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Low back pain is a common complaint among competitive cyclists. 1 2 The posture associated with cycling may stress lumbar spine structures, however, the pelvis and hip joint complex are also potential generators of pain as many large lower extremity muscles cross the hip and attach to the sacrum, pelvis and/or lumbar spine. The attachments of the iliopsoas muscle on the transverse processes, bodies and discs of the lumbar vertebrae and its role as a hip flexor and lumbar spine stabilizer make lesions of the iliopsoas a potential source of low back pain. 3
This report describes a competitive master cyclist who presented with low back pain and whose symptoms ultimately resolved when he was treated for internal snapping hip syndrome. Internal snapping hip syndrome is a painful lesion of the iliopsoas caused by snapping of the iliopsoas tendon over the iliopectineal eminence or anterior femoral head when the femur is extended from a flexed position. 4 5 This is the first published report that we are aware of that describes this syndrome as a potential cause of low back pain in a competitive cyclist.
CASE REPORT
A 48-year-old male master cyclist presented with bilateral low back pain, described as worse on the right side and accompanied by sensation changes to his right anterior leg and right quadriceps weakness. He described a 6-month history of intermittent low back pain with occasional mild sensation changes over the anterior portion of his right leg. The patient had been training roughly 300-500 km/week and 1 week prior to the onset of his current symptoms had competed in the first cyclocross race of a new season. He reported a 12-year history as a highly competitive amateur athlete with rigorous annual training regimens.
A radiographic study of the lumbar spine...