Biking for Hip Pain (that is probably a back problem)
 

I have recently encountered some unpredictable muscle pain (not deep in the groin) in my left hip. It is inconvenient but more seriously is keeping me off the golf course. And the intensity of the discomfort varies widely hour to hour.

What is fascinating here is that a bike ride is almost instantly soothing to this problem. So far any time I got out for a 'real ride' (more than an hour) I can count on the back feeling fine when I dismount. I have an upcoming appointment with my orthopedic doc with whom I have a long term relationship regarding my 'old as I am (71) knees'. I am convinced that the issue is my back and that the forced straight back posture on a road bike is the reason that biking provides relief. The other day it got particularly bad, so I just got on my spinner bike (set up to match my road bikes) for 10 easy minutes. It helped.

Biking as back therapy - who knew. And maybe I can get back to golf if I buy a pull cart and attach it to a bike and use that on the course (I normally walk and carry my bag). Or I once saw a guy riding a bike to the course with a full (smallish) golf bag across his shoulders.

dave

When I had a pinched sciatic nerve that caused a lot of lower back pain on the left side I struggled to pay flat, I struggled to sit, and standing kept the pain at bay. Although it was hard getting on the bike, a moderate 15mph on the road bike at the bike path would make the pain disappear. The doc thought it should make it worse but after a 2 hour ride I would be pain free for another couple hours till I sat again. So I know it can help.

Russ Roth The doc thought it should make it worse but after a 2 hour ride I would be pain free for another couple hours till I sat again. So I know it can help.

That sounds so much like my experience to date (even though my pain seems to manifest in the Piriformis muscle in the hip). Thanks for the comment.

dave

Hate to deliver bad news but... you've probably got an arthritic left hip (if the pain is on the inside as opposed to the outside of the hip) which undoubtedly will be clearly visible on an x-ray. I may be wrong but, if not, it's better to know, right? If so, a few things you may be interested to know-- it doesn't get better because it's an irreversible degenerative disease but, exercise does help, along with NSAIDs to keep down the inflammation and also, riding within your limitations and not pushing it because it can only get worse, e.g., 12 to 13 mi instead of 20 to 25. The good news is, you have picked the very best sport to keep exercising while getting by as best you can. Unfortunately, a hip replacement is the only 'fix' but I can't speak with experience because I have not gone there... yet, nor have I undergone cortisone injections to delay the inevitable. On a positive note - the modern method of a hip replacement-- going in from the front-- is said to be, a lot easier than a knee replacement. Again, on a positive note, I have done some googling around and there are the experiences of many who have undergone a hip replacement without having to make many if any changes in their riding style and preferences, such as, enjoying a road bike as opposed to an upright cruiser. As far as the back goes, you probably do need a more upright position so if you are riding a road bike you might look to see if your handlebars are up at least as high as your saddle.

McBTC I am not a doctor, but I would be surprised if this were arthritis. The location (to my uninformed mind) is not in the right place. The pain is next to iliotibial band (slightly to the rear of it) way on the outside of the hip.

My biggest fear is that it will be some back related issue that is a tough diagnosis and/or treatment with risks and/or unpredictable outcomes. Arthritis really doesn't scare me as I seem to be afflicted with that in multiple places and would be surprised if the hip were an exception here - just a matter of degree.

If you were to kind of list the 'working joints' in order of pain that they give me on a daily basis (knees, ankles, hips, shoulder, and back), hips and back are last on the list (until 12 or so days ago).

dave

That's good Dave - if it's to the outside as opposed to the inside there's so many other and probably more likely causes than arthritis... just googling which is always dangerous but...

"Two of the most common causes of lower back pain in older adults include osteoarthritis and spinal stenosis. Degeneration of joints in the lumbar spine is a common cause of back pain in older adults."

Do you ride a road bike? If so, hopefully a less aggressive position may ease and perhaps eliminate the lower back pain. And if so, perhaps a stem extension would help solve the back issue...

