NECK & UPPER BACK PAIN FOR CYCLISTS

How you can relieve neck and upper back pain from cycling

Article by Scott Rolph, Physiotherapist at Point 2 Point

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).

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.

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 Set Up

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.

What should you do?

To prevent issues occurring the set up of the bike, and the training loads should be reviewed to ensure it is optimal.  In conjunction with this strategies should be put in place to offset the effects of sitting in the saddle for prolonged periods of time using a cross training program. Exercises to help maintain mobility of the spine and shoulders and prevent neck and upper back pain should be included. The program should also include exercises that build up soft tissue tolerance to load in prolonged postures.

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