Pain in the back pocket

[flyingporkpies]

Not due to expensive bicycling purchases or even the emergency banana I like to carry on long rides. No, for the last couple of years I get pain in the back in the region under my left shirt pocket, from glute to lower back. I have tried physios, osteos, chiros, podios, bike fit tweaks, exercise to strengthen the area etc etc. The pain begins under hard efforts, especially hill climbs which I like to do fast. Keeping cadence high (80, 90, 100+) and my back stretched out has reduced the incidence but it hasn't gone away. Mountain biking in particular has suffered because once the back goes I can't use body english to rail the singletrack. Any diagnoses or shared experience welcome.
Cheers.

 

[mherm79]

I used to get tight glutes / sciatic which went away after raising my seat and moving my saddle further back.

i've also read that the seat angle / saddle compression can cause some issues, maybe try lowering your saddle angle slightly?

start with one change at a time and give yourself 3 rides of <1hr to let your body adjust.

 

[Steve Hogg]

pain in back pocket

G'day flyingporkpies,
The most likely causes of your problem is either or any combination of -
1. you are dropping and rotating the right hip forward and down and using the left side of your lower back to brace against that movement (common)
OR
2.you are overextending the left leg and straining the entire left side
.OR
3. You are sitting too high which will cause you to favour one side (generally the right) and pay a price in strain in discomfort on the other side (very common)

Here's what I would suggest-
Mount your bike on a trainer, making sure that it is level and warm up thoroughly with your shirt off. Have an observer standing behind and above you on a stool or chair. What I need to know is - Which hip are you dropping under reasonable load?
On which side is the gap between inner thigh and seat post greater?
Which side has the elbow more locked than the other.
On which side is the shoulder thrust forward more than the other?

Post reply and I'll do my best to advise on a solution.

Regards,
Steve Hogg

 

[Capt_phun]

Steve,
I get the same issue. Answering your questions:
1. dropping the right hip
2. gap is greater on right side
3. Left elbow if more locked.
4. Shoulder of right side sits forward/lower

 

[Steve Hogg]

G'day Capt.
Unless you are really 'special' the only way that the gap could be greater on the right side with a dropping right hip is if you are sitting off centre to the right. Almost always, the gap between inner thigh and seat post is the opposite side to the one with the hip drop. What to do?

The 100& solution is to find out why you function the way you do. An x ray to determine whether there is a leg length difference, a global structural assessment to determine relative patterns of tightness between left and right sides and so on. Once issues are identified, then solution paths can be planned and once that's done, you then your 'homework' for some time to come.

There are a raft of other factors that could conceivably play a part in what you describe but no time to write a book about it. The better you function off the bike, the better you will function on the bike and now is as good a time as any to start the process. Best of luck.

 

[flyingporkpies]

I think it's 1.

Hi Steve, I'm in the middle of moving house at the moment so won't get a chance to do the stationary test for a week or so (borrowing a friends). I didn't want you to think I'd gone 'off-air' though so I thought I'd reply now.

I'm pretty sure the problem is best described by your first educated guess. I have a Brooks saddle and the sitbone indent is further forward and more depressed on the right side. A podiatrist has measured my upper/lower/whole leg length and found no discrepancy. The number of different seat heights I have tried up and down from Lemond's measure may also confirm this. I always get the pain whether the seat is lower (and also power goes down so I find myself on the back 'shelf' of the Brooks) or just right. Once the load goes up the pain comes back. I have tried riding for extended periods with a very still body and so far have found this very exhausting despite going slower. My right knee is further from the toptube and kicks out at the top. Since moving to Speedplay pedals a month ago I have also found with the free float that my left ankle wants to go close to the crank whereas my right ankle points out. I have treated this as natural and not adjusted the stops to correct this. My upper body may also turn out to be out of whack when I do the test but it doesn't present itself as a symptom I have been aware of up to now.

I will get back to you again when I have more information.
Thankyou

 

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[Steve Hogg]

G'day Flyingporkpies;
I'll wait to hear from you.

