Elite motorcyclist & low back pain

[jools987]

I've seen an elite enduro (off-road) motorbike rider for massage only a couple of times now. In my initial assessment, he mentioned that his lower back feels 'weak' since around 6/12 ago.

When bending to touch his toes he is very wary and uses his hands to assist him when straightening up. An MRI scan revealed nothing abnormal. The movement in his spine is generally good throughout during all ranges of movement with no noticeable abnormalities in the lumbar region. Strength must be pretty good given what he does for a living though due to the nature of the complaint I haven't properly assessed spine extension. He rides at an international level and is extremely fit and well built.

Only obvious postural abnormalities are probably related to the position held when riding and are rounded shoulders and inferior edges of both scapula being excessively externally rotated.

He has only seen me for massage so far but next time I would like to address his lumbar spine issues. Any thoughts?

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[isramedcenter]

I've seen an elite enduro (off-road) motorbike rider for massage only a couple of times now. In my initial assessment, he mentioned that his lower back feels 'weak' since around 6/12 ago.

When bending to touch his toes he is very wary and uses his hands to assist him when straightening up. An MRI scan revealed nothing abnormal. The movement in his spine is generally good throughout during all ranges of movement with no noticeable abnormalities in the lumbar region. Strength must be pretty good given what he does for a living though due to the nature of the complaint I haven't properly assessed spine extension. He rides at an international level and is extremely fit and well built.

Only obvious postural abnormalities are probably related to the position held when riding and are rounded shoulders and inferior edges of both scapula being excessively externally rotated.

He has only seen me for massage so far but next time I would like to address his lumbar spine issues. Any thoughts?

I the doctor-masseur. The problem can consist in deep muscles of a stomachspasm that will complicate straightening a back from position an inclination forward. It is desirable to make tests for slanting muscles of a stomach and forward muscles of a stomach. In case of negative result probably presence of a disproportion of force of muscles of a stomach and straightening muscles of a back. Muscles of a stomach are stronger and at their full compression the back does not suffice straightening muscles of force to return them in neutral position

[msk101]

HI jools? are you a physio? is there a history of injury or fall or imact from 6/12 ago? are there any peripheral symptoms that go along with the "weak" back feeling and particularly on movement? perhaps some functional postural lumbar x-rays would indicate if there's a spondylo or retro listhesis instability secondary to prolonged flexed posture and/or injury history. Assess a spondlylo stork lumbar extension test and see how it goes ... also consider TA involvement and core stability because athletes can have great power muscles with overcompensate for weak core which in the end cause torsional and or power imbalance issues.
good luck
msk101

[xplando]

I would check with a neurologist to rule out any other conditions such as fascioscapulohumeral dystrophy .....

then I would proceed with my examination!

[alophysio]

Hi jools987,

Interesting - how did your rider go?

If MRI was negative, then to me it is probably a movement dysfunction / motor control issue.

He may be overactive causing excessive compression of his spine and thus pain and tenderness like sore bones in a non-specific way

He may be overactive in the hips causing increased flexion to occur in the back and so he might have a "hinging" vertebral joint which is excessively loaded or moving - PPIVMS and PAIVMS should be able to let you know about this

He might have other problems in his thorax such as thoracic rings laterally shifting/rotating causing failed load transfers. This could cause his long thoracic extensors or obliques to become overactive can so cause low back pain...the low back is the source of the pain but the cause could be failed transfer elsewhere.

Any, just some thoughts

Cheers!