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Cycling with Degenerative Disc Disorder

Old 10-31-16, 10:00 PM
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Cycling with Degenerative Disc Disorder

Does anyone else here ride with DDD?

I have recently been diagnosed, after a debilitating muscle tear/pinched nerve left me almost unable to walk and in excruciating pain for a few days. I was on the last 10kms of a 100km bike ride and I felt my back go out as I twisted slightly to check traffic behind me. My back really shouldn't have been affected by the movement, but two days later I was on my hands and knees getting out of bed, getting up the courage to stand and almost blacking out from pain (probably due to swelling irritating a nerve). It was a very sobering experience.

Anyway, I am off my bike for now. It's a Specialized AWOL, and my doctor has said I need to have a more upright posture, so I am going to get rid of the drop bars before I ride it again. Thankfully it has a long top tube and a short stem, so I am going to put Jones Loop Bars on the short stem with new shifters and brake levers for a more upright posture.

My doctor has recommended I ride a recumbent bike, as the posture is perfect for patients with lower back issues--my DDD is in the lower spine--but it is just not an option for now. All my money is in my AWOL and with a young family, I just can't afford to go out and buy a new recumbent. Maybe it will be an option in 4-5 years, but until then, I will ride my AWOL.

Does anyone have any tips for riding with DDD? Does riding ever cause flare ups of pain? Are there any measures other than altering the reach and drop of my bike that I can take? I have started a program of stretching every morning and I am cutting down on food to lose weight, so I am on the right track there, but I would really appreciate any advice or tips any of you have.
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Old 11-04-16, 08:00 AM
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I have 2 damaged vertebrae in my neck from sitting at a stoplight in my Alfa 20 years ago and watching in my mirror as I was hit from behind.
After awhile I could no longer tolerate long-reach drops and built my bike semi-upright with a moustache cockpit. I also ride compact drops and an upright.
Most important thing I can tell you is get off your neck and shoulders. Support yourself with core muscles. Always ride with bent elbows, always ride with straight wrists. Think about leaning into your core muscles and you will find a burst of spin energy.
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Old 11-08-16, 04:46 PM
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PDKL45,

I am not a medical professional, so take my recommendations with a grain of salt, but below is what I have experienced so far:

I also have degenerative disc disease (DDD). Specifically, my lower two discs (L5/S1 and L4/L5) are "dead"; on an MRI scan, they show up as black and weak, whereas the discs higher in the spine are white and healthy. I am 32. I have had low-back issues since 2010, at age 26, when I injured myself while using a leg press machine. Since then I was able to complete a short stint in physical therapy and improve and do a lot of quality fast-paced group riding in late 2011 and all of 2012; complete a cross-USA tour (4,000-plus miles) in 2013 with amazingly little back pain; and continue the quality riding through 2014. But in 2015 and 2016 I have experienced similar muscle pulls/spasms as you mentioned, which have completely debilitated me for days/weeks at a time, and I have only been able to do lots of garbage cycling miles.

Unfortunately, it seems there is no one cure. Just today I got back from an appointment with the most highly respected spine doctor I could find in my area, and he had little reassuring good news. He said that if the discs are in a state of DDD, then they will not get better; they will just deteriorate over time. My doctor did not recommend any surgical fixes to my issues because of my young age and (relatively high) activity level. Of course, I am in pain most of my life, either on the bike or off, ranging from low-level soreness, to quite sore and pained, to excruciating pain during flareups of the injury, so even though I am trying to continue to be highly active, I feel like ****!

The main recommendations to deal with DDD and being a cyclist are:

1. Lose weight if you are overweight -- and don't smoke, as that can make discs problems in particular worse. Although I am not overweight by "normal people" standards, I am about 20 pounds heavier than I was in 2013 (some of that being extra muscle, not fat), so I am going to try to recommit to being as light as possible, as it can only help things.

