Guest Article - Low Back Pain, Cycling and the Iliopsoas Muscle

**This informative article is written by Matthew Gibble (Colorado Registered Massage Therapist), Feedback Sports Road Racing team member, and owner of Raining Faith Massage who we are very happy to have as a new team sponsor in 2010. Yes, that is Matthew showing example stretches towards the bottom of the article.**

It’s that time of the year when many cyclists are getting increased time on the bike in preparation for races which are just a few months away. If you’ve taken a break or are significantly increasing the length of your rides the body requires a little time to adjust to that flexed trunk and hip position we maintain while riding. Quite often a rider will feel the urge to get up out of the saddle and try to stretch the low back to gain some comfort. You know the stretch, it’s the one where you’re pulling your abdomen toward the bars and stem.

The muscle that is affected is actually two muscles, the Iliacus and the Psoas. Sometimes they are lumped together and called Iliopsoas. Few people know about them until they have the kind of pain where they can’t quite stand up straight or have a “kink” in their back.

The Psoas is located on the front of the spine, specifically the lumbar vertebrae L1-L5. The Iliacus fills an area called the iliac fossa which lies in the pelvis. The two muscles converge to attach to the femur which makes them primarily hip flexors. They also perform some other minute movements of the hip as well as maintaining that curve in our low back called the lordotic curve; essentially pulling the spine toward the front of the body.

Accessing the muscle is a bit tricky but it can be done. It requires a therapist to come through the abdominal region to be able to palpate both the Iliacus and Psoas directly. It’s hard to imagine unless you’ve had it worked by a massage therapist.

The reason that it is so important to cyclists is because it is in a constant state of flexion and contraction for extended periods of time while riding. Even for the general public it is affected and compromised due to sitting at a desk for extended periods of time or while driving. If you’ve been riding for decades like me it can become like a piano wire that just needs to be opened up or stretched.

For many cyclists and racers this flexed position on the bike can lead to a chronic tightening of the Iliopsoas which then manifests itself as low back pain and discomfort. However, in recent years there have been cases where professional cyclists have developed more serious problems such as Iliac Artery Syndrome due to an extreme flexed position on the bike. This can require surgery to correct the problem and is believed to stem from the vast number of hours that professional cyclists spend in the saddle; many more hours than what we’re looking at as riders with Feedback Sports.

One rider that suffered from this was Stuart O’ Grady back in 2002, who had surgery to correct the problem. It leads me to wonder if the emphasis on aerodynamics and time trialing in the last ten to fifteen years has contributed to the problem. It wasn’t until the advent of aero bars and Greg LeMond’s stunning victory in the ’89 tour that aggressive positions on the bike for cyclists and triathletes became the norm leading to much more training time in these positions as well.

But I digress. What we want to look at is increasing length and maintaining a healthy Iliopsoas muscle. We certainly don’t need to strengthen this muscle; it is probably already too strong due to the extended time on the bike. As cyclists, we want to take the time on a regular basis to open up the trunk and pelvis when we are off the bike. However, even when we are on the bike we can positively affect this muscle. I tell my clients that are cyclists to try and avoid “collapsing” over the bike. Especially when climbing it helps to try and remain open through the shoulders, rib cage, chest and low back. It’s better to forego arerodynamics for easier breathing and opening up the thoracic region and low back. Think about tilting your hips forward a little bit while climbing to take the pressure off the low back and Iliopsoas musculature. I’m talking about a microadjustment that can make a nice difference in how you feel.

When aerodynamics are of primary concern such as time trialing, working in a breakaway or screaming along in a criterium think about lengthening your spine while on the bike. Again, it is the intention of not collapsing on the bike and making a microadjustment to try and be a little “longer” in the spine that can make a difference in how you feel. Thinking about a “flat back” can help with this as well. Remember, we’re not going to overcome the hyperflexion that is occuring but trying to compensate as much as we can for this compromised position that we put ourselves into.

If someone has a real problem with a tight or even spastic Iliacus or Psoas muscle then massage therapy can help to correct the issue. Trigger points can develop in either of the muscles that leads to a chronic problem. Additionally, often times a harsh crash can cause the low back to spasm and the Psoas or Iliacus can be affected as well. A lot of times I’ll work with a client that has fallen to release muscles that have “splinted” due to hitting the deck while racing or riding.

Once the Iliopsoas is released, if it is chronically tight, it is then imperative to maintain that open effect through some stretches or lengthening postures. It is important to open up the low back, spine and shoulders.

A modified warrior stretch or pose accomplishes everything we want. The hips move forward to stretch and open the Iliopsoas while the hands go toward the sky to get the lengthening in the spine. The hands moving up also bring more of a stretch into the Iliopsoas so it is important to work with your breath and move slowly. The back foot will be slightly pointed out from the center line of the body but not further than 10 or 15 degrees. If you open the hip up too much you’ll stretch the Adductors or groin instead of the Iliopsoas. Be careful not to hike the shoulders too much up to the ears; stay relaxed, breathe slowly and don’t force the stretch. The stretch needs to be done bi-laterally to affect both sides of the muscle.

If you have the strength, flexibility and confidence you can also do a good old fashioned back bend. There are a couple of important things to remember. Start with straight legs and contracted glutes. It is more important to lengthen the spine and bring the arms back than to try and bend too far. You don’t want to compress the spine in any way; it’s all about lengthening. And bring the hips forward as well.

I’m a good example of what cycling and being a massage therapist does to one’s posture. My shoulders are chronically tight and don’t open up so well limiting how much I can open in the front of the shoulders. Ideally I’d like to see my spine and arms more like that long, curved blue arrow. As long as I’m on a bike and doing massage it may not happen.

A good alternative to the previous backbend is using a fitball to open the front of the body and the spine. However, the same principles apply. Keep the legs straight and locked at the knee and the elbows locked and open at the shoulders with the axillaries (armpits) toward the ceiling. Think open at the hips to open up the Iliopsoas.

This will hopefully give you some new information about the low back and how it pertains to cyclists. Even if you don’t experience any low back pain or discomfort it is still a good idea to do these exercises. It’s easier to maintain a healthy body than to correct the body after an injury might occur.

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Good information

Thanks for the great article. I had never heard of the psoas until I started having hamstring problems a few years ago. I have found that years of cycling have tightened the illopsoas and other hip muscles. I'm still struggling with opening up those muscles. Your comment "It’s easier to maintain a healthy body than to correct the body after an injury" definitely rings true!

Thanks for the stretching information. I have been doing the back stretch over the ball, but not with straight legs. I'll try it that why from now on.