cycling neck pain

Neck and Upper back pain for Cyclists

How you can relieve neck and upper back pain from cycling.

Whilst everyone is focused on the legs of cyclists, as a physiotherapist I tend to be busier looking after their necks and upper backs. Just like a professional that works at a desk, athletes that spend time in flexed positions such as cyclists are also at risk of neck pain and tight shoulders (1). In fact, a study of 518 recreational cyclists showed the prevalence of neck pain was 49%! (2) This doesn’t mean that neck pain has to be part of cycling – and in most cases it’s preventable. If you follow the advice from this article you should find that you are enjoying your ride, and that cycling isn’t so much of a pain in the neck (sorry but I had to).

Article by Scott Rolph, Physiotherapist at Point 2 Point Physiotherapy in Sandringham and Oakleigh. For more details click here.

Anatomy

A cycling posture on a road bike involves a forward inclined seated position.  The thoracic spine (upper back) is made of 12 vertebrae that attach the ribcage to the body. The shoulder blades sit against the ribcage and the muscles working to control the shoulder blades, extend the spine and head all have attachments here. The forward inclined position means the upper back and shoulder blades are more rounded, the arms and shoulder girdle weight bear and neck is extended to maintain a forward gaze.

cycling neck pain

Courtesy of cyclingweekly.com

Recent research argues that posture alone is not a cause of injury (3). Simply sitting in a slouch position for a second doesn’t cause pain, because you are moving your body in a way that it is naturally capable of. However holding this posture for long periods of time can result in the neck and shoulder feeling very tight and sore. This overuse type injury comes on slowly. It occurs when tissue accumulates damage caused by repetitive and sustained submaximal loading. The sustained posture fatigues the muscles of the neck. With inadequate recovery microtrauma stimulates the inflammatory response and other processes, resulting in weakness, loss of mobility and chronic pain. Cyclists can develop:

  • tender muscles with areas of localised spasm (trigger points)
  • headaches
  • cervical and thoracic joint pains
  • back, chest and arm referred pains

 

Bike Setup

Suboptimal bike setup can place undue stress on the neck, shoulders and upper back. Some things to look out for include:

  • Excessive reach to the handlebars: If the length is too long between the saddle and the handlebars, the rider will have to over reach. This will create more forward lean, greater weight bearing through the arms and more extension occurring at the neck. This will also occur if the handlebars are too low.
  • Excessive width of handlebars: The handlebars should be shoulder width apart. This will allow better riding posture, more bend at the elbows, less stress on the back and neck.
  • Poor saddle: If a saddle is too uncomfortable to use properly, the pelvis may roll back (posterior pelvic tilt), increasing curvature of the spine and therefore affecting the upper back and neck.

bike setuo physiotherapy

Load Management

Poor load management can be another cause of issues for cyclists. Simply put, if you increase the amount you are doing too rapidly the body doesn’t have adequate time to adapt. One study has shown that 40% of injuries occurred during exercise as a result of increasing training load by more than 10% on the previous week (4). Another study showed that the risk of injury was increased about 10% when training loads were increased by less than 10%. When training loads were increased 15% the rate of injury jumped to between 21% and 49% (figure 1)(5).

This isn’t a blanket rule, and individuals will respond differently, but it can be used as a rule of thumb. Too rapid an increase in workload may result in built up tension in the area. To avoid this, ensure you are consistent with your workload. Gradually build up your volume over time. Also pay attention to what else you do with your day. If you are a desk worker ensure you have a good ergonomic set up. Stand often or use a standing workstation. Break up your sitting posture with exercises or with your schedule.

physiotherapy load management

Figure 1. Likelihood of injury based on the increase of training load per week.

 

Exercise program

The following exercises help to maintain mobility of the spine and shoulders and prevent neck and upper back pain.  These are great exercises but are general in nature.  For an individualised exercise program to help you book a thorough assessment today.

 

Cervical retractions

This is a great exercise to reverse forward head posture that helps cause cyclists’ neck pain.  Slide the head back slightly and hold for 10 seconds. You will be lengthening the muscles at the back of your neck and contracting the important postural muscle at the front of the neck.

neck pain posture exercise

Foam Roller Thoracic Extension

Extending over a foam roller can be a simple and effective way to reverse the forward bending posture on a bike. You’ll want to put your hands behind your neck to prevent extension and use your tummy muscles to prevent you arching your lower back. Try and arch over the roller for 5 seconds and repeat.

thoracic extension foam roller

Thoracic rotations “Open book”

