Cyclists Can Prevent Low Back, Hip and Knee Pain

J9A – The following is the first part of a two–part article. It has 1722 words. Copyright permission is granted when used without alteration and bio is included.

Part I – The Cause

By Julie Donnelly, LMT

Pain can stop you in your tracks and stay with you for years! Cyclists are especially prone to low back pain, and when combined with knee pain and having hip muscles that are extremely tight, riding becomes a challenge, if not near impossible. It´s amazing how many athletes suffer with these conditions every day and still continue to live "life as usual". All of these conditions are caused by one key muscle, the iliopsoas, which is compounded by the quadriceps of the thigh.

Most athletes are aware of the fact that muscles are causing their pain, but they don´t know what to do about it. When you are cycling you stay in the bent–over aerodynamic position for an extended period of time, often for hours, and when you go to stand up the pain shoots up your back and down your legs. It takes a few moments before you can stand up straight and when you finally do you still have an ache in the low back. The only relief you get is to bend over, but when you try to stand again, the pain returns! At the same time you feel pain in the front of your hips, and often your range–of–motion is severely limited. You´ve lost power in your hips and legs and you see that your performance isn´t at the level you set for yourself.

You´ve been to doctors, chiropractors and all types of therapists. You may wear a back belt, have a lumbar cushion in your car or at your desk, and you´re taking more pills than you ever thought possible, all without permanent relief. You stretch, but it doesn´t seem to help, in fact, sometimes it makes it worse! Sometimes you think it´s hopeless, but your absolute determination keeps you going. You´re often told to "rest", but you know that isn´t an option if you are to win the race you´ve set as a goal. Perhaps you´ve even been advised to go for surgery, but that thought is more frightening than the pain, if the surgery doesn´t work you could easily have more problems than you are already experiencing. What should you do? Is it hopeless?

No, it certainly isn´t hopeless. The good news is a simple stretch, combined with an easy self–treatment, can help to alleviate the pain and often eliminates it totally. To understand how something this simple can accomplish a "miracle", it is important to understand the role of the primary muscle that is causing the problem.

The spine is the frame upon which the entire body is dependent for motion. Beginning at the base of the skull the spinal cord passes through seven small vertebrae called the cervical vertebra. The next section, called the thoracic vertebra, begins at the level of your shoulders and goes down to the bottom of the ribcage. It is at this point where the low back begins with the five lumbar vertebrae that end at the sacrum, commonly known as the tailbone. The spinal cord divides at the sacrum (and is now called the sciatic nerve) passes through the hips and then continues down your leg.

We can move our waist in so many directions because of several muscles that attach at the area of the low back. The muscle responsible for the majority of low back pain is the iliopsoas, (pronounced "ill–e–o–so–as"). The iliopsoas is a "hidden" muscle because of its location on the front of your lumbar vertebra, directly behind your abdominal organs. When you rub your low back you are actually rubbing two other back muscles called the erector spinae and quadratus lumborum. The iliopsoas is between these muscles and your abdominal organs. I call it the hidden muscle because most people aren´t aware that it exists, but without it you wouldn´t be able to sit down or take a step!

Its importance comes from the fact that it goes along the front of the spine, through the inside of your pelvis, and inserts into the top of your thigh bone. When the iliopsoas contracts (shortens) you bend over, lift your leg, or sit down. When you are cycling you are bent over and you are bringing your knee up toward your chest, totally contracting the iliopsoas repeatedly for hours. When you add to this normal sitting, walking and bending over, you realize that the iliopsoas muscle is contracted at least 90% of your life, even when you are sleeping! This is how the problem starts. A phenomenon called muscle memory causes a muscle to re–adjust its size to the length that is most frequently held; in this case, shortened. When you try to stand up the now–shorter iliopsoas muscle can´t stretch long enough to allow you to stand, and because the muscle goes along the inside of your pelvis it pulls your lumbar vertebra forward and down. You feel the pull on the vertebra but your brain doesn´t register that it is the front of the vertebra, so you rub your low back. It doesn´t help, the pain is still there!

