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.

 

 

 

Backache, Pain, Back. DEADLIFT. REHABILITATION

The Deadlift: a back’s Friend or Foe?

SHOULD THE DEADLIFT BE FEARED AS AN INJURY RISK? OR EMBRACED AS AN IMPORTANT REHABILITATION TOOL?

One thing I’ve heard a lot, during my time as a physiotherapist, is how bad deadlifts are. Usually those complaining have come to see me for their back pain after they had hurt themselves deadlifting in the gym. Now of course people can get a sore back from deadlifts, but the cause is usually a breakdown of technique, the use of excessive load or poor programming. But doesn’t the same go for any exercise?

The deadlift is a basic functional movement where you are picking something off the ground. So why do so may people fear it when we do it all the time during daily function? Why do many health practitioners, including physiotherapists, turn away from the deadlift? Is the deadlift good or bad for your back when performed properly?

If you have back pain have it seen to. Book your appointment today and get it sorted!

Proof is in the powerlifter

A study by McGill et al (1992) looked at highly trained elite powerlifters and what sort of flexion forces were applied to their spines by deadlifting when compared to just standing and bending forwards. The idea was that in a flexed position the load would put excessive strain on the vertebrae and ligaments, possibly leading to injury.

A real time x-ray was used to assess the participant bending and the deadlift of 400 pounds. With the exception of one subject in one lift, all lifters completed their deadlift within normal range. They were completed without excessive force applied to the wrong tissues when compared to just bending forwards. As a result, good technique and the use of an appropriate weight, the deadlift is not dangerous for a well functioning back.  Please note the importance of correct technique to avoid back pain from deadlifting.

Practice makes perfect: use correct technique

I often tell patients that if they want to be good at something, practice it. Think of it this way; If you’re not usually a runner, but decided to run for hours one day, it should be no surprise to became very sore and possibly sustain an injury. However if you’re conditioned to run for hours, a different result would be expected. Therefore, it makes sense that if you want to become better at lifting and bending during daily function, you practise these tasks in order to condition your back for them.

The paraspinal muscles are big cable like muscles running up each side of the spine. 80% of people with lower back pain have poor paraspinal muscle strength. Strong paraspinal muscles reduce the sheer force occurring in the spine, meaning strong back muscles, put less force onto the discs of the lower back. A study by Colado et al. (2011) demonstrates that the deadlift is the most effective exercise at recruiting the paraspinal musculature compared to other exercises. It is also extremely functional and has great application for progression given the compound nature of the exercise. Essentially, the deadlift is an effective method to build the muscles that are very important for supporting the spine.

Another study by Welch et al. (2015) showed that over a 16 week free-weight-resistance based program 30 participants with over 3 months of lower back pain reduced their pain by 72%, their disability by 76%, greatly improved their back strength endurance and paravertebral size. There was also a decreased presence of fat infiltration in the spine, which is a common finding in MRI of people with longstanding lower back pain. Interestingly, a maximum weight intensity of  6-10 repetitions was used in the study. Therefore the intention was getting the participants strong using relatively heavy weights, not shying away from them.

Deadlifts proven to reduce back pain

A study by Aasa et al. (2015) showed a group of participants with over 3 months of lower back pain improved greatly with exercise. Participants were broken up into high-level lifting loads, including the deadlift, and low-load motor control exercises, such as Pilates.  After eight weeks both groups showed similar improved results with pain, strength and endurance. The only difference between the groups was that the low-load motor control group showed better results with movement control. Given this is what they were training this makes sense. So what would happen if these two methods were combined? Should they be combined, or should we just get stronger given the improvements were similar across the board?

Later Aasa et al. published the paper Which Patients With Low Back Pain Benefit From Deadlift Training? (2015). The paper broke the study down further to assess what participants did better, with deadlifts as their prescribed form of treatment. It was found that patients that did better with the implementation of the deadlift generally had better back endurance during the Biering-Sorensen Test, and less pre-exisiting pain (VAS <60mm) prior to commencement of the study.

Consequently, deadlifts are a very valuable tool in the rehabilitation process for someone with lower back pain. When performed with proper form and appropriate load, deadlifts are not dangerous. Aasa et al. (2015) study results demonstrate it’s advised to undertake low-load exercise to improve back endurance and pain, prior to commencing functional strength work such as the deadlift. Importantly, all study participants were instructed with correct lifting form. If unsure of the proper technique, or having trouble in the gym – seek the advice of a trained professional.

References

Berglund LAasa BHellqvist JMichaelson PAasa U. Which Patients With Low Back Pain Benefit From Deadlift Training? J Strength Cond Res. 2015 Jul;29(7):1803-11. doi: 10.1519/JSC.0000000000000837.

Burton AK, et al. Chapter 2. European guidelines for prevention in low back pain: Eur Spine J, 2006.15 Suppl 2: p. S136-68.

Cholewicki JMcGill SM. Lumbar posterior ligament involvement during extremely heavy lifts estimated from fluoroscopic measurements. J Biomech. 1992 Jan;25(1):17-28.

Colado JCPablos CChulvi-Medrano IGarcia-Masso XFlandez JBehm DG. The progression of paraspinal muscle recruitment intensity in localized and global strength training exercises is not based on instability alone. Arch Phys Med Rehabil. 2011

Welch N, Moran K, Antony J, et al. The effects of a free-weight-based resistance training intervention on pain, squat biomechanics and MRI- defined lumbar fat infiltration and functional cross- sectional area in those with chronic low back. BMJ Open Sport Exerc Med 2015;1:000050. doi:10.1136/ bmjsem-2015-000050

 

 

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