By Alan Bragman
Question: I have recently been diagnosed with osteoarthritis in my lower back, after having seen a variety of health professionals. I am a keen recreational cyclist who enjoys competing in centuries and double centuries, but as my back condition has gradually deteriorated over the past few years, I wonder if these longer distances are becoming out of the question. I have had my bike professionally fitted, but I have to take anti-inflammatories and pain killers to manage the pain during multi-hour training rides. Do you have any advice on alternative bike set-ups, or should I start looking at recumbents? — Chris J. (Wellington, NZ)
Alan Bragman, D.C., Replies:
Osteoarthritis is the most common joint disorder, caused by wear and tear on the joints related to aging. Cartilage is a firm, rubbery gristle-like tissue found between joints that allows the bones to move and glide smoothly.
As we age the cartilage has a tendency to break down and wear away, which allows the bone surfaces to rub together. This results in inflammation, pain, stiffness and swelling in and around the joint. In addition, as we age the muscles, ligaments and soft tissue surrounding the joint become stiffer, and calcification with spurring may occur, especially in the spine and weight-bearing joints.
While cycling is easy on the weight-bearing joints, the unnatural position can irritate the neck and lower back, especially on extended rides. I know this first-hand, Chris. Your situation sounds very similar to my own. When I reached my 50s it became increasingly difficult to do longer rides without tremendous discomfort.
In an attempt to keep riding, I modified my position by raising the bars, changing my seat position and, eventfully, changing to a bike with less aggressive angles. This did not provide much relief, and finally I switched to a recumbent bike for my longer rides. I still ride an upright for shorter rides and when I travel. But the recumbent allows me to comfortably do longer rides at a fast pace.
You cannot reverse the degenerative process associated with osteoarthritis. And, unfortunately, it usually becomes worse with time. But there are a number of things you can do to help deal with it, including:
- Keep your weight down
- Strengthen and stabilize the surrounding soft tissue by doing strength, cross-training and core training*
- Increase flexibility with stretching*
- Eat a healthy, well-balanced diet
- Protect your joints from temperature extremes
- Get lots of rest
- Physical and massage therapy, chiropractic and acupuncture treatments
- Pain medication (acetaminophen, NSAIDs), pain-relieving skin creams (Capzasin-P, Menthacin, Zostrix, Bio-Freeze, Cryoderm). However, avoid overuse and abuse of these!
Good luck, and don’t give up. I’ve learned to deal with this problem, and I think you can, too.
Alan Bragman is a chiropractor living in Atlanta, Georgia. He is a former Cat 3 cyclist and nationally ranked inline speed skater. He was on the medical advisory board at Bicycling magazine for 10 years and has written for other sports publications.
I too have very bad DDD from two discectomies and suffering since my early 30’s, I’m in my mid 50″s now. I was miserable for years, even standing to do dishes was excruciating. I saw a pain management doctor and asked if there was something I could do without taking narcotics. First came the steroid and nerve block injections, they’ve never put much of a dent in my pain. Then Dr recommended Radio Frequency Ablation of the Facet joints, which is where most pain comes from when the disc collapses as we age (or removed in my case). The RFA procedure uses high frequency radio waves to burn off the nerves on the Facet joints. It has transformed my life! I am pain free for at least a whole year (been over two years since my last one) then the procedure can be repeated. Very easy procedure and it only takes a about 30 minutes. Plus they use only local anesthesia so your’e not all groggy, In fact I’m up and riding the next day. My cycling distances have expanded and I’m much happier on they bike, and no more standing every few minutes to take pressure and pain off the low back.
My low back feels better when I’m stretched over the TT as it extends and releases the Facet joints. I found if I’m too upright I get more pain as the the joints collapse onto each other. Flexion is bad for me and extension feels good. Hope this helps and good luck.