Anthony Nolan Ride London-Surrey 100 Training Day

Backs & Beyond Anthony Nolan Ride

This is a synopsis of the talk I gave to a most excellent group of people at the Anthony Nolan offices in ‘appy ‘ampstead in London this afternoon. It was great to see you all! There are a few common cycling injuries, which include lower back pain, neck and shoulder pain, wrist and hand pain (handlebar palsy), hamstring pain and knee pain.

Bike Fit

Most of these injuries can be cured, or at least helped, by making sure the fit of your bike is as good as possible.

Body Imbalance

Our bodies are naturally left- or right-side dominant, and therefore we have a strong and a weak side, a flexible and a stiff side, and a twist that runs through our bodies clockwise or anticlockwise, determined in part to whether we are left- or right-handed.

The relevance of this is that when we’re stretching our muscles, we should always aim to stretch the tighter side for twice as long as the looser side. So if our left calf muscles is tighter than our right, we will stretch the left calf for longer than the right. This way we will end up with muscles of equal length each side, and a healthier biomechanical symmetry.

Also, if you’re someone who works out in the gym, then you need to ensure that you’re doing more reps on the side of the weaker muscle with each exercise, so as to bring the muscles into equal balance.

At this point it’s worth mentioning that everyone who’s doing any type of race should get themselves checked out by a good sports osteopath or physiotherapist, to make sure their bodies are as symmetrical as possible in terms of joints and ligaments, especially in the pelvic area.

Sitting Posture

When you’re sitting on your road bike you’ll of course be bent forward at the hips, so that you can reach the handlebars. This is often a position that can give one back pain, and can also slightly destabilise the bike at speed, as the back is not braced and can twist from side to side following the movements of the hips and legs, leading to pain and dangerous wobbling. The answer to this is to tuck your tummy in just below the navel, a feeling of bringing your navel closer to your spine. This will give you a much more stable and powerful posture, and doesn’t allow the lower back to twist or the bike to wobble with the movement of the legs.

Head and Shoulders

We usually hunch our shoulders when we ride, because it feels like this gives us more stability and strength. Sadly, it does the opposite. Muscles become weak and the cyclist can lose stability. As a rule, it’s wise to drop your shoulders down and perhaps even slightly forward, and feel as if your neck is lengthening by a few inches.

Holding the Handlebars

On a long ride I always feel it’s best to spend the majority of our time on the top of the handlebars, with the hands on top of the brake levers. This gives the most obviously comfortable position for long periods. However, it’s certain that we should vary the way we hold the handlebars, using the drop section, and also the centre of the bars near the stem. Variety helps to reduce injury.


There are a range of important stretches for cyclists, the Best Stretches for Cycling article on VeryWell offers a good selection. It’s worth doing all of these at least directly after cycling, and if possible another time during the day.

Back-terial Cure!

Backs & Beyond Back-terial Cure

The news that broke today that over 40% of all chronic back pain could be due to a specific bacterium, Proprionibacterium Acnes, the bacterium that causes acne. This is a revelational step in an industry that has for many years struggled with a true understanding of what could be the cause of intractable back pain.

As osteopaths we pride ourselves on our crisp and accurate biomechanical diagnostic skills, which are effective in treating many types of back pain. It has, however, also been clear, as it has been for our sister profession physiotherapy, that there are many people who suffer long-term back pain, for whom improving the mechanics and strengthening their core muscles makes no difference whatsoever. This study could pave the way to helping those who we in the manual therapy professions find so frustrating to treat, and it could save the health service an absolute shedload of money.

There are two papers on the subject, both of which were published in the European Spine Journal, and are linked here. In the first study, Hanne B. Albert PT., MPH., Ph.D., from The Back Research Centre, University of Southern Denmark, and team demonstrated how bacteria invade the injury sites of slipped discs and cause painful inflammation, and harm surrounding vertebrae.

In the second study, Hanne B. Albert PT., MPH., Ph.D. tried out an antibiotic combination treatment, based on their discovery. They recruited 162 volunteers, all of them chronic back pain sufferers (back pain that has lasted for more than 6 months). All of the participants had had a slipped disk and had signs of bone swelling.

Several newspapers published stories on the research and findings:

The Chemical Day

Backs and Beyond The Chemical Day

I’ve just read an interesting part in Professor David Nutt’s book ‘Drugs, without the hot air – minimising the harms of legal and illegal drugs’. It takes you through a typical day of a mythical character called Ben, a clean living boy who takes no drugs, not even caffeine, showing what chemicals in the brain do which jobs through the day… fascinating.

To quote:

“As he wakes up and gets out of bed, glutamate is released, kickstarting his body’s transition into being awake. He drives into work, getting stuck in traffic; it’s really important he’s on time today, and his brain is flooded with noradrenaline as he becomes angry and stressed at the thought of being late. When he gets to work, it turns out his boss is late as well so he isn’t in trouble after all, and a rise in serotonin levels makes him feel better. As lunchtime approaches, there’s a dip in his cholecystokinin which makes him feel hungry, so he goes to the canteen and his cholecystokinin level rises again as he eats.

After lunch he gives an important presentation, which his boss is really pleased with, and his being congratulated causes the release of the reward chemicals endorphins and dopamine. On the way home he has an argument on the phone with his wife, and his serotonin drops making him feel miserable, but after going for a run his endorphin levels go up and he feels a lot happier. While making dinner to apologise, he cuts his finger and endocannabinoids and endorphins help numb the pain. As night falls, adenosine builds up in the brain, glutamate falls and GABA levels rise, making him feel tired and ready for sleep.”

The Independent Scientific Committee on Drugs website: