Introduction: Elite track cycling places unique demands on the body with cyclists required to perform at a maximal intensity level over a short duration. To achieve a more aerodynamic position on the bike, cyclists are required to adopt postures that put the lumbar spine and hip in increased flexion with a loss of the lumbar lordosis. Previous research has found that a flexed posture and loss of lumbar lordosis decreases multifidus function, which is important for spinal stability. In cycling, a stable lumbar spine and pelvis could be important for the efficient function of the lower limb muscles to generate power in the propulsive phase of cycling. This case report describes how assessment and treatment of individual lumbo-pelvic muscle asymmetry and function was used to treat a cyclist who presented with low back, buttock, and leg pain associated with a loss of power during cycling. Methods: A 27 year old female elite track cyclist presented with left sided pain in the lumbar, gluteal and adductor region with hamstring pain and tightness. Symptoms were aggravated by training loads greater than 300 watts for longer than 2 minutes, prolonged sitting greater than 20 minutes and lumbar extension. When aggravated, aching in the left calf and foot was also present. Easing factors included hamstring stretches and massage of adductor and lateral thigh muscles. She had a previous 3 year history of intermittent lumbar and thoracic pain and a L5/S1 spondylolisthesis defect diagnosed by Xray investigation. Magnetic resonance imaging (MRI) and real-time ultrasound (RTUS) examination of her individual lumbo-pelvic muscles demonstrated muscle asymmetry and altered function. Physical therapy treatment focused on specific re-training of her multifidus, transversus abdominis, iliopsoas and gluteal muscles with feedback from RTUS. Results: Within 3 weeks of commencing weekly motor control retraining, less intensity of pain was noted and training loads were increased. Re-assessment with MRI and RTUS 6 months later revealed improvement in muscle size and function. In addition, lumbar and gluteal pain had improved with only intermittent adductor and calf muscle tightness still a problem. Conclusions: Individual lumbo-pelvic muscle asymmetry and altered function contributed to the patient`s symptoms. The physical demands and adopted postures of certain sports can result in muscle asymmetry, which may be related to injuries. Addressing imbalances in muscle size and function can help to treat injuries and optimise performance.
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