2. Strengthen core muscles to reduce the load placed on the lower spine, and exercise to increase flexibility. You are likely a candidate for physical therapy. I just finished up eight weeks of therapy; I do feel better and can usually ride leisurely for about 30 minutes before any indication of soreness or pain, but of course that's still not remotely close to where I want to be. Still, maybe several more months of doing the strengthening and stretching will pay off. It is now almost winter, so I can commit to doing that stuff during the cold months.

3. Try an inversion machine or traction to reduce pain. I'm going to try the former; a friend of mine with disc problems recommends it.

4. Try a long-acting NSAID like meloxicam -- which I have just heard about and am going to try soon, at my doctor's recommendation.

5. Steroid injections. I have always heard about them, never tried it. If I do any longer tours, I will likely try it. A Band-Aid fix, but better than nothing.

6. Adjust your seated posture if you spend a lot of time sitting. I work a desk job and my posture was horrible and probably contributed to my issues.

7. Alter your fit. For your situation, before you go all out and replace your bike, you could try an adjustable stem and set it to the most upright position. I recently installed a Ritchey adjustable stem for my Surly Long Haul Trucker. It has helped me somewhat, but it is mainly a Band-Aid to my overall problems. However ... I do wonder if an upright posture is better over the long term. In my non-bike life, I feel much more at ease when I'm in a plank-like position (which is more similar to an aero cycling fit) than when sitting in a chair (which is like an upright bike position). I'm not sure.

As for recumbents, yeah, I guess they probably are better for low-back pain. I have never tried one, though. Once you feel well enough to ride one, you could rent one for a day and compare it your regular bike. If the recumbent feels good and the upright bike doesn't, that is valuable information. My doctor says I may have to stop cycling because of the bent-forward position being back for my situation, which is pretty scary.

I am also curious how old you are, what you do for a living (sit, work construction, etc.), what your previous stretching regimen was like, etc. That could reveal problems as to why you developed DDD in the first place. In my case, as far as I know, it was a single traumatic incident.

The main thing I am hoping for now is that my low back and ab muscles were so weak -- due to no substantial stretching or strengthening of them since mid-2015 -- that I can make huge strides via physical therapy and correct things, and get back to where I was in 2012-2014.

Sorry for the long and somewhat depressing-sounding post! I think the prognosis for severe DDD is not good, but I am hoping the physical therapy can win out in the end. Feel free to reply or private message me if you want to discuss further!

--Patrick

Last edited by ptotheatsign; 11-08-16 at 04:53 PM.
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Old 11-13-16, 07:58 PM
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Thanks both for the great replies.

Specifically, I am 40 years old. I have a desk job, involving long periods of sitting, that has only been the case for 10 years now. My doctor seemed to think that my condition probably stems from weight issues, as well as normal aging. He said that it usually strikes between the ages of 30 and 50 and it can stabilize, with reduced weight and exercise.

I have always stretched and have always been flexible, but I have also been overweight for a long time. I am currently working at losing weight, as well as doing stretching and core-strengthening exercises. I have to say that pain is a great motivator; I am fairly driven to make changes at the moment, if only to try to avoid a re-occurrence of inflammatory pain for as long as possible.

I altered my bike on the weekend, going from drop bars to falt Jones style bars--there are pics in the Clydes and Athenas sub-forum in the "I bought an AWOL today" thread. I am very hesitant to give up cycling, as it is my main form of recreation as well as aerobic exercise. I am going to ride for a month or two and decide whether I need a steerer extender to bring the bars further up.
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Old 11-14-16, 10:22 AM
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saw your photos, that's a great bar choice.
My upright is built with Ahearne Map bars, which have the same sweep as the Jones H. Hand position couldn't be more natural and relaxed.

