends on which discs are damaged. I’m currently recovering from Nerve Ablation to facets on L4/L5 & L5/S1. Really wanted a disc replacement (TLD) but was advised it is not possible for those 2 discs. They operate from the front and there are too many vital organs in this area for them to carry out on both discs. I’m now at 3 weeks post op and know already it’s not worked. Only options left now are pain management or Fusion.
Just started Pilates, physio, stretching and drinking lots of water. Don’t underestimate how your body reacts to being well hydrated. FatboyFat tells the story of my life over the past 10 years. It’s not gonna beat me and I’ll carry on riding in some form. Just have to remember to stretch morning, during longer rides and before I go to bed. Good luck and try and find what works for you, everyone’s different.