title: Relationship Between Body Positioning, Muscle Activity, and Spinal Kinematics in Cyclists With and Without Low Back Pain: A Systematic Review.
abstract: BACKGROUND
  Low back pain is reported by more than half of cyclists. The pathomechanics and association of risk factors of lumbar spine overuse injuries in cycling are not clearly understood.
  
  
  OBJECTIVE
  To determine whether relationships exist between body positioning, spinal kinematics, and muscle activity in active cyclists with nontraumatic low back pain.
  
  
  METHODS
  In August of 2015 and April of 2016, a comprehensive search of the PubMed, CINAHL, Ovid MEDLINE, and Scopus databases was performed independently by 5 reviewers.
  
  
  METHODS
  Included articles consisted of biomechanical studies examining factors relating to low back pain in cyclists as agreed upon by group consensus.
  
  
  METHODS
  Systematic review.
  
  
  METHODS
  Level 4.
  
  
  METHODS
  Five reviewers appraised by consensus each article using the Downs and Black checklist.
  
  
  RESULTS
  Eight studies met criteria for this review. There is evidence that cyclists with lower handlebar heights displayed increased lumbosacral flexion angles during cycling. Core muscle activation imbalances, back extensor endurance deficits, and increased lumbar flexion while cycling were found to be present in cyclists with low back pain.
  
  
  CONCLUSIONS
  Spinal and core muscle activation imbalances in a prolonged flexed posture associated with cycling may lead to maladaptive spinal kinematics and increased spinal stresses contributing to overuse low back pain.
authors: Department of Physical Therapy, Thomas Jefferson University, Philadelphia, Pennsylvania.
authors: Gabriel M
authors: GM
authors: Streisfeld
authors: Department of Physical Therapy, Thomas Jefferson University, Philadelphia, Pennsylvania.
authors: Caitlin
authors: C
authors: Bartoszek
authors: Department of Physical Therapy, Thomas Jefferson University, Philadelphia, Pennsylvania.
authors: Emily
authors: E
authors: Creran
authors: Department of Physical Therapy, Thomas Jefferson University, Philadelphia, Pennsylvania.
authors: Brianna
authors: B
authors: Inge
authors: Department of Physical Therapy, Thomas Jefferson University, Philadelphia, Pennsylvania.
authors: Marc D
authors: MD
authors: McShane
authors: Department of Physical Therapy, Thomas Jefferson University, Philadelphia, Pennsylvania.
authors: Therese
authors: T
authors: Johnston
keywords: cycling; low back pain; muscle activity; spinal kinematics