Sometimes it happens with a bang, like when former Tour de France pro Marty Jemison was racing Tour of Flanders in the late 1990s. His saddle slipped to be nose up. He thought “no big deal” until one of the steep cobbled climbs, where he was in the saddle cranking out maximum wattage.“And my back just popped,” he says.
Jemison finished the race and the others that followed until he retired about 18 months later, though he had pain off the bike and for the first 30 or 60 minutes of riding, and knew something was wrong. That something was a herniated disc that became nearly debilitating after retirement, eventually required two procedures, and still flares up to this day if he’s not meticulous about his bike position and on top of his core work.
Other times, it’s the proverbial straw that breaks the camel’s (or the cyclist’s) back, as was the case with avid long-distance cyclist Mark Elsasser of Philadelphia who developed some sciatica in 2018. He was able to ride through it just fine, but couldn’t sit for any length of time before the pain was unbearable. The diagnosis: a herniated disc in his low back, which he resolved with physical therapy and has kept at bay by changing his position on the bike, going from a 0-rise to 5-degree stem. “My spine is less compromised being a bit more upright rather than nose down on top of the stem
Herniated discs are fairly common in the general population, occurring most frequently among 30- to 50-year-old adults, and men more often than women. Interestingly, you may have one right now and not even know it. “We know from radiographical studies that 50 percent of those aged 40 may have some form of disc herniation. We might consider it normal, age-related changes, and many of those won’t be symptomatic,”
fact, one research review published in the American Journal of Neuroradiology found that degenerative changes in the discs, which include herniated discs, are present in nearly 90 percent of adults 60 and older and often require no intervention. A herniated disc only causes pain if it’s pressing or otherwise irritating a nerve root in the spine
What Exactly Are Herniated Discs?
Your spine is comprised of 24 vertebrae. Between those vertebrae are fluid-filled cushions known as discs, which act as shock absorbers for your spinal bones.
“Imagine your spinal discs as jelly-filled doughnuts,” says Andrew Pruitt, Ed.D., the founder of the Boulder Center for Sports Medicine and CU Sports Medicine and Performance Center. “A herniation happens when the jelly inside pops out.”
You may hear people using other terms like “bulging disc,” “ruptured disc,” or “slipped disc.” Technically, a bulging disc is just that: It’s when the jelly inside the donut is pushing against the side enough to bulge out from the vertebrae but isn’t leaking out. A ruptured or slipped disc refers to an actual herniation, where the doughnut cracks, allowing the gel-filled center to squeeze out.
A bulging and/or herniated disc can cause pain by creating pressure on the nearby nerves. There’s some evidence that the leaked fluid from herniated discs also can cause chemical irritation and inflammation of the spinal nerve roots.
What Are the Symptoms of Herniated Discs?
Again, it’s possible to have an asymptomatic herniated disc where you feel no pain. When you do have pain from a herniated disc, however, you’ll know it.
Pain from the herniated discs is sharp and radiating. Most cyclists experience herniated discs in the lower, lumbar back (we’ll get to why in a bit). So you may feel burning pain often known as sciatica that radiates from your lower back into your glutes and down one or both legs, sometimes even into your feet. You may feel pain similar to an electric shock when you stand or sit or walk. You may also feel radiating numbness, tingling, and/or weakness in your lower extremities.
What Causes Herniated Discs?
So how does the jelly get out of the doughnut and start wreaking havoc on your spinal nerves? In a word: pressure. It can be extreme and sudden, like Jemison cranking on the cobbles. Or, in many instances, it can happen gradually over time, as was the case with Elsasser.
When your spine is in its generally straight, neutral position, the pressure from the top down is uniform on your discs, so the jelly inside those cushions is evenly distributed, Pruitt explains.
“When you bend forward, the jelly is pushed back, stressing the skin of that doughnut,” he says. “If you’re sitting all day, that jelly is pressing back there for eight hours. Now jump on a bike, and you add another two hours in an even more extreme position, pressing that jelly further and further, until—pop—it comes out.”
Though herniation can happen anywhere in the spine, in cyclists it happens most frequently in the lumbar (low back) region close to the base of the spine, or the L5-S1, the bottom-most disc that sits right on top of your tailbone, because that’s where we bend the most
For many cyclists, the L5-S1 is where they’re getting their flexion, and the lumbar spine has about six degrees of movement,. So if you’re not hinging from the hips and keeping your spine within its safe, natural range, you’re pushing those limits. Keeping your spine under that kind of stress for prolonged periods of time pushes you closer to the failure point.
Along those lines, research shows that riders with a lower handlebar position and greater flexion in that key lower back region were more likely to have low back pain. Though, importantly, the research also suggests that poor core strength and endurance could contribute to the spinal stress and low back pain in cyclists.