If our mid back becomes tight we will loose our ability to rotate well. Laying on your side as shown, watch your upper hand as you raise it to the sky and over to the ground on the other side. Maintain your leg position. It is very important to breath with this exercise, as you should with all mobility exercises. Repeat on both sides for repetitions.

thoracic rotation stretch pilates

Wall Openers

This exercise presents a great and simple way to break up sitting postures throughout your day. Put your hands straight in front of you on a wall, take a small step back and then bend at the hips. Keep your abs switched on so you don’t arch through your lower back and instead mobilise the mid back.

stretch posture backpain

Foam roller Postural Stretch

This is a fantastic movement to stretch the muscles of the chest and shoulders that become tight with prolonged seated postures.  This creates a more rounded posture leading to neck stiffness and pain in cyclists.  Lay on a foam roller length ways. Let your hands come down to the ground palms facing up. Keep your abs switched on to prevent excessive arching through the lower back. Lower your arms out to the sides, sweep the ground up towards your head and continuing up to the sky to complete a full repetition. You will feel a pulling in the front of the shoulders and chest. If the movement is too strong you can hold a stretch position instead.

thoracic posture foam rollerposture stretch foam roller

 

Theraband shoulder exercises

When seated the muscles of the shoulders are kept in a lengthened posture for a sustained period of time. This can cause them to feel tight and sore. By exercising these muscles you help to prevent this and also get stronger. In exercise one hold a band with your elbows bent at 90 degrees. Pull the band apart squeezing your shoulder blades together and hold for five seconds and repeat. In exercise two hold a band straight in front of you and pull it apart in diagonals. Alternate arms and don’t let your shoulders shrug up.

shoulder pain postural exerciseposture exercise theraband

 

To learn more about how Point 2 Point Physiotherapy can help you click here.

 

References:

(1) Asplund C, Webb C, Barkdull T. Neck and back pain in bicycling. Curr Sports Med Rep. 2005;4:271–274.

 

(2) Wilber CA, Holland GJ, Madison RE, et al.: An epidemiological analysis of overuse injuries among recreational cyclists. Int J Sports Med 1995, 16:201–206.

 

(3) Laird, Robert & Kent, Peter & Keating, Jenny. (2016). How consistent are lordosis, range of movement and lumbo-pelvic rhythm in people with and without back pain?. BMC Musculoskeletal Disorders. 17. 10.1186/s12891-016-1250-1.

 

(4) Piggott B, Newton MJ, McGuigan MR. The relationship between training load and incidence of injury and illness over a pre-season at an Australian Football League club. J Aust Strength Cond 2009;17:4–17

 

(5) Gabbett TJ. The training-injury prevention paradox: should athletes be training smarter and harder? Br J Sports Med 2016;50(5):273–80.

 

 

 

painful knee with osteoarthritis

The best treatment for hip and knee osteoarthritis

The GLA:D program is a 6 week exercise and education program provided by a certified physiotherapist reflecting the most up to date research helping people manage with hip and knee osteoarthritis.

Did you know that osteoarthritis affects about one in eleven Australians?  That’s 2.2 million Australians!  Many risk factors exist that increase your likelihood of developing the condition. Whilst some risk factors can not be altered many are modifiable.  These include being overweight, a lack of muscle strength, over loaded joints and physical inactivity.

Clinical guidelines recommend exercise, education and weight loss (if needed) as front line treatment.  However, too often clinical practice doesn’t follow these recommendations, instead relying on medication and referrals to an orthopaedic surgeon.

GLAD facts and myths about knee oseteoarthritis

Danish researchers developed The GLAD Program, or Good Life with Arthritis, Denmark Program,  for people with knee and hip osteoarthritis symptoms. Exercise and education offer a better and safer alternative to surgery.

Research in Denmark has shown the GLA:D program reduced symptoms by 32% on average.

Recorded symptom improvements include less pain, reduced medication use and improved function.  Follow up studies reveal an increased level of physical activity in patients 12 months after starting the program.

The goal is to strengthen, improve function, prevent symptom progression and reduce pain.

What does the program involve?

The GLA:D exercise program includes:

  • Initial Appointment: to assess and fully understand your current level of function and pain, to explain the GLA:D program and to cover any questions you may have.
  • Two education sessions: which will help to educate you about osteoarthritis, how to manage it and how the GLA:D program can help.
  • 12 group exercises sessions: completed twice a week over 6 weeks working on exercises to reduce symptoms and improve your quality of life.
  • A Follow Up Appointment: to reassess your condition 12 weeks after commencing the program.

glad exercise osteoarthritis of knee and hip

Can I do the program?

