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.

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.

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.

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.

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 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.

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.

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.

 

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.

 

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.