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Cyclist's Neckback pain are extremely common in cyclists, occurring in up to 60% of riders. 30% of elite British cyclists reported having upper back or neck pain in a 1996 report Pain in and around the neck area are often caused by bearing too much weight through the upper limbs. This causes the neck to receive too much pressure - ideally only 40% of weight should be transmitted through the upper limbs. Management of overuse injuries in cycling generally involves Bike Fit adjustments as well as medical management. Also the position in the neck in the cycling position calls for good neck strength, The head position of a cyclist is forward of the shoulders ( not the optimal position for neck muscles) the need for muscular activity is increased and the stress imposed on the cervical tissues is increased. Forward head posture (FHP), defined as the forward displacement of the head on the cervical spine, has been commonly associated with neck pain.
Mechanism of Injury / Pathological ProcessMost commonly neck pain arises from poor posture on the bike or a poor bike fit. This includes
- Reach too long or handlebars too low
- Saddle tipped for forcing more WB through upper limbs
- Elbows in full extension, hence not softening the impact up to the neck region
- Stiff upper thoracic spine or rounded upper spine causing cervical spine to hyperextend to see ahead.
- High pressure in tyres causing less absorption of terrain bumps.
- The extended position of the neck can cause the deep neck extensors to become fatigued if insufficient to support head weight during length of cycle. The trapezius muscle and other neck muscles, over time, can develop also stiffness and pain.
- Poor adjustment of a helmet - if the helmet is too low in front, the rider is forced to extend head upward to keep the helmet from blocking the view forward.
- Poorly fitted eyeglasses eg glasses sliding down nose causing extension of cervical upper spine to be able to be looking through, not over, the glasses.
The cyclist will present complaining of neck pain arising when on the bike. A variety of presentations are possible eg dull ache at the base of the skull; aching in the trapezius muscles; twinging in the neck with turning neck or looking up; neck pain with headaches; tightness between shoulder blades and trapezius muscles.
Questions to ask include:
Past neck or back issues; any accidents falling off bike; ( note a 2018 USA study found sporting-related cervical fractures increased by 35 percent from 2000 to 2015, mainly due to an increase in cycling-related injuries); check for any red flags eg recent malignancy, unremitting pain, weight loss etc; is it chronic, subacute or acute; has a Bike Fit been done?; recent changes in bike parts or training regime/terrain; what type of work do they do may predispose to neck pain; how long does it take for pain to come on; is it only with certain movements or terrains.
Check the client on the bike; cycling position (look out for extended reach, forward tip of saddle, elbow joints locked out, lack of thoracic flexibility, hunched upper back, hyper extended cervical spine - all point to potential cause of problem)
A spinal assessment should be undertaken noting any aberrations from the norm. Check movement in mid thoracic spine (rotation, extension, flexion) and cervical spine ( upper and lower cx movements)
Muscle lengths ( and fascial bands) and strength should be assessed in the major muscles involved in support of upper body during cycling. These being
- core muscles, as involved in stabilising/supporting upper limb.( A 2017 systematic review found that core muscle activation imbalances, back extensor endurance deficits, and increased lumbar flexion while cycling are often present in cyclists with low back pain)
- cervical muscles
- trapezius muscle
- latisimuss dorsi and thoracolumbar fascia
Neurodynamic tests: ULTT's
Management / Interventions
Based on finding the following treatments are often used
- Mobilisation of the stiff joints eg Maitland mobilisations upper thoracic spine or cervical spine as needed, upper spine extension over swiss ball/foam roller/towel, rotation manipulation thoracic spine
- Release of tight myofascial/trigger points using ART's
- Stretching of tight musculature eg trapezius muscles, pectoral muscles, cervical flexors and extensors, upper cervical spine extensors
- Strengthening of weakened musculature eg deep neck flexors, trapezius, muscles of cervical spine movements, core muscles.
- Ensure a good bike fit is evident and educate about cycling posture and need to maintain good flexibility and strength of cycling muscles.
- Home exercise plan (HEP) incorporating self mobilisations, stretching and strengthening exercises. The video below gives one example of a HEP
Neck pain from cycling can often be fixed with: a good bike fit; correction of postural problems associated with spending hours on the bike; and implementation of a good maintenance program for the cycling muscles. So.....happy cycling.
- Mellion MB. Common cycling injuries. Sports Medicine. 1991 Jan 1;11(1):52-70. Available from: https://link.springer.com/article/10.2165%2F00007256-199111010-00004 (last accessed 3.9.2019)
- Michael J Callaghan, Christopher Jarvis. Evaluation of elite British cyclists: the role of the squad medical BrJ7 Sports Med 1996;30:349-353[last accessed 3.9.2019)]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1332424/pdf/brjsmed00008-0078.pdf
- Ghamkhar L, Kahlaee AH. Is forward head posture relevant to cervical muscles performance and neck pain? A case–control study. Brazilian journal of physical therapy. 2019 Jul 1;23(4):346-54. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6630105/#bib0255 (last accessed 4.9.2019)
- Bespoke Blog. LET'S TALK ABOUT... NECK PAIN Available from: https://www.bespokecycling.com/blog/training/lets-talk-about-neck-pain (last accessed 3.9.2019)
- Harris cyclery Bicycling and pain. Available from: https://www.sheldonbrown.com/pain.html#neck (last accessed 4.9.2019)
- Streisfeld GM, Bartoszek C, Creran E, Inge B, McShane MD, Johnston T. Relationship between body positioning, muscle activity, and spinal kinematics in cyclists with and without low back pain: a systematic review. Sports health. 2017 Jan;9(1):75-9. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5315261/ ( accessed 3.9.2019)
- The Motive Physical Therapist Specialists The 5 Best Exercises for Neck Pain in Cyclists Available from: https://www.