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Old 06-15-21, 02:11 AM
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Cycling modifications

Originally Posted by ptotheatsign
PDKL45,

I am not a medical professional, so take my recommendations with a grain of salt, but below is what I have experienced so far:

I also have degenerative disc disease (DDD). Specifically, my lower two discs (L5/S1 and L4/L5) are "dead"; on an MRI scan, they show up as black and weak, whereas the discs higher in the spine are white and healthy. I am 32. I have had low-back issues since 2010, at age 26, when I injured myself while using a leg press machine. Since then I was able to complete a short stint in physical therapy and improve and do a lot of quality fast-paced group riding in late 2011 and all of 2012; complete a cross-USA tour (4,000-plus miles) in 2013 with amazingly little back pain; and continue the quality riding through 2014. But in 2015 and 2016 I have experienced similar muscle pulls/spasms as you mentioned, which have completely debilitated me for days/weeks at a time, and I have only been able to do lots of garbage cycling miles.

Unfortunately, it seems there is no one cure. Just today I got back from an appointment with the most highly respected spine doctor I could find in my area, and he had little reassuring good news. He said that if the discs are in a state of DDD, then they will not get better; they will just deteriorate over time. My doctor did not recommend any surgical fixes to my issues because of my young age and (relatively high) activity level. Of course, I am in pain most of my life, either on the bike or off, ranging from low-level soreness, to quite sore and pained, to excruciating pain during flareups of the injury, so even though I am trying to continue to be highly active, I feel like ****!

The main recommendations to deal with DDD and being a cyclist are:

1. Lose weight if you are overweight -- and don't smoke, as that can make discs problems in particular worse. Although I am not overweight by "normal people" standards, I am about 20 pounds heavier than I was in 2013 (some of that being extra muscle, not fat), so I am going to try to recommit to being as light as possible, as it can only help things.

2. Strengthen core muscles to reduce the load placed on the lower spine, and exercise to increase flexibility. You are likely a candidate for physical therapy. I just finished up eight weeks of therapy; I do feel better and can usually ride leisurely for about 30 minutes before any indication of soreness or pain, but of course that's still not remotely close to where I want to be. Still, maybe several more months of doing the strengthening and stretching will pay off. It is now almost winter, so I can commit to doing that stuff during the cold months.

3. Try an inversion machine or traction to reduce pain. I'm going to try the former; a friend of mine with disc problems recommends it.

4. Try a long-acting NSAID like meloxicam -- which I have just heard about and am going to try soon, at my doctor's recommendation.

5. Steroid injections. I have always heard about them, never tried it. If I do any longer tours, I will likely try it. A Band-Aid fix, but better than nothing.

6. Adjust your seated posture if you spend a lot of time sitting. I work a desk job and my posture was horrible and probably contributed to my issues.

7. Alter your fit. For your situation, before you go all out and replace your bike, you could try an adjustable stem and set it to the most upright position. I recently installed a Ritchey adjustable stem for my Surly Long Haul Trucker. It has helped me somewhat, but it is mainly a Band-Aid to my overall problems. However ... I do wonder if an upright posture is better over the long term. In my non-bike life, I feel much more at ease when I'm in a plank-like position (which is more similar to an aero cycling fit) than when sitting in a chair (which is like an upright bike position). I'm not sure.

As for recumbents, yeah, I guess they probably are better for low-back pain. I have never tried one, though. Once you feel well enough to ride one, you could rent one for a day and compare it your regular bike. If the recumbent feels good and the upright bike doesn't, that is valuable information. My doctor says I may have to stop cycling because of the bent-forward position being back for my situation, which is pretty scary.

I am also curious how old you are, what you do for a living (sit, work construction, etc.), what your previous stretching regimen was like, etc. That could reveal problems as to why you developed DDD in the first place. In my case, as far as I know, it was a single traumatic incident.

The main thing I am hoping for now is that my low back and ab muscles were so weak -- due to no substantial stretching or strengthening of them since mid-2015 -- that I can make huge strides via physical therapy and correct things, and get back to where I was in 2012-2014.

Sorry for the long and somewhat depressing-sounding post! I think the prognosis for severe DDD is not good, but I am hoping the physical therapy can win out in the end. Feel free to reply or private message me if you want to discuss further!

