anti-road bike doctor

Grrrr...I went to the doctor today for an ongoing problem I have with my back. I have a rib that likes to pop out of place (technical name is subluxation) and once it does that, the muscle over it gets irritated and goes into painful muscle spasms. My dr is an osteopath, picked specifically because I have had ongoing back problems and he specializes in back stuff. He does something called a "myofascial release" to get rid of the spasm, and then pops the rib back into place using osteopathic manipulation. I usually pop it out again within a few weeks just doing normal life stuff, and we repeat the process.

So I ask him how we can keep this from happening. And he says basically nothing, but he thinks the posture a road bike puts me in is causing the muscle irritation, and that I should consider switching the kind of bike I ride. He also said that if I didn't want to switch, I should be ready to deal with the consequences. I told him a different bike wasn't really an option.

I've had back problems for five years now, and during a lot of that time I was inactive and gained some weight. Road biking is the ONLY exercise I enjoy, and I won't be giving it up. At least he suggested a different kind of bike rather than stopping cycling. But I really was hoping he'd be willing to work with me to figure this thing out. I really believe if it wasn't biking exacerbating it, it would be something else.

Needless to say, I'm annoyed. There is a physical therapy place in town that actually specializes in sports and cycling specifically, but they don't have a contract with my insurance company. I think maybe improving my core strength would help, but I'm hesitant to do anything that could pop the stupid rib out or cause muscle spasms. Has anyone else dealt with a doctor that has been less than enthusiastic about your choice of sport? What did you do?

What are your goals in cycling? Do you race? How important is it to go a little bit faster? How many more years, or decades, do you want to continue riding?

I ask these questions because it seems to me that in addition to not wanting to listen to the doctor, you're not listening to your body. Rather than changing the type of bike you ride, you could modify your roadbike. I found that the more hours I rode the more my neck would hurt because of bending up to look forward when by body was leaning forward. I replaced the handlebars (and necessarily the shifters and brake levers) with straight across handlebars - still weren't high enough, so I got an extension to lift them even higher. I can now ride sitting up, bend when I want to. The bike is still pretty light, but unquestionably the aerodynamics are not good and not as fast as the bent-over position. So goals are important - for me the goal is not speed but to enjoy the ride - for years to come.

Hmm, I've had a similar conversation with my doc but regarding a completely different issue (crohn's disease complications that we really don't know if they're exacerbated by me biking or not). I basically told him that he was going to have to figure out how to manage it without me giving up biking. And that I was completely ready to accept any consequences from my "hard headedness", as he put it. It wasn't a matter of switching bikes, but stopping altogether. So I understand your frustration. It's never easy to hear that you need to stop doing something you absolutely love. Maggie gave some great tips and advice. Maybe you can do some mods and help the ol' back out a bit. And I don't know if a dislocated rib is as painful as a dislocated knee cap, but you gave me some flashbacks. Ouch!

Good luck!

uhmmm....would you consider another opinion? Perhaps from a doctor who rides?

what she said, find someone who understands cycling. I have the same rib thing , but I see a chiropractor who is a mountain biker and does an adjustment for it. She has also made me see how other things affect it, like stress and the ergonomics of my work etc. Chiropractors and Ospteopaths do pretty much the same thing. She did give me strentgh exercises for my back that make a huge difference when I do them.

It's important to understand the triggers, so that you can do self care so that it will happen less. I elminated 95% of the emotional stress in my life, and I'm down to a couple of adjustments year ( osteopaths do an adjustment too) instead of once a month or so. Usually after a mtb wreck.

So perhaps you can find someone to guide you in what else you can do for yourself.

As for the insurance issue - it comes down to what is it worth to you to get some support or different answers. I recently switched to a high deductible plant that covers almost nothing. It sure makes me think about what I need to pay for out of pocket, but it doesn't stop me from going when I think it's important. I think we get too spoiled with our $10 copays.

iurlan

I think I'd find a different doc - a cyclist or at least a sports medicine doc.

Have you tried Pilates for your back? It made a world of difference for me, I havea slight curvature of the spine. Since I started Pilates, my chiroprator tells me there is a huge difference - straight, strong spine.

