REF-1266 · Streisfeld et al., 2017 · Sports Health: A Multidisciplinary Approach · Paper · PubMed · Free full text

Will raising my handlebars help my lower back?

Lower bars flex the lumbar spine more, and riders with back pain sit more flexed — but no study here tested raising the bars as a fix. Eight small studies, all men.

Main caveat: Small, observational, low-to-moderate quality. 255 men in 8 studies, 4 with fewer than 20 participants, one a single case; median Downs and Black 12 of 27.
limited evidenceMeasured on non-athletes to elite athletes

Streisfeld et al. (Department of Physical Therapy, Thomas Jefferson University) asked whether body position on the bike, spinal kinematics and muscle activity are related in cyclists with non-traumatic low back pain, and how bike fit affects them.

Five reviewers searched PubMed, CINAHL, Ovid MEDLINE and Scopus in July 2015 and April 2016, excluded studies already covered by a 2010 review, and included 8 studies (255 participants, all men), appraised by consensus with the Downs and Black checklist (median 12 of 27; no blinding anywhere).

Three studies of handlebar height or hand position found that lower bars increased lumbar flexion, reduced the lumbosacral angle and increased anterior pelvic tilt.

Riders with back pain showed arm and spinal muscle fatigue (one EMG study), thinner abdominal and back muscles with lower back-extensor endurance (one ultrasound study of off-road riders), and greater lumbopelvic flexion with more time at end range during a 2-hour road ride, while pain rose (one field study); a single case improved flexion and pain with cognitive functional therapy and biofeedback.

The authors conclude that trunk-muscle imbalances in a prolonged flexed posture may lead to maladaptive spinal kinematics and higher spinal stress, and suggest that time in the position and endurance deficits may matter more than the position itself.

Our reading: the base's first source behind "raise the position" for back pain — lower bars do flex the lumbar spine — and a pointer to trunk endurance; but the posture studies did not compare riders with and without pain, the muscle data from one or two small studies, and nothing here tests raising the bars or training the trunk as a treatment.

Protocol

Searches: PubMed, CINAHL, Ovid MEDLINE and Scopus on 16 July 2015 and 1 April 2016 (the abstract gives August 2015 and April 2016); terms cycling, cyclists, bicycling, low back pain, overuse injury, back pain.
Selection: biomechanical studies (comparison, cross-sectional, case-based) of muscle activity and characteristics, spinal position or angles, or the bicycle, in riders with non-traumatic, non-specific or overuse back pain; studies before 2007 already in the Marsden and Schwellnus review excluded. 50 articles screened, 16 eligible, 9 excluded as already reviewed, 1 added from the second search: 8 included.
Appraisal: Downs and Black checklist, all grades by consensus of 5 reviewers.
Participants: n = 255 across studies (1 to 120 per study), men only, 18-57 y, 54.43-72.57 kg, 1.6-1.85 m; designs 4 within-participant, 3 case-control, 1 single case; 3 compared riders with and without back pain.
Methods in the included studies: surface EMG, ultrasound and biofeedback; handlebar heights of +16, +8, 0, −8 and −16 cm relative to the saddle (one study) or upper, middle, lower and aero hand positions (another); a lumbar strain-gauge posture monitor on the road; video motion capture; a surface spinal-curvature device; pain by the Rehabilitation Bioengineering Group scale or the Numeric Pain Rating Scale.
Funding and interests: no funding statement in the article; the authors report no potential conflicts of interest. All six authors are in an academic physical therapy department; the review is also listed as a doctoral (DPT) capstone in the university's repository. No industry ties are printed.

Key Results

QuestionStudiesFinding
Handlebar height and spinal posture3 (no comparison of riders with and without back pain)Lower bars → more lumbar flexion, smaller lumbosacral angle, more anterior pelvic tilt
Frame type and muscle fatigue1Greatest arm and spinal muscle fatigue on a sports (racing) frame vs rigid or suspension frames
Muscle fatigue with back pain1Riders with back pain fatigued in arm and spinal postural muscles
Trunk muscles with back pain1 (off-road riders)Thinner abdominal and back muscles at rest and in contraction; lower back-extensor endurance
Lumbar kinematics with back pain1 (2-h road ride)More lumbopelvic flexion, more time at end range; flexion did not change over the ride while pain rose
Intervention1 single caseCognitive functional therapy with biofeedback reduced lumbopelvic flexion and pain
Quality: median Downs and Black 12 of 27 (highest 20); four studies had fewer than 20 participants; no blinding in any study.
Citations that do not match: the Discussion cites the handlebar-position studies as references 9, 24 and 25, while the Results cite 9, 23 and 25 (reference 24 is a hamstring-extensibility study); the multifidus co-contraction finding is cited to a 2004 pilot study and the 2010 review, both outside the 8 included studies; the search months in the abstract and the methods differ. The study-by-study extraction table is an online appendix not in the PMC text.