Anyone suffering osteoarthritis symptoms of the hip or knee, regardless of the severity, can complete The GLA:D program.  You may not complete the GLA:D program if you:

  • Have another cause for your pain such as inflammatory joint disease, a fracture, a soft tissue cause or tumour.
  • Have other symptoms that are more pronounced than the osteoarthritis problems.
  • Are unable to communicate in English.

Cost of the GLA:D exercise Program

The initial and follow up appointments are priced as physiotherapy appointments.  The two education sessions are provided at no cost. The 12 exercise sessions are $420 ($35 per session).  No referral is needed. You can discuss with your doctor to see if you qualify for a Health Care Plan, which would cover part of the cost of the program.  You can also check with your health insurer, Workcover, TAC and DVA.

GLAD osteoarthritis exercise program

click here to book your appointment today. 

Like or Share this article with a friend if you think they would benefit from this program.

To find out more contact us on 9521 6633 (Sandringham) or 0414 199 664 (Oakleigh).  The GLA:D Exercise Program is available from both Point2Point Physiotherapy practices.

For further information read more here about the structure of GLAD at Point 2 Point Physiotherapy.

 

Physio foam rolling painful ITB

Foam Rolling – Keep on Rolling?

is foam rolling beneficial or are we wasting our time?

Foam Rolling has risen in popularity recently as a self-massage tool. It’s believed that some benefits of foam rolling muscles over different areas include breaking up adhesions, scar tissue and loosening the connective tissue of the body. On first glance this makes sense. Similar to rolling out a piece of dough until it is nice and smooth. However is this really what occurs? It’s important to take a minute to review the evidence to best understand how it works, what benefits of rolling out muscles exist, and how you can implement it to best achieve your goals.  If you still have any questions after you’ve finished please contact me or book an appointment if you have an issue.

Does foam rolling cause structural changes?

A study by Hayashi et al. (2011) made this seem very possible. In this study humans used tools to apply pressure to the ligaments of rats. This showed successful remodelling of the collagen fibres in the ligaments. So how well would this apply to humans performing self-myofascial release on a foam roller? Well there are some issues with applying this study to humans. The main issue is the relative size of a human applying the force to a much smaller rat. Extremely large forces would be required on a human to come to the same findings. In fact Chaudhry et al. (2008) quantified this. It was estimated that approximately 852kg of pressure would be required to alter our tissue structure just 1%. It’s no wonder why the rats were unconscious during the study! Therefore it is very unlikely that foam rolling alters the tissue structurally.

What is this tissue and how is it so strong?

The connective tissue (fascia) we are trying to release by rolling is made up mostly of collagen. Collagen is a protein primarily responsible for resisting and adapting to tensile stress. It lies beneath the skin and attaches, stabilises, encloses, and separates muscles and organs. Think of it as your body’s natural glad wrap. Now this tissue is very strong. In fact studies have come to conclude that fascia is proportionally stronger than steel. Further studies show that no meaningful deformation of the tissues was achieved after foam rolling.

So what is actually happening when I foam roll?

Instead of physically breaking down tissues, what is occurring is a bit different. Firstly what is the feeling of tightness? Well there is a difference between a muscle feeling tight and a muscle actually being structurally tight. Firstly if a muscle is actually tight it is due to the tissues becoming physically tighter. For example if you took your arm out of a cast it has been in for 6 weeks.

A very different example of feeling tight would be if you’ve been sitting down at a desk for a prolonged period of time. Afterwards you feel tight in your middle back or the tops of shoulders. However, in this posture your muscles were held in a lengthened, not shortened, position. So tightness in this example has nothing to do with the tissues being structurally tight, it’s a sensation. A feeling of tightness is related to muscle tone. Muscle tone is the subconscious level of nervous system activity to the muscle. If the nervous system perceives a threat it can tighten up such as an injury due to muscular weakness or a prolonged posture.

Physio foam rolling painful ITB

Now you know when you have bumped your knee on the edge of a desk and you rub it to make it feel better? Physically you are not changing what just happened. What you are doing is giving your body another stimulus. And that is exactly what foam rolling does. And that’s why foam rolling can relieve the feeling of tension in a matter of seconds.

IMPORTANT NOTE:  Tone is used for protection and so if something is regularly tightening up there may be an underlying cause that needs to be addressed. An increased amount of tone to an area for an extended period of time may lead to a physical tightening of the tissues. I’d strongly suggest seeing a good physiotherapist to access this.

So what are the benefits of foam rolling?

Improved mobility.