--Patrick
Hi Patrick,
I found your post above incredibly useful. How have you progressed with cycling? I am curious once painful flare-ups subside, could you go back to any cycling?

Thanks,
Abhi
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Old 06-15-21, 09:34 AM
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Originally Posted by abheerao
Hi Patrick,
I found your post above incredibly useful. How have you progressed with cycling? I am curious once painful flare-ups subside, could you go back to any cycling?

Thanks,
Abhi
Hi, Abhi. My journey with low-back pain has been long and deeply troubling a few years, and did not resolve quickly as it sometimes can. I eventually developed a chronic condition where I was in pain 24/7, and cycling was not possible, nor was almost anything in a pain-free state. However, I've been able to essentially reverse that, and that's quite an accomplishment.

This is the first year I've attempted to get back into cycling, after a long break. I have a new bike with a more upright posture. I'm slowly returning to a more aggressive on-bike posture as my health allows, but riding my previous road racing bike feels ridiculous right now.

I'm no longer such a serious cyclist and don't plan to be. I had to take seriously daily core stability exercises, and later heavier weightlifting (not daily), in order to build total-body resilience and improve my neurology in order to beat chronic low-back pain (CLBP). I also integrate hiking a lot more than previously instead of being so bike focused.

I also don't agree with some of what I originally wrote above, specifically numbers 3-5. I take issue with the notion of degenerative disc disease (DDD). By itself, it is a poor diagnosis. Instead, you need to figure out what postures and loads cause pain, and which don't, in order to get better.

The most useful resources for me were back pain rehab work by Stuart McGill; information and strategies about the nature of pain and chronic pain by Lorimer Moseley and David Butler; the book "Crooked" by Cathryn Jakobson Ramin; and some mind-body visualization concepts. The most core introductory pieces behind my rehab process are below:
  • The book "Explain Pain" by Lorimer Moseley and David Butler. In its place, this online lecture is a good primer: "Getting a grip on pain and the brain" (search on YouTube)
  • Stuart McGill, "The Science on How to Avoid or Improve Back Pain Podcast with Stuart McGill" (search on YouTube)
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Old 06-15-21, 11:58 AM
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DDD Rehab

Hi Patrick,
thanks again for the useful info on Rehab and pain. I will defo look up those....I have started swimming as that seems to give me relief. I am also incorporating a daily core strengthening and stability regimen over the last 6 months. Did you try a recumbent at all or not bother? I have been through multitude of physios but did you find any specific stability exercises that started making a difference to your chronic back pain?

I am glad you are back relatively pain free but it must have been a miserable few years in pain. I can't believe that doctors, physios etc tell us that 'you have DDD...learn to live with pain'...

​​​​​​Hopefully, there will be more research on this over the coming years.

Abhi
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Old 06-15-21, 10:47 PM
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Originally Posted by abheerao
Hi Patrick,
thanks again for the useful info on Rehab and pain. I will defo look up those....I have started swimming as that seems to give me relief. I am also incorporating a daily core strengthening and stability regimen over the last 6 months. Did you try a recumbent at all or not bother? I have been through multitude of physios but did you find any specific stability exercises that started making a difference to your chronic back pain?

I am glad you are back relatively pain free but it must have been a miserable few years in pain. I can't believe that doctors, physios etc tell us that 'you have DDD...learn to live with pain'...

​​​​​​Hopefully, there will be more research on this over the coming years.

Abhi
A good guide is: If something gives you relief, do it. If something causes you pain (more than a 2 or 3 out of 10), don’t do it.

I gave up cycling for about two years and was prepared to give it up permanently if needed. It wasn’t helping me get better, actually making me worse due to my specific injury causes by lumbar flexion (forward bending). I never tried a recumbent due to cost and feeling that it wouldn’t help my situation.