After exhausting all the more conservative treatments, I had surgery to correct a disc problem that was causing severe sciatic pain in my thigh and knee. Over time, the surgery did a good job of significantly reducing the pain as the nerve became less inflamed. Concurrent with the recovery after surgery, I developed pretty bad lower back pain. Related to the surgery? Dunno.

I rode comfort bikes as part of my recovery, moving to endurance road bicycles. Amazingly, the stretched out position helped alleviate my back pain. After trying PT, I moved on to chiropractic therapy. That with the bicycling fixed it.

I now ride proper road bikes around 180 miles a week. No back pain.

The doctors don’t know the reason for the problem or why bicycling helps so much. But their advice is to keep it up.

I realize my situation is different than yours. My point is, keep looking for medical and other solutions. And good luck.

McBTC Do you ride a road bike? If so, hopefully a less aggressive position may ease and perhaps eliminate the lower back pain. And if so, perhaps a stem extension would help solve the back issue...

I have a 2020 Trek Emonda SL6 and a 1995'ish Bianchi EL/OS NIvacrom steel frame with 2014 Campy Chorus (both road bikes). The Bianchi is relatively aggressive in its setup while the Trek is somewhat more moderate. WRT this problem I find the Bianchi slightly more comfortable than the Trek (and either one is more comfortable than just about any other activity or inactivity that I am likely to encounter.


@BCAC Your story is my fear - long and complicated diagnosis and recovery process. But since yours had a happy ending I guess there is hope.

dave

On your Emonda for example if you put a yardstick across your seat to the top of your bars and put a level on it, how many inches would you have to raise the bars to make them level with the seat?

I had hip and lower back pain and poor mobility and flexibility for years. Cycling wasn't helping. Might have been making it worse. It was so bad I could hardly walk a mile without severe pain in my hips and lower back.

It was incredibly painful for awhile, but full body scans -- CT, MRI, X-rays -- showed no significant skeletal or joint damage other than whatever is typical for my age. I figured it should respond to physical therapy and other types of exercise. Seemed sensible to vary my workout routines for better overall flexibility.

So last autumn I cut way back on cycling and switched to long walks, then jogging, and eventually running. At first a mile or two was all I could manage. Now I'm up to 5-7 mile runs and aiming for 10 miles this month and a half-marathon by summer.

The nagging hip and lower back pain is greatly reduced. I still have some neck and shoulder pain from other injuries (hit by cars twice), but that mainly hinders me on bike rides, not so much when walking and running.

canklecat So last autumn I cut way back on cycling and switched to long walks, then jogging, and eventually running. At first a mile or two was all I could manage. Now I'm up to 5-7 mile runs and aiming for 10 miles this month and a half-marathon by summer.

Interesting how things are different for different people. I started out a runner and ended up a cyclist simply because of susceptibility to ankle sprains. However, at this point my orthopedic guy has forbidden running due to osteoarthritis in my knees (not that I would be so inclined anyway, given how they feel).

McBTC On your Emonda for example if you put a yardstick across your seat to the top of your bars and put a level on it, how many inches would you have to raise the bars to make them level with the seat?

I got my second Covid shot yesterday and (arm soreness) I literally cannot (or at least will not) get either of my bikes down (they hang from the ceiling in the garage). I am not sure that I see the point right now as I am not going to do anything (like setup changes) until I have solid medical info (that is more than a week out).

dave

It's probably "piriformis syndrome." I think calling it a syndrome of a bit weird. Your sciatic nerve comes out of your spine and on its way down your leg, passes through your piriformis muscle, which can squeeze it and produce pain right there. If you don't do something, good chance you'll get a case of sciatica with pain all the way down your leg. "Do something!?" I had exactly the same thing (maybe exactly) this past summer. What I did:
First, my usual morning stretches: https://www.bikeforums.net/road-cycl...l#post15372967
Then a set of McKenzie stretches: https://spineone.com/mckenzie-method-back-pain/ I do these:

https://encrypted-tbn0.gstatic.com/i...4IVK5HVgnzls&s

Then I did these stretches: https://www.healthline.com/health/ba...sciatic-nerve?

