I'm not a medical expert, but I've had my share of low back pain and I've 
learned a few things.  When in doubt, go see a medical professional.

Low back pain is one of the most common problems afflicting humans.  It's 
been estimated that about 80% of these problems arise because of poor 
posture.  These posture problems occur when we stand but are even more 
significant when we sit or ride a bike.  We tend to round up our low 
backs, stressing the ligaments and tendons which lie along the spine.  It is 
the irritation and inflammation of these ligaments and tendons which leads 
to most low back problems.

It is important to remember that back pain results from the sum total of 
ALL the stresses your back experiences.  Even if you only experience pain 
when you're riding, poor riding posture may not be your only problem.  
For example, you may be sitting poorly at a desk all day or lifting boxes 
poorly.  


**Low Back Pain and Posture**

Since posture is the problem, it is also the solution.  Those of us who 
suffer from low back pain need to be constantly vigilant.  We need to 
maintain some arch in our backs as much as possible.

Sitting is a particular problem.  Most chairs, coaches, car seats, etc 
provide little low back support.  You can buy low-back support pads at some 
drug stores.  Try them before you buy them because they are not all 
comfortable.  Alternatively, you can fold a towel and put it behind your 
low back.  The key is to maintain some arch without being uncomfortable.

Position on the bike is also important.  Get your bike fit checked at a 
shop that you trust.  You should also work on maintaining a flat back 
when riding.  One way to achieve this is to push your belly button toward 
the top tube.


***Stretching***

Stretching is an important way to achieve flexibility and improve your 
posture.  A very useful stretch is to place you hands on you butt and 
push your hips forward while standing:

  o
  <\
   /

you should feel this in the front of your hips.  Tight hip flexors 
prevent an upright posture.  After a few seconds, arch your back and 
slide your hands down the back of your thighs:

  o
  |)
  /

This movement puts the arch in you low back.  You can do this stretch 
many times a day.  It is particularly useful to do it periodically when 
you have to sit or ride for an extended period of time.

A more potent stretch that can be done a couple of times a day starts 
with you lying on your front.  Using your arms, push your shoulders off 
the floor.  Don't lift with your back.  Keep your low back as relaxed as 
possible.  Let your hips hang down, staying as close to the floor as 
possible.

    o
 __/|

This is a powerful stretch and should be started gradually.  Otherwise, 
it can do more harm than good.  However, done properly, it can be 
enormously helpful.  Over a period of weeks, you should gradually 
increase the height you achieve and the time you hold the position.  It 
is also less stressful to do this stretch for short periods with a little 
rest than for a long period (for example, 3 X 10 sec with 5 sec rest 
rather than for 30 sec straight).

Once your back starts to heal, you will probably need to stretch it 
deliberately.  This is apparently because of the scar tissue that built 
up during healing.  Keep it gentle, especially at first.  You could 
easily reinjure your back.  Here's a good one: lie on your back with your 
legs straight.  Pull your knees up, grasp your thighs by your hamstrings 
and gently pull your knees to your chest.

Stretching the ham strings can also help relieve low back pain.  Tight 
ham strings tend to pull the pelvis out of line.  This can stress your 
low back.  The problem with most ham string stretches is that they also 
tend to stretch the low back by forcing it to round up.  The most 
appropriate stretch I know requires the use of a doorway.  Lie in the 
doorway with your butt near the wall.   Gently slide your foot up the 
wall until you feel the stretch.

   doorway
      |
      |-
      ||
      ||
   |___|____O
           /

Two ways to make the stretch more gentle are (1) bend the lower leg, 
keeping only your foot on the floor or (2) move your butt further away 
from the wall.  To make the stretch more intense, loop a cord or towel 
over your raised foot and gently pull it away from the wall.  As with all 
stretches, this shouldn't hurt.


***Exercises***

Another key to preventing low back pain is to keep your abdominal muscles 
strong.  These muscles help support the back.  Do abdominal crunchers, 
not sit ups.  Sit ups emphasize the hip flexors, not the abs, and can be 
hard on the back.  Crunchers are done by lying on your back with your 
knees bent.  Press your low back into the floor and curl your head and 
shoulders off the floor.  Hold for a couple of seconds, then lower back 
to the floor.  Repeat until you can't get your shoulder blades off the 
floor.  Abs can be worked every day.

Strengthening the low back muscles can also be helpful.  To start, lie on 
your front with your arms and legs extended in a straight line with your 
body.  Raise your right arm and left leg.  Put them down and raise your 
left arm and right leg.  Put them down and continue.  As your back 
strength improves, try raising both arms and legs at the same time, arching 
your back in a "reverse stomach crunch".  There are, of course, more 
powerful back exercises, but they are also more stressful and shouldn't 
be considered until your back is 110%.


***Medication***

Antiinflamitory medication can be helpful.  Ibuprofen, naproxin and 
aspirin are all available without a prescription.  Acetominophen (eg. 
Tylanol) is NOT an antiinflamatory.  These drugs are most effective if 
they are taken early since inflamation is hard to get rid of once it's 
become established.

A danger in antiinflamatory drugs is that they are also pain killers.  
Pain is your body's way of telling you that your doing damage.  If you 
block the pain signals, you can easily aggravate your injury without 
knowing it.  

Muscle relaxants are sometime prescribed for back problems.  These should 
only be obtained from a physician.


***Ice, Heat and Massage***

Ice is a great way to reduce pain and inflamation.  A good way to apply 
ice is to freeze water in a paper cup.  Peel the cup back to expose the 
ice and then use the cup as a handle while gently rubbing the ice over 
the effected area.  Ice is particularly good for the first couple of 
days.  Some people find that it's useful to continue ice treatments 
beyond that.  Others find that the ice treatments make their backs tight 
if they continue beyond a couple of days.

Heat, especially moist heat, can be useful.  However, it should not be 
used for a couple of days after injuring your back or after aggravating a 
current injury.  Regardless of the timing, if you feel worse during or 
shortly after heat treatment, stop doing it.

In the later stages of a back problem, I find that my low back muscles 
get tight.  Gentle massage seems to help them relax, promoting the 
healing process.  I suspect that massage could make things worse in some 
cases, such as when the injury is fresh.


***Book***

An excellent book on this subject is "Treat Your Own Back" by Robin 
McKenzie, Spinal Publications Ltd., P.O. Box 93, Waikanae, New Zealand
ISBN 0-9597746-6-1.  They use this book at the Low Back Center of the 
University of Minnesota Hospital.

Some parts © 2009 Advameg, Inc.