There actually has been a lot of research (mainly by people like Moseley and Butler on the neuroscience of pain, and McGill on the biomechanics to suss out pain generators and avoid them), but the medical establishment has been slow to respect the research — perhaps because it is much more lucrative to give people endless physical therapy (that often doesn’t help), surgery (spine surgeons are huge money makers for hospitals with suboptimal results), or drugs. (The truth is any number of things may help someone, sometimes due to the placebo effect, so I don’t criticize something if it works. But much of mainstream back pain care is random and ineffective.)

My go-to exercises were the McGill Big 3 (bird dog, side and front plank), clamshells, focused abdominal breathing, as well as activity and movement changes to avoid triggering micro movements that were often painful.

Good luck! If you wish to converse further or I missed something, feel free to email me (it’s my username here @ gmail) as I don’t use this forum much anymore.
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Old 06-16-21, 03:52 AM
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I also have DDD from working in a factory for 40 years. I would also suggest in looking at a suspension seatpost in addition to core exercises.
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Old 06-16-21, 11:32 AM
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DDD Rehab

Thanks Patrick and Blue192 for your tips and advice
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Old 08-02-21, 10:04 AM
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Hello. I also suffer from lots of lower
back stuff. I am on disability and am
awaiting a orthopedic referral. I ride
but not much. My weight, back and
right knee all get angry when I ride.
l mess around with saddle settings.
Sometimes I use a gel saddle pad.
I had COVID-19 in January and was
sick for a long time. Long hauler I guess. My arthritis in all my joints
became worse post Coronavirus.
Anyway best of luck and take care.

Last edited by EricWade; 08-02-21 at 10:23 AM.
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Old 10-11-21, 05:57 AM
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I’m in my mid 50s and have a a couple degenerated discs in my lower back (I believe s1/L5 and L4/L5.

There has already been some good advice here, I will just add the 3 things has have made the difference for me (only one bike specific)

1- Core strengthening. Originally leaned it at pt, but it is a lifelong thing that I have to keep doing either daily or close to it. If I slack off for long, I pay the price.

2- Reading Esther Gokhale’s work on posture has been a huge help to me, and it has changed how I sit, walk, and fit myself on a bike.

3- And more bike specific: I have focused my riding posture bending at the hips (tilting my pelvis forward) as opposed to my waist (lower back). I’ve needed to tilt my saddle forward a bit to be able to do this while leaning forward much.

One of the keys to the last part is stretching my hamstrings so that I CAN pivot at the hips.

For me, I find the a more upright riding position is not necessarily better, and in some cases it is worse. For me, the key is not how upright I am, it is how well I can maintain the proper curve in my lower back. The more flexibility I have in my hamstrings, the farther forward I can lean and maintain that. And what I have found is that for long pedaling excursions, my back feels better when I am more bent at the hips.

I wish I could say I am pain free, but I am not. But It all helps a lot
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Old 10-11-21, 07:14 AM
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I have DDD, central stenosis, and osteophytes in the foramen at various levels in the cervical spine from C2 to C7/T1

It is painful. I can relate to your challenges although lumbar is not the same.

Few really understand chronic pain. For instance, I recently fractured my hip, broke 5 ribs, broke my clavicle, broke my humerus, and shattered my elbow. I crashed. They set or reduced my compound fracture w/o pain medicine in the trauma center. Ultimately, they had to do surgery.

At no time was the pain greater than a 6 and typically the pain was comparable to what I experience everyday with DDD. I say this because even the MDs won't grasp the pain that you might feel. Yet, when folks see broken bones everywhere, they freak out when in fact the nerve pain from the spine can be much worse yet invisible

I will say that riding a recumbent on good roads is almost like traction and it can actually ease the pain, surprisingly. I was able (with some challenge ) to complete the 1220Km Paris Brest Paris in 2019 on a recumbent with my messed up neck, so, don't give up hope. Sorry I could give any good medical tips. A bent might help. It did for me
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Old 10-11-21, 03:18 PM
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Thank you both. I am starting 3 separate rounds of nerve shots
at 3 different sections of my spine.
I am trying to stay active but it is
not easy. Anyway thanks again and
I hope the future gets better for all
of us. My magic wand is on back order.
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