 

[flyingporkpies]

back pain

Back again with obseravtions.
It is easy to see the right hip drops and the right leg is further from the seatpost but not as much since I put an in shoe wedge under the outside of my right foot (about a year ago). Possibly more of a wedge or outside shoe cleat wedges might fix me up completely??
I don't have a very stretched out position so it's harder to see elbow and shoulder imbalances. My observer reckons the left shoulder is possibly more dropped and the right elbow more forward.
If this doesn't help I think we'll have to try video.

 

[Steve Hogg]

G'day Flying Porkpies,
Okay, so you drop your right hip noticeably. The larger question is why?
Potential answers are -
1. Measurably shorter right leg;

2. Functionally shorter right leg; i.e. tighter around R hip, hamstrings and low back

3. Left cerebellum motor control dominance

4. Compensatory mechanisms that you have evolved to selectively protect various areas. The problem being that for every compensatory mechanism we develop, we pay a price at some level, elsewhere in the body.

Plan of action:
1.Place a 5 mm shim under your cleat and see whether that has any effect on the degree of R hip drop. If yes, good and you may or may not need to increase the size of the shim.
If no, then even if there is a shorter right leg, the major culprit is either a significantly tighter R side low back and hip OR a motor control dominant left cerebellum.
2. Also experiment with wedges under both feet. Be careful with this and trial each change for period before adding or subtracting. There is a definitive test for wedging but it is not something that lends itself to email.
3. Get a referral for an x ray. You want the x ray taken in a standing position and make sure that both feet are locked and that you are barefoot. You don't need a large film for the entire leg length. All you want is a film that will tell you what the difference is in the height of the femoral heads.

Let me know how you go.

 

[flyingporkpies]

Disinformation

Steve, so sorry to do this, but your diagnosis is based on wrong information that I gave you! I have done the test again but this time used a video camera instead of a slightly blind friend.
1. Right hip drops, yes
2. Right leg passes noticeably CLOSER to the seatpost, not further away.
3. Left elbow locks before right one when I stretch out and it's harder to tell but the right shoulder seems lower/slightly more forward if that makes sense.
As I said previously my legs have been measured and found to be the same length. Two professionals have suggested an outside right foot wedge, but I haven't gone over a 2mm cant because the shoe gets too tight.
Does this change your diagnosis? Sorry to waste your time.
flyingporkpies

 

[Steve Hogg]

Pain in back pocket

No, it doesn't change anything. I ignored what you said about the gap between RH inner thigh and seat post sitting further away from the seat post because based on what you had already told me, I assumed you were mistaken.

Another thing; when you say that it has twice been confirmed that there is no leg length difference; how was this determined. If it was by measuring from bony landmarks, then understand that the even if the person knows what they are doing, there is a potential measurement error of plus / minus 5mm. What I'm saying is that external measurements are not definitive and are more of an educated guess. So have that X ray. You will need a front on shot (make sure knees are locked) of the pelvis with the relative height of the femoral heads noted (not really concerned about what happens below that and will explain if necessary) as well as a side on shot so that it can be determined whether both iliums are in the same plane.

To clarify, I don't know whether you have a short leg but it is worth finding out. Even if you don't, try the shim. If you are dropping the right hip because you are significantly tighter on that side, a shim can work a treat to give you relief while you work to redress the difference in range of movement between sides.

On that subject, do you stretch much?

If not, start. Two really good self help books for people with problems are " Stretching and Flexibility" by Kit Laughlin and "Stability, Sport and Performance Movement" by Joanne Elphinston. Lastly, most people who do stretch have poor technique and a distorted view of what they are trying to achieve and how best to go about it. Read this link, particularly the contribution by Dave Fleckenstein, for more info on the most effective way to stretch -http://www.cyclingnews.com/fitness/?id=2008/letters04-30#8

Have fun!

 

[flyingporkpies]

Thankyou Steve. Yes, the bony protrusions were used. I'll let you know how I got on in a few months.
cheers
fpp

 

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