Riding a motorbike and low back

If you a suffering from low back pain universally in india you will get a advice to stop driving your motorbike. It is common to hear patients say “last week i rode my motorbike incessantly that why i have back pain”. Adding my doctor told me to stop but i could not.

Why is the motorbike demonised so badly lately? Does riding cause or is it a risk factor for low back? If yes what can be the hypothetical reasons? What is the solution? not riding? is it possible?

Let’s try to answer these questions?

Firstly, it's important to acknowledge that the cause of back pain is often elusive, leading to its classification as non-specific back pain. Therefore, while motorbike riding may be considered a potential risk factor, it is not definitively identified as a direct cause. With that clarification in mind, let's delve into the potential risks associated with riding motorcycles.

We have been riding on something for centuries, a horse, donkey, bullock cart, dog drawn sledges, later cycle. From the 90s motorbikes became a preferred mode of transport for the majority. So, what’s so special about motorbike? is it the speed? I hardly think so, with the amount of traffic, the cycle can be faster than a motorbike.

Vibrations and shock:

Is it the vibration and shock which unique for motorbike? really you think i don’t know where the potholes are in my usual route to my office? was the cycle smoother than the motorbike? are the roads bad than 50 years back? we hardly had roads once we moved into the suburbs of madurai, we even had roads made of red soil. So actually the vibration and shock might be less. While it's true that some roads remain in poor condition year-round, our ability to adapt helps mitigate potential risks. we adjust our speed and technique to minimize the impact of vibrations and shocks. So, i am not sure vibration and shock are as big a risk factor as people think it is.

Remember our biology is adapted for us to move in uneven surface. Our degrees of freedom of the joints in the lower limb is useful for walking and running in uneven surface and also be stable whilst doing it. Likewise the architecture of the spine with its beautiful movements and disc is made up to absorb vibrations and shocks. So it cannot be vibration and shock alone.

Please note all these adaptation is within a limit. On a rainy day while riding, without any warning my bike went into small pothole and i had a near fall and another time i flew for 5 feet with my bike stuck in the hole. These can sometimes lead to pain, in some part including the back. But i think these are outliers and not a daily event to assume as the risk for back pain.

It’s the posture silly

There isn't a definitive correct posture for sitting on a motorbike, bicycle, or donkey. Your body naturally settles into a position that it deems most comfortable and efficient, largely beyond conscious control. While you might believe sitting upright without slouching is ideal, your body may not always conform to this expectation. Instead, it adapts to what it perceives as suitable, regardless of conscious efforts to maintain a specific posture.

Here is a small experiment you can do. sit on a stool and start watching the TV for 15 minutes. whilst doing that video you sitting posture. You will understand even if you wanted to sit erect slowly you sloughed or started to change your posture subtly. for many of you, you will also notice you will slowly start to tire, you want to rest your back. Probably for some of you the discomfort becomes worse and becomes pain in the back. Why?

Is this the same when i ride, i am unable to sit without back support. Is that the reason i am slightly more comfortable in the public transport bus or my car?

Endurance and adaptation:

However, the vast majority are able to sit in the motorbike and not get back pain. We have these adventure types sitting on motorbikes and go on for days. How are they able to do that? does that mean sitting in the bike for long time not a risk factor for pain?

Well, we know the system adapts to what you do. If you sit without back rest for hours, the endurance of the muscles of the back and legs get better. They feel less discomfort without resting the back. So, probably if you are riding your motorbike everyday for miles you slowly will get adapted.

So, does riding 10- 50 Km daily lead to back pain?

Will not the system fail leading to Low back pain?

The next question that follows is whether a biological system will eventually fail, possibly leading to issues like low back or neck pain. This concern, however, extends beyond just your riding experience—it's a fundamental aspect of any biological system to encounter occasional failures. Consider individuals engaged in manual labor, such as the boy carrying water to the office above mine or the person moving milk crates; they adapt to repetitive strenuous tasks, but there may come a day when their systems fail. If a system never failed, it would be deserving of the title "God."

So does riding a motorbike cause back pain?

Low back pain and Riding

While the evidence for riding as a trigger factor for low back pain is not clear, we know you back or neck pain might worsen if you ride with back pain or neck pain. I think this is where the idea of not driving after back pain might have first started and then it became a demon advice of “never drive.”

What causes pain to worsen at times?

We understand that low back pain or any pain can result in changes in muscle recruitment as a response to pain. These adaptations may decrease muscle endurance or lead to reduced activation of certain muscles. This can lead to the system being over protective and start your alarm (pain signal).

The primary concern arises when we instruct patients not to drive and emphasize how driving could cause their disc to displace onto the ground, creating a negative perception of driving. When coupled with a back pain episode or an escalation in pain, this can result in associative learning where riding a motorbike becomes linked with increased back pain. This activates a cascade of physiological and neural activation sometimes even to persistent pain.

So should i ask my patient to stop driving a motorbike, a horse or a donkey?

1. Well, no disc will come out, or you L4 L5 will slip away if you ride. So stop terrorising your patient.

2. If someone tells you to stop driving, you should ask them can i sell my Yamaha and buy a donkey (please note the south indian donkey population is declining very badly hence it could be of great help if we start buying them for short transport).

   

3. Do and don’t following back pain is usually pseudoscience but this one is bull shit so dont tell you patient not to drive. Please note he came to you for getting better not to be more disable.

4. You will not go driving if you have severe fever- no one has to tell you we know we cant drive- same advice for low back pain patients also. they will know.

5. Please note if your city has a metro, a good public system use them, we are all going into the sea soon, so it can help the global warming.

6. Most of southeast asia uses motorbikes for transport, so i think someone from the car lobby started this “advice”

No conflict of interests: i was not paid by Yamaha or hero to write this blog

With so much of love
K. Hariohm