Studies have shown that performing foam rolling prior to exercise can improve mobility. This effect is short term however, lasting about 10 minutes. This does make sense given the nature of improvement appears to be due to a change in the nervous system as opposed to any meaningful structural change. This may explain why rolling out one leg improves the mobility in both legs not just the one treated and why in another study massage to the sole of the foot could improve hamstring flexibility.

A study showed that foam rolling and stretching was twice as effective as static stretching alone. Another benefit found was that foam rolling doesn’t have the same decrease in performance that static stretching causes prior to exercise. This is likely due to the fact that foam rolling doesn’t stretch the neural tissues like static stretching does.

Improved recovery

2 studies done in 2014 and 2015 looked at groups performing squats (10 sets of 10 repetitions). They demonstrated that the group who foam rolled had benefited from less soreness at 24, 48 and 72 hours after exercise.

In the 2015 study they also measured how quickly performance measures returned to baseline where the foam roller group was superior to the control group. These same positive foam roller effects were demonstrated with professional soccer players in a 2017 study where they enjoyed the benefits of decreased post exercise soreness and also a quicker return of their agility measures between training sessions.

A 2017 study looking at participants completing 40x15m sprints showed no difference between the control and the foam roller group. However, a dynamic warm-up was completed prior to assessment, as opposed to the other studies where the control group did nothing. This would suggest that other methods of recovery are effective.

So looking at the evidence yes it would appear that foam rolling helps to reduce post exercise muscular soreness and can assist in the quicker restoration of performance measures after training. It also seems that when compared to an active/dynamic approach there is little difference. Therefore the recommendation would be to utilise foam rolling but to understand it’s just a tool in the toolbox to assist your recovery, not the be all and end all.

Physio Foam rolling his glutes

Take Home Message

The mechanism of how a foam roller works is different from what was previously thought. It seems much more likely that it causes changes in the nervous system to effect change rather than having any meaningful effect on the structure of soft tissues. Given we better know how foam rolling works we now have a better idea on how to implement it. Short-term mobility improvements should be taken advantage of prior to training but don’t waste a long period of time doing it as the results are short lived. Benefit from utilising a foam roller after a workout to reduce post exercise soreness and improve recovery.  This may lead to more productive training sessions and a reduced rate of injury. There are definitely great benefits of foam rolling.

References

Chaudhry H., Schleip R., Ji Z. Three-dimensional mathematical model for deformation of human fasciae in manual therapy. Journal of the American Osteopathic Association. 2008;108(8):379–390
Cheatham S., Kolber M., Cain M., Lee M. The effects of self myofascial release using a foam roll or roller massager on joint range of motion, muscle recovery, and performance: A Systematic Review. Int J Sports Phys Ther. 2015 Nov; 10(6): 827–838.
D’Amico A., Gillis J.The influence of foam rolling on recovery from exercise-induced muscle damage. J Strength Cond Rep. 2017 Sep 6.
Hayashi K., Ozaki N., Kawakita K. Involvement of NGF in the rat model of persistent muscle pain associated with taut band. J Pain. 2011;12:1059–68.
MacDonald G., Button D.Drinkwater E.Behm D. Foam rolling as a recovery tool after an intense bout of physical activity. Med Sci Sports Exerc. 2014 Jan;46(1):131-42.
Pearcey G., Bradbury-Squires D, Kawamoto J., Drinkwater E., Behm D.Button D. Foam rolling for delayed-onset muscle soreness and recovery of dynamic performance measures. J Athl Train. 2015 Jan;50(1):5-13.
Ray E., Padron-Cabo A., Costa P,. Barcala-Furelos R.The Effects of Foam Rolling as a Recovery Tool in Professional Soccer Players. J Strength Cond Res. 2017 Oct 7.
Schroeder A,. Best T. Is self myofascial release an effective preexercise and recovery strategy? A literature review. Curr Sports Med Rep. 2015 May-Jun;14(3):200-8.
Sullivan K., Silvey D., Button D., Behm D. Roller massager application to the hamstrings increases sit and reach range of motion within five to ten seconds without performance impairment. Int J Sports Phys Ther. 2013 Jun; 8(3): 228–236.

 

 

 

 

 

 

 

 

 

Exercise-Morning-Or-Night-Which-Better

When is the best time to train?

Is the best time to exercise morning or night?

I’ve always preferred training in the morning. I feel it sets me up for the rest of the day.   If I leave it till after work things can come up, or fatigue can set in. In turn this affects the quality of the workout.  Chtourou & Souissi showed in their Literature Review: The Effect of Training at a Specific Time of Day (2012) that whilst aerobic performance is equivocal in the morning Continue reading