The thing which helped me the most was doing for 3-5 miles brisk walks using a rolling hip motion where each hip travels in a circle as I walk. That seems to loosen up the spine or something(?) Worked though. Hurt like hell the first mile, but steadily improved during each walk.

Riding is really good, though. Every day. It relieves the pain, but unfortunately is not a fix.

No, don't change your bike fit. It's fine. I didn't.

Carbonfiberboy It's probably "piriformis syndrome."

Based on the research that I have done, that is my best guess as well. I hope to have an answer on 3/24 when I see my orthopedic guy.

dave

I have a very strong riding buddy, ~65, who's lived with diagnosed piriformis for years. The only things he's said which help him are 800mg ibuprofen, the "snake in the grass" McKenzie pose, and lowering(!) his bars. Having it that bad is due to a genetic defect in the location of the sciatic nerve as it passes through the muscle.

My riding is somedays the least painful part of the day for my back. Being banged up in my youth and now having classic osteoarthritis for my age (70s) has me down to 20 mile rides every other day. Longer or more often no more. I have used chiropractics for years, wonderfully exercises from Living Pain Free by Peter Eroscue and raising my bars just in the last year. Raising the bars is the most painful (not physical pain) as I can not bare to do it it on the C&V Italians which means they will have to find new homes.

I've always thought the Burley Travoy would make a fine golf bag transport.
https://www.burley.com/wp-content/up...IN-900x900.jpg

I hate to hear about the hip or related issue keeping you off the course. At first to me it sounded like an arthritic hip since you didn’t have pain pedaling but maybe not based on the location of the pain and others suggestions.

I have a reoccurring back muscle issue that flared up yesterday. It sounds very similar to what Freddie Couples experiences occasionally. We kept the grandkids over the weekend and between picking them up a lot and being in awkward positions on the floor my back said “enough”. It takes about 7 days to get it loosened enough to swing a club. I let my buddies know that I wouldn’t be joining them this week. Btw, we use push carts, I quit carrying my clubs 5-6 years ago.

But, like you I’m pretty much pain free while sitting and pedaling the bike. In fact I rode 82 miles and spent almost 5 hours on the bike yesterday. The hardest part was getting on and off the bike and walking around a store refueling. I walk pretty bent over......just can’t stand up straight.

FWIW, here is the latest of my hip. The diagnosis was gluteus medius syndrome tendonitis. The treatment is physical therapy and 'dry needling' which is mechanically similar to accupuncture but the goal is to mechanically stimulate the inflamed area which promotes healing. The first 10 days was just stretching and dry needling (which is vaguely uncomfortable but not really a big deal). Not much came of that so we proceeded to add strength stuff which was an absolute disaster.

I could not do the 'wobble board' unless my body was perfectly upright (too much pain in the hip otherwise). Then I did a few resistance band things where you (against band resistance) move your left leg directly to your left while standing on the right (then repeat on the other side). Really light resistance and I could not proceed after one easy set. And ever since then my left hip has gone from keeping me from doing a few things (like golf or mopping the floor) but otherwise just being a minor irritation, to now being a big deal where (sometimes yes, sometimes no) even the simplest things are REALLY difficult. On 3 separate occasions (2 of them on getting out of bed) I had to get onto the floor and do some stretches just to be able to walk. Other times I am pain free but never know what is going to trigger a big problem.

So I am now back in the queue waiting to see the doc again (and physical therapy agreed that this was proper in my case). I am not sure what is next.

Still bike rides are consistently therapeutic (although my PT is suspicious about it being a causal issue here).

dave

If you get any relief from the needling technique, "activator" clicky pen/gun doodad used by some chiropractors, etc., you might benefit from careful use of a percussion massager. These look roughly like a cordless drill, and instead of just vibrating the head works like a jackhammer, punching in and out. Seems more effective to me than my chiropractor visits with the activator.

