Effects of Bike-Fitting on Lower Back Pain in Cyclists: A Systematic Review

Lower back pain (LBP) is one of the most common overuse complaints among cyclists and is frequently linked to suboptimal bicycle configuration. Bike-fitting seeks to optimize the interaction between rider and bicycle to enhance comfort, efficiency, and injury prevention. This systematic review examined the effects of bike-fitting interventions on LBP in cyclists. A comprehensive search was conducted in PubMed, Scopus, Web of Science, SPORTDiscus, and the Cochrane Library up to October 2025 to identify studies evaluating any bike-fitting or ergonomic adjustment aimed at reducing LBP or related discomfort. Methodological quality was assessed using the Physiotherapy Evidence Database (PEDro) scale for randomized trials and the Methodological Index for Non-Randomized Studies (MINORS) checklist for non-randomized studies. Three studies met the inclusion criteria: one randomized controlled trial and two quasi-experimental designs. Interventions spanned static and dynamic fitting procedures, as well as ergonomic saddle adjustments, with follow-up periods ranging from 30 days to six months. All studies reported significant reductions in LBP or discomfort following individualized fitting. These improvements were primarily associated with optimized pelvic tilt, improved spinal alignment, and more efficient lower-limb kinematics. Although methodological quality was generally moderate to high, variability in intervention protocols and relatively short follow-up durations limit the generalizability of the findings. Overall, bike-fitting, particularly when personalized, dynamic, and tailored to workload demands, appears to be an effective strategy for reducing LBP and enhancing comfort in cyclists. However, further high-quality research is needed to standardize fitting parameters, incorporate objective biomechanical assessments, and determine the long-term efficacy of these interventions.