Of course, the bike isn’t the only place you can stress your spine. The gym can be another place riders put their spine under unhealthy stress.
Maintaining a stable, neutral spine is very important when resistance training, especially when doing big lifts like deadlifts and squats as well as under velocity like with kettlebell swings,
How Are Herniated Discs Treated?
The good news is a 2020 scientific paper, “Slipped disc: Overview,” reports that about 90 percent of people will get relief from their pain and restricted movement within six weeks even if they receive no medical treatment. That’s because the body gets rid of part of the prolapsed tissue or it shifts position so that the nerves aren’t irritated anymore, according to the overview.
You can help that process along with physical therapy, “The vast majority of folks feel better and have a great outcome by doing mobility exercises for the hip and low back and decompression exercises for the spine.”
The exercises you do depends on your individual situation, but your physical therapist may recommend mobility, stability, and core strengthening exercises such as:
- Press Up: Lie facedown with your feet together, toes pointed, and your forearms on the floor palms. Pull your shoulder blades down and in towards your spine and press into forearms to lift your chest off of the floor, keeping your neck long and hips on the floor. If mobility allows, you can press up further by placing hands below your shoulders to come into an up-dog position. Hold for 3 to 5 seconds. Repeat about 15 times.
- Hip Flexor Stretch: Kneel with the affected knee on the floor, tighten your glutes, and brace your abdominal muscles while keeping your back straight. Pressing hips forward. Hold this stretch for 30 seconds. Do 3 times.
- Bird Dog: Get on your hands and knees with your palms flat on the floor, shoulder-width apart. Slowly raise and straighten your right leg and left arm at the same time. Keep your hips aligned with the torso and not tilted to one side. Hold for 10 seconds. Return to start. Repeat on the other side.
Cycling itself, when done with a healthy riding posture, can also be a great rehab tool to strengthen the discs and surrounding structures, In fact, a study done on high-volume road cyclists who rode nearly 100 miles a week for five or more years had beneficial adaptations to their discs and psoas (the biggest hip flexor muscle), which were beneficial for spinal health.
If you’re riding through your rehab, Brodie recommends “crocodile breathing” when you get off the bike. To do it, lie facedown with your forehead resting on the back of your hands and let your chest and hips sink into the floor. Inhale deeply into your belly, expanding your diaphragm for four slow counts. Pause for two seconds, then exhale for six slow counts.
Finally, while many herniated discs can be treated conservatively with physical therapy, some require injection therapy like nerve blocks, if the symptoms are severe, . In rare cases, spinal disc herniation can cause extreme pressure and swelling of the nerves at the end of the spinal cord causing a medical emergency known as cauda equina syndrome.
How to Prevent Herniated Discs
Again, cycling can actually improve spinal strength and the health and hydration of your discs
Having a good bike position and the right saddle is key. “You want your spine in a healthy position that doesn’t strain those discs in your lower back. If you ride a gravel or a mountain bike, you’re likely already in a slightly more upright, more neutral spine position,
An anatomical saddle will also allow you to put your weight on your perineum without putting harmful pressure on those sensitive tissues, so you’re able to reach the bars without bending too far and putting your spine in an unhealthy position. “Saddle technology improvements have really helped reduce degenerative disc disease
You also can protect your spine by doing core-strengthening exercises several times a week.
- How to do these exercises: The American Council of Exercise recommends performing three sets for each using a reverse pyramid rep/set scheme. Start with a higher number of repetitions for the first set, then decrease by 2 to 6 reps, then decrease by another 2 to 4 reps on the last set. So you might start with 8-6-4 reps and work your way up to 12-10-8 reps as you get stronger and build endurance. Hold each exercise for no more than 8 to 10 seconds.
- McGill Curl-up: Lie on your back with one leg extended and the other leg bent, foot flat on the floor. Put your hands under your low back to maintain your natural arch. In one move, lift your head, shoulders, and chest off the floor, keeping your neck and back in the neutral position. Hold. Then slowly return to start. Do half a set. Then switch legs and complete the set.
- Side Bridge: Lie on your right side, with your forearm on the floor and elbow underneath your shoulder. Bend your knees at a 90-degree angle. Place your left hand on the opposite shoulder for stability. Lift your hips off the floor so your body forms a straight line from your head to your knees. Hold. Then lower to the starting position and repeat to the other side. Work up to doing the move with your legs straight.
- The Bird Dog: (As explained in the previous section)
You can make these exercises part of your warm-up, along with dynamic mobility moves before you get into your bigger lifts.
Practicing good spine hygiene by avoiding hunching forward when you sit and not sitting in a static position for prolonged periods of time, but rather shifting positions in your chair every 15 minutes and getting up, moving around, and doing a little standing stretch, extending your arms, reaching overhead and taking a deep breath every 60 to 90 minutes.
Original Post bicycling.com