With the appropriate head I've found them very effective for my persistent tight spots and spasms. The heads range from medium density foam to hard plastic tips about the size of a magic marker tip, with a range of tips shaped like two or more fingers, another about the size of a quarter, etc. The foam tips are good for work close to bones where a hard plastic tip would cause bruises over bone and injured tendons/ligaments. I use the hard plastic tips on dense muscle around my glutes, hips, the knotted up muscles between my neck and shoulder, etc.

I use these so often I've worn out my first percussion massager after a year of nearly daily use, and replaced it with a single-tip version shaped like a cordless drilll, and another with dual heads that straddle the spine and a long handle to easily reach my own back.

Since I added jogging to my activities a few months ago I have some new injuries, which are mostly due to poor skeletal alignment caused by mild scoliosis and other issues. So while the pain might be around the shin near the knee or hip adductors, the real cause of the problem is poor technique such as over-striding, or needing a bit of a shim in one shoe to compensate for different leg lengths. Running is even more unforgiving than cycling for poor technique, fit and ergonomic imbalances.

For the golf course, you might consider:

https://www.rockbottomgolf.com/bags-...CABEgIfffD_BwE

An LBS local to me built something quite like this a few years back, but they seem to have gone out of the business. These look to me to be cheaper knock offs. One of the courses I regularly play has a couple of the local version in the cart barn and they look to be a more well built machines. There was also an e-version and I see one guy regularly who has one of the first generation of those.

Since the PT made it worse, my guess is that there a tear at an attachment point and the diagnosis is incorrect. One thing you can try while waiting is taking 600mg ibuprofen every 6 hours for a few days. No harm in it. After you quit if the pain is much, much less and doesn't come roaring back, perhaps the tendonitis diagnosis is correct. It's interesting the stretches help, though. It's also interesting that I don't see any tendons involved with the gluteus medius. Pain in the hip could be a lot of things - it's a large area. Can you walk? If you walk, where does it hurt, or does it not hurt? Some reading:
https://health.ucsd.edu/specialties/...-bursitis.aspx
https://www.americanhipinstitute.org...dius-tear.html

So what are you doing to change your golf swing?

My experience with hip and back pain has been bike is good, golf is bad. I had an interesting situation where I found out years ago my left leg was slightly shorter. Easy fix for the bike, but for tennis, golf, basketball, etc., I just went about it without a thought. Started catching up with me in my late 60's to the point where walking pain free was tough, but riding was fine. Once I added a lift to my left shoes, my pain, "for the most part" went away. I'm not saying that is your issue, but if riding is pain free, it is not the bike and you'll need to address the other stuff you do.

My hip pain was also on the outside.

John

I also have hip problems. Where the gluteus medius attaches to the femur there is also the pyriformis and gluteus minimus attaching there. I think my problem is more with the pyriformis, but the docs and PT don’t have a clear answer. Well, they think the ultimate problem is in my back and this pain is just part of a cascade.

I have had dry needling in this area and it helps, but like the poster above I have found the percussion guns to be a better deal. Compared to the needling the main thing is I can do it 2x per day instead of every other week. I would recommend giving them a try. I have a Hypervolt but there are many similar options, and on Amazon there are some pretty reasonable cheaper ones.

It sounds like you have an injury you need to rest for awhile, in particular on hip-stressing things like golf. I don’t find biking has much effect on any of my back/hip issues, but I have an endurance geometry and stand up a lot.

Re: Can I walk.

Anything that stays "centered without rotation" is fine. Anything else is maybe (or maybe not) a serious issue.

dave

Ps. I have been taking 15mg of meloxicam daily for years. This hip thing is new and not related to my meloxicsm script. . But it certainly is relevant to any other NSAID selection.