Mechanisms

Measured (in the included studies): lower bar height went with more lumbar flexion; riders with back pain rode in more lumbopelvic flexion from the start of a ride and spent more time at end range; they had lower back-extensor endurance and thinner trunk muscles (one study).
Authors' interpretation: trunk-muscle activation imbalances and back-extensor endurance deficits in a prolonged flexed posture may lead to maladaptive spinal kinematics and higher spinal stress (the flexion-relaxation hypothesis: as the extensors fatigue or switch off in flexion, load shifts to ligaments and discs); it may be the time spent in the position and the endurance deficit, more than the position itself, that matters; which comes first, muscle imbalance or altered kinematics, is unclear.
Inference: in the road study the riders with back pain were already more flexed at the start and did not flex further while pain rose, which points to how they hold their spine rather than to a position that drifts with fatigue; changing the bar height changes the angle the rider must hold but does not by itself change how they hold it.
Inference: the trade-off runs the other way for performance: in well-trained men every maximal value, peak power included, fell as the torso was lowered (REF-793), so a higher front end is not a physiological cost; its cost is aerodynamic drag, which matters most on flat, fast roads.

Practical Application

Will raising my handlebars help my lower back? Lower bars flex the lumbar spine more, and riders with back pain sit more flexed — but no study here tested raising the bars as a fix. Eight small studies, all men.
Raise or shorten the front end as a trial, not a cure (B): lower bars increased lumbar flexion in three posture studies that did not compare riders with and without back pain. Not from this paper; the base's own practice: raise or shorten the front end in small steps, one change at a time, and re-check after about two weeks (SYNTH-73 lower-back row).
Trunk endurance is a lead, not a tested treatment: riders with back pain had lower back-extensor endurance and thinner trunk muscles in one study of off-road riders; no included study tested trunk training in riders, and the review reports nothing on hamstring flexibility. Not from this paper; the base's own practice: back-extensor and trunk endurance work alongside riding.
Change position during long rides: the authors point to time held in flexion; standing and moving between hand positions breaks it up (inference, not tested here).
Ask about the history: back pain before taking up cycling was the strongest marker in one survey of Italian amateurs (REF-1265, OR 4.20, cross-sectional) — position is a second question.
Red flags: pain down a leg, numbness or weakness, night pain → clinician (SYNTH-73).

Limitations

Small, observational, low-to-moderate quality. 255 men in 8 studies, 4 with fewer than 20 participants, one a single case; median Downs and Black 12 of 27; no blinding; non-random samples.
Mismatch between question and data. Posture-by-bar-height studies did not compare riders with and without back pain (the review does not say whether any had pain); only 3 studies made that comparison.
No pooling and no grading of the strength of each finding; "evidence" in the abstract can mean one study.
Citation and date inconsistencies (see Key Results); the extraction appendix is not in the PMC text.
Men only, 18-57 y; no women, no data on mountain-bike geometry beyond one ultrasound study, no time-trial pain data.
Interests. No funding statement; no conflicts declared; academic authors.
How this entry was checked and changed
Why this level

read from the full text (PMC). A systematic search, but the 8 studies are small (n = 255 in total, 1-120 each, 4 with fewer than 20), observational and unblinded, of low to moderate quality (median 12 of 27), only 3 compared riders with and without back pain, and the synthesis is narrative; the review carries cross-sectional evidence (rubric B), not the trials the rubric's review rows assume; held below REF-1260 and REF-919 (B+) because each finding rests on one to three studies of 1-120 men

Full text (checked 2026-10-27)
Eight studies met criteria; the number of subjects ranged from 1 to 120, with a total of 255 subjects (full text)
Studies included only men aged 18 to 57 years (weight 54.43-72.57 kg; height 1.6-1.85 m); 4 within-participant, 3 case-control and 1 single case study (full text)
Four studies had sample sizes of less than 20; the median Downs and Black score was 12 of 27, with the highest score of 20; no blinding occurred in any study (full text)
Handlebar heights of 16, 8, 0, −8 and −16 cm in one study; lower handlebar heights increased lumbar flexion (full text)
Searches on July 16, 2015 and April 1, 2016; 50 articles, 16 eligible, 9 excluded as already in an earlier review (full text)
The authors report no potential conflicts of interest (full text)