Back/hip/what's going on?

Hi, just wanted to see if the collective crowd wisdom could help me get some direction on back/hip pain.

I’ve been struggling with lower back/hip pain and referred nerve pain down my leg for about a year now, and it unfortunately seems to be really limited to the bike at this point. Aka I took a month off the bike, and it completely went away. During that time I ran a lot, and even raced a half-marathon and the back was perfect, no leg pain. Tuesday I did a ramp test to start my next adaptive training plan for next year (so cool, but another topic), and yesterday I did a super easy endurance ride as prescribed.

Woke up last night with the back locked and signicant pain trying to roll over in bed, and it hurts sitting at work this morning (well maybe the hip/leg more than the back). It’s so dumb that I can run 10+ miles with no pain at all and the second I’m back on the bike it’s fireing again (seemingly). I’ve been to several doctors, and had an mri. There is nothing concerning on the imaging, and they say that I have a structurally sound back. I have an appointment next week to get a steriod injection in my hip (since there’s nothing wrong with my back, the doctors think it’s the hip perhaps), but I’m not even sure if I should be doing that since the pain just goes away if I don’t cycle.

I’ve had a bike fit, I try to stretch, do core work every day, etc. I’m bad about true strength training though. My volume was fairly high, averaging about 14 hours a week/700tss for 2+ years with little slowing down, so I’m sure I have something messed up.

I know the internet isn’t a place for medical advice, but since medical professionals seem to basically have no idea what’s going on, I’m confused.

Go see a physio not a doctor.


I tried a couple different physios this summer, one told me that I should quit cycling if it hurt–ha. I then switched to another who was great and who I did sessions with for about 6 weeks straight, but the workouts just didn’t seem to do much for the pain.

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Don’t you just hate these people that say stop cycling. My previous GP was of that way. Have you had an xray or any further investigatory work done? If not ask your GP for a referral.

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Have you checked your cleats? It’s possible one of them moved or is worn down causing problems.

Or check your saddle to make sure it isn’t askew / worn unevenly

Or checked your pedals for wear. I have time pedals and was noticing issues with my left leg. At first I thought it was cleat wear, and I was in the process of changing the cleats when I noticed in the insert a pedal float setting. I checked and the left pedal was different from the right. When I adjusted the left to match the right, the issues I was noticing went away

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See a sports doctor with the accompanying PT.

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This is good advice, the trainer saddle is super old. I also did use old shoes on the trainer yesterday, so perhaps the cleats were worn. I might try to put a new saddle on the trainer bike and check that. But this also happens inside/outside/gravel bike/road bike/etc… so I do think something deeper is still going on.

Not to try and aggravate the problem, but if you only ride outside does this happen?

Trying to isolate if it is related to one of your bike setups, or happens no matter what bike you ride

Where the physios you saw connected in any way to cycling or triathlon? That can go a long way in diagnosing sport specific injuries as the stuff that causes you back pain would be different from an overweight, sedentary 60 yr old.

My first guesses would be either tight hamstrings or hip flexors as it only seems to present when you are folded over. But I’m not a PT so I probably won’t be much help. When I had hip pain while I was into olympic weightlifting I saw a chiropractor who really helped me with that. I ended up being an impinged hip flexor deep under my abs. But he was able to diagnose it in about 5 seconds because he had a history with the US Olympic Weightlifting team.

I’m battling somewhat similar symptoms, but without the pain down the leg. Can you isolate the back pain to the hip joint or the gluteus medius muscle, which is a fan-like muscle that attaches to the top part of the hip (iliac crest)?

At least for me, until recently, I thought my pain was in the hip joint but now realize it is actually the muscle. If strained, this muscle can cause the other lower back muscles to over work to compensate, sieze, and lead to hip misalignment, which results in one leg being effectively shorter than the other and then to knee pain.


So funny you ask that, the one who told me to lay off the cycling was on the podium at masters nats a few years ago :laughing: . I did see a cycling-specific chiro a few times too (kona qualifier, so knew a few things about volume), and the work she did seemed to help in the short term but the pain always just came back after a week or so. Also, there’s no pain on the bike when I’m inside or doing short rides but after an hour or so it does get pretty rough.

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hmm, looking at a diagram that is where the pain seems to live. I’ll do a little research into that. Also, the pain is on the left side, and I’m suuuuper dominant on that side (like 30 watts higher power per my assiomas) so I’m pretty out of wack in general that way.

Yeah, I’ve learned that the more specific you can be with both the location and the sensation then the easier it is for doctors to diagnose it correctly. There are so many different things that can cause it so a difference in location of a couple inches or describing it as ‘shooting’ vs ‘stabbing’ etc can make a pretty big difference

Please post what you find out - my Sports Med doc (physio) is booked until January. :frowning: Until then I’m working on strengthening / activating glutes, IT band exercises, and lifting (squats, leg press, leg curls, etc).


I think I’ll be with you. But yeah, it does seem like activating glutes is a great idea for this kind of thing.

Hope I’m not opening a can of worms, but did you have a MRI of your hip joint? (assuming the pain is on one side.)
It’s interesting that running is ok, but not cycling. For many people it is the other way around, as running is harder on the body .
Don’t give up pursuing the cause of your pain. Until you get a correct diagnosis you can’t address the problem. This is frustrating, and can go on for years, usually ending up with the injury becoming worse.
I went through this from 2014-2016 ,starting with a mild groin pain when I ran uphill, and by winter 2016, sciatica-like pain in the glute, and sharp pain when lifting the leg (to get on/off the bike, or into the car) .
I had lots of misdiagnoses, injections, excersise programs, etc, and I finally decided to pay for a MRI scan of the area, and a consultation with a specialist.
Once I had found the cause (torn labrum, arthritic femoral head), I was able to take action.

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Yeah, as much $$ as I’ve spent on physio, chiro, etc I think an mri of the hip might give me some peace of mind. That might be what I try before injections, since injecting the hip with really no evidence of what’s going on seems kind of wild to me.

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I’m not a doctor at all but have occasional discomfort in my gluteus medius and minimus. So similar area, It usually feels weird when hunched over on the bike or sitting in a chair. if you have a job where you are sitting a lot it could also be causing some issues. You might even have what they call lower crossed syndrome, but I am not a doctor or physiologist. So take my advice with a grain of salt.
For me what has helped is lots of core stabilization exercises with hip mobility, daily 10-15 minutes after work. Plus before each ride I always do some dynamic stretching and glute activation. I got a lot great advice from SOCALBIKEDEPOT, his bike body strength program really helped open my eyes. I never had discomfort til recently and realized how weak my core was when trying to do a simple plank for a minute…
Usually a problem stems from overactive muscles compensating for under active muscles.
The screenshot I’m sharing is from NASM, lower back arch ( lower crossed syndrome) The way to combat that is stretch your overactive muscles and strengthen your underactive muscles.

Going to get a MRI and talking with a doctor is your best bet but maybe this will help someone.


Stretching will not help. I’ve had a number of trainees with similar issues and best addressed by strengthening the erector spinae (lower back muscles) and connected posterior chain (gluteals and hamstrings), as well as working on accentuating hip-extension in your pedal stroke (play with your on-bike position to address that). I’ve yet to have anyone not respond positively to the foregoing as well as ride stronger with better posterior recruitment in the pedal-stroke. Look at back-extensions (on roman chair), deadlifts, good-mornings, and/or a number of other exercises.


How do you do that?