Dear Dr. Sankoff,
Could you help me out with a primer on neck problems related to biking, including hyperextension? My problem is very tight neck and shoulder muscles, which I’ve been told is due to cycling in an aero position -- not just after riding but chronic. I tried laying off a few months but no relief. The good news is that I’ve had MRIs indicating no structural issues, which leads me to believe it’s muscular. I have a torn labrum in one shoulder, but I’ve been told that is a separate issue.
Thanks,
David
Manhattan Beach,
Calif.
The short answer: Neck and back pain are very common among cyclists. The most important determinant of both of these problems is poor bike fit.
The long answer: Neck and back pain are two of the most common complaints of cyclists. The back must be flexed while the neck is extended. This places both areas at risk of absorbing significant micro-trauma; that is to say, minor amounts of trauma that do not cause pain at the time that they are incurred. Over time though, the accumulation of micro-trauma can lead to over-use injuries that result in chronic pain. Furthermore, if repetitive strain is allowed to continue unabated, trigger points in the muscles of the neck or back may form. Trigger points are small rubbery knots in muscle and the adjacent muscle sheaths (fascia) that send pain signals to the brain and contribute to a pain-spasm-pain cycle.
How then should these problems be managed? As is often the case with over-use injuries, the best approach is to simply prevent them in the first place because once they are established, they may be exceedingly frustrating to deal with effectively. Understanding why neck and back injuries occur is important to knowing how to prevent them.
The development of neck pain results primarily from the fact that the neck is extended for prolonged periods when cycling, and this leads to muscle fatigue and pain. Riding in drop handlebars further extends hyperextension of the neck and increases stress on the arms and shoulders. Triathletes are even more susceptible to this because of their use of aerobars. The situation may be compounded if the total top-tube length (top-tube plus stem length) is too long for the rider.
Back pain can arise from several factors. An excessively long top tube tends to increase flexion and puts stress on the muscles of the back, which can cause injury and pain. In addition, if the handlebars are too low flexion is further increased. Riders with unconditioned back muscles are predisposed to these issues, even with proper bike fit. The angle of tilt of the pelvis may also contribute to back pain and is directly related to tightness in either the quadriceps (which tilt the pelvis forward) or the hamstrings (which tilt the pelvis backwards). Pelvic tilt may also be influenced by fatigue in the hamstrings or gluteals as a result of prolonged hill climbing or pushing big gears. Again, this may cause a backward tilt of the pelvis, further straining the back muscles.
Thus, the majority of the causes for both neck and back pain relate to poor bike fit. Consequently, preventing these problems begins with a proper bike fit from a trained professional. A proper fitting bike should allow the rider to generate the maximum power and assume the most aerodynamic posture while maintaining a reasonable degree of back flexion and no over-reaching with the arms and shoulders. The width of the handlebars is also important and should be no more than shoulder-width to ensure a proper riding posture. Finally, a properly fitting helmet is also important. If the helmet sits too low, the eyes may be partly blocked, necessitating further neck hyperextension to allow for good vision.
If the bike is properly fitted but pain continues to arise, there are other steps that can be taken. One important measure to consider is changing riding technique. Maintaining a rigid riding position transmits more shock directly to the neck and shoulders. Riding with unlocked elbows and frequently changing hand position (i.e. from drops or aerobars to brake hoods) can alter neck posture, minimizing pain. Frequently stretching the neck during more leisurely parts of the ride may also help reduce the frequency and severity of neck pain.
Finally, because cycling demands prolonged back flexion and neck extension, ensuring that your neck and back are flexible is very important. All riders should strive to attain core strength and flexibility. In addition, strong and flexible quadriceps and hamstrings are important. A physical therapist or a sports-medicine provider are excellent resources for common back and neck stretches and core-strengthening exercises.
Once the problem is established, management of bicycling-related neck and back pain takes a three-pronged approach: The first step is to allow for healing of the injury. This may be best achieved through a combination of rest, massage or acupuncture and the use of anti-inflammatory medications. The second is to address any factors that may have contributed to the problem in the first place. Get your bike fit analyzed and make any changes needed to ensure an improved riding position. Lastly, working on strength and flexibility will help in reducing the likelihood that the injury will recur once you resume riding.
Train hard, train healthy.
Dr. Jeffrey Sankoff, MD, FRCP(C), is a two-time Ironman triathlete and ER physician based in Denver, Colorado. To learn more, visit Sankoff’s Web site
.If you have a question for Dr. Sankoff, please e-mail feedback@triathletemag.com Triathlete Magazine Interactive. Please include “Dr. Sankoff” in the subject line.