Sue, Irulan and Snap have said what I want to say

Find a doctor who understands cycling, or who is a cyclist

Hopefully this person will have constructive feedback for you

Depending on where you live it may be really hard to find a cycling doctor. What matters is finding care-givers who see keeping you active as an important part of their jobs. My chiropractor is over 40 and still playing basketball regularly. He understands that an aging athlete's life is not pain free, it just feels better. His goal is to get me back on the bike not to cure me by limiting my life to activities that are guaranteed to be painless.

I ask what Maggie does. What are your goals? Racing? Fitness? Just getting out on the road?

I know you don't necessarily want to change the bike, but you could try a recumbent. They really are easier on the back, and some of them are quite fast. If what you want/need is to go screaming down the road, you could do worse than a nice 'bent.

As for your back itself, strengthening the core couldn't hurt, if you start slowly. I think.

Thanks everyone for your feedback. I may seek a second opinion, not just because of his bike recommendations, but because I hope another doctor might have some different ideas about treatment and prevention.

maggieH, thanks for the ideas about modifying the bike. I'll definitely think about what I can do. I'm going to raise the handlebars up the two spacers I have left and see if that helps some. I'm also considering a set of those short reach brake levers so I can reach the brakes from the top of the bars without having to stretch out so much to ride on the hoods. Maybe an extender to raise the bars would be a good idea too.

My goals are to continue to improve on my long weekend rides, become a better climber, lose some weight, and ride a (fast) century in the fall. Being in the most aero position possible isn't as important to me as being able to comfortably stay on the bike for a long time. But I have to admit, speed is part of what makes riding fun. And getting a new bike right now isn't really an option, because I just bought this one a few months ago, and I love my bike.

I guess I'm most frustrated by his answer of "nothing" when I asked how I could prevent this in the future. This flare up was most likely caused by biking, but many, many flare ups in the past weren't caused by biking, because I've only been riding again for 8 months or so, and seriously riding the road bike for three months. So it's not like the bike is 100% of the problem. There must be other options for decreasing the frequency that my back goes into crazy muscle spasms. My doctor doesn't seem to view this as a very serious problem, because 99% of the time it isn't. He does understand that I want to keep active, but for whatever reason he thinks the road bike posture isn't very back friendly and doesn't understand why a hybrid or a recumbent just isn't the same as my road bike.

I'm going to work on my core strength with "The Core Program" by Peggy Brill and Pilates. One of the guys I ride with has been doing lots of core strength work (at physical therapy for a knee injury) and he says it has made a huge difference in his riding. Irulan, thanks for the reminder that there are many contributing factors in back pain. Honestly stress and anxiety are probably the biggest triggers for me. Since cycling helps with both, I really think it is probably helping more than it is hurting. If my back continues to be a problem, I'll probably seek a second opinion from another doctor, and look into phyisical therapy.

I'm partially just venting, as this is one of those things that isn't catastrophically bad, just really annoying and persistant. I'm 25 and the prospect of this continuing to be a problem for the rest of my life, with no real prevention or permanent treatment, is too much for me to even think about.

Hi, Simple!

I once had a similar problem...except it was 10 ribs, put out by a large mountain bike crash....and they stayed that way for 17 months. Physio Therapy was no help at all. It wasn't until I'd found a chiropractor (again) that I found relief.

Now, for those 17 months I had a constant muscle spasm in the rhomboid muscle - kind of beneath the lat, sort of where the lat and the traps meet. On a good day it was the only point that hurt, on a worse day the pain went from top to bottom!!

The crash was in 2000. 5 years later it is still a point that will flare up if I'm not good to myself. but it's way better than it was.

My cross training is kickboxing. Lots of back strengthening in that, and I've found it has primarily been helpful. But I also do yoga, and I can definitely tell if I haven't done enough yoga stretching....it's one of the first places to get sore.

I can do this one yoga stretch that hits exactly that point for me, but my bottom leg is bent under me and I have to use a towel, my hands don't reach!! but it is a life-saver!!

http://www.yogajournal.com/poses/939_1.cfm

I also frequently will lay on a heat pack, sometimes just as I'm going to bed, to try to relax the muscle. Basically I know that if the muscles is getting rather sharp/sore, the rib will come out soon, if it hasn't already.

I'm now seeing a massage therapist for cranial sacral therapy, and I'm way happier with this than any other health care practitioner I've tried! She's amazing!!

Speaking of all this, I need to go do some stretches right now! Take care of you!!!

Namaste,
~T~

Wow, that is quite the stretch.

http://www.yogajournal.com/poses/posesimages/70.jpg