Accelerated Physical Therapy: Low Back Pain in Triathletes
For triathletes, the transition between the bike and the run can be brutal on the low back as you move from a forward flexed sitting position to a relatively erect position during running. Improving mobility into backward bending, or extension, at the lower lumbar spine may be the key to losing less time getting back to an erect posture after cycling.
L5 normally sits at a slight downward tilt on the sacrum. This relationship allows for a tremendous amount of shock absorption as the weight of the body is translated from the trunk through this segment into the pelvis and lower extremities. Gravity tends to want to pull this segment further forward. Sitting in the car, at work, or more significantly on an aggressively set up bike, promotes a forward flexed position of L5 on the sacrum through joint and myofascial restriction. Many times triathletes have a difficult time getting out of this flexed position after a long bike ride.
In standing, many athletes can bend forward and place their hands on the ground with their knees straight, but can barely get past neutral when bending backwards. When bending backwards the hips and pelvis must move forward under the belly button so that the trunk can move into extension. If your hips are restricted such that the pelvis can’t shift forward during backward bending, you will fall backwards as your center of gravity moves outside of your feet. Restriction at the hip, lumbar spine, or sacroiliac joint can produce a feeling of being locked in a bent forward position because your brain obviously won’t allow you to fall backwards.
Lumbar extension is essential for proper gait during running. As the right leg moves forward, the left leg must be able to move behind you. If you lack extension at the hip or lumbar spine on the left, your body will compensate in any number of ways such as trunk rotation to that side. Abnormal trunk rotation to compensate for a hip or lumbar restriction can cause excessive stress and pain at the lumbar spine or lower extremity.
Adding a couple of stretches to your daily workouts can make the first couple miles of the run more pleasant because you will be able to get out of that forward flexed position. Of course, if you are feeling numbness/tingling, pain down the leg, or any other unusual symptom, make sure to check in with your medical practitioner prior to adding any of these exercises to your daily work out.
Hip extension stretch
One foot up on a chair, opposite foot behind you with toe pointed inward
While standing tall, shift forward to stretch the front of the hip
Hips side to side in a doorway
Standing in doorway, move hips from side to side keeping head in middle
Allow your trunk to make a “C” shape, without rotating
Prone press up
Laying on stomach, leave hips on the floor as you press up into a cobra position
Dave moved to Spokane in 1995 to study Biology at Eastern Washington University. He was accepted to the EWU Physical Therapy program, and graduated in 2001. Dave earned his level III certification from the North American Institute of Manual Therapy in 2006 by attending over 160 hours of continuing education, writing three case studies, passing a written test, and passing a live practical test. Dave loves to golf with his wife, Sarah, who tends to beat him on a semi-annual basis. While Dave is a skilled manual therapist, he feels that some of his best work is performed at his barbeque in his back yard. He enjoys mountain biking, adventure racing, triathlons, fly-fishing, and most any other outdoor activity that can be done in the beautiful Pacific Northwest.
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