Realizing that "point A" is at the lumbar vertebra, and "point B" is on the top of your thigh, when you are standing straight up the muscle is now at its longest length. When you sit down or raise your leg, you are bringing point B closer to point A, and when you are cycling you are bringing the two points almost together. However, when the muscle stays in the shortened position for an extended period of time it cannot stretch back to its full length and the two points must stay together – so you cannot stand up.

Since the distance between the origination and the insertion points remain the same, the iliopsoas muscle is pulling hard on both points. If you are lying on your trunk you will be told you have a "short leg". But, unless your bones are actually different lengths, your leg isn't "short"; it is just being pulled up toward your trunk. Or, if you are standing up, the pressure on the lumbar region will pull the vertebra forward and down, causing your sacrum to move up, and also causing your pelvis to rotate forward and down.

A Major Cause of Hip Pain and Inflexibility

The iliopsoas triggers so many muscles to shorten, torque, or overstretch, that it became an entire chapter in my book The Pain–Free Triathlete. In fact, it will soon become it´s own book!

Meanwhile, here is a short synopsis of the many facets of an iliopsoas contraction:

The anterior pelvis goes forward and down. As a result, the posterior pelvis is moving up and is overstretching the hamstrings which will cause pain to be felt at the top of the thigh/buttocks and also at the posterior knee. Since the hamstring fibers will be stretch so tightly, the hamstrings will appear to be contracted. You will either be treated for contracted hamstrings, or told you need to do hamstring stretches. However, you´ll find that stretching the hamstrings only adds to the pain – a sure sign of a iliopsoas contraction.
Contracted quadriceps especially the fibers on the outside of the thigh. The quadriceps originate at the front of the pelvis, so as the pelvis is rotating down, the quads must shorten or they will be loose and unstable, unable to function. As they tighten to conform to the new required shorter length you will lose strength. Also, the now shorter quadriceps will be putting pressure on the insertion point at the knee so you may feel pain in your knee when you try to bend your leg, and in your anterior hip when you stand up straight..
All muscles that attach to the sacrum are pulled out of alignment. This will cause the piriformis muscle to press into the sciatic nerve and you may feel pain in your hip, hamstrings, calf, and the ball of your foot.
The pelvis is pressing up on the sciatic nerve. This causes the same pain pattern as above.
The nerve to the thigh is entrapped. The femoral nerve, which exits the spine through the lumbar vertebre and then travels through the inside of the pelvis, can become impinged and cause the front of your thigh to become numb.
The iliotibial band becomes tight. The tensor fascia lata muscle of the hip is stretched and is therefore pulling on the ITB, and causing pressure on the lateral knee.
The entire vertebral column is being pulled from the bottom and causing disks to be compressed and nerves to be impinged along the spine – causing untold problems throughout your body!

As amazing as it sounds, this is the short list of conditions caused by a tight iliopsoas muscle!

Each of these situations will cause you to lose strength because your muscle doesn´t have its full length needed to pull on its insertion point. You also lose flexibility because the short muscles won´t allow your thigh bone to move properly. You try stretching your hip muscles but it doesn´t help, and it won´t help until you release the tension in the iliopsoas muscle.

It sounds incredible that one muscle can cause such havoc in the body, but I have seen this phenomenon in hundreds, if not thousands, of athletes and non–athletes. By simply releasing the tightness in the iliopsoas muscle the pelvis rotates back to its correct position and relief is felt in areas all over the body.

In fact, my experience has shown that no matter what is happening to a person, it is vital to do the iliopsoas stretch, and the quadriceps treatment, before doing anything else. It´s amazing how often this one combination is all that is required to get a person back into a pain–free state.

Understanding the logic of the body is important to athletes, but it makes for a very long article. The second half of this article will explain how the iliopsoas is causing tension in your hamstrings and ITB (iliotibial band), which then puts pressure on your knee. Two important treatments will be given; the stretch for the iliopsoas and the treatment for the quadriceps. Both treatments, and lots more, are taught in The Pain–Free Triathlete.

Julie Donnelly is a licensed massage therapist specializing in the treatment of chronic pain and sports injuries. She has co–authored several self–treatment books, including "The Pain–Free Triathlete" and "Carpal Tunnel Syndrome–What You Don´t Know CAN Hurt You." She teaches Julstro self–treatment workshops nationwide and is a frequent presenter at Conventions and Seminars. Julie may be contacted through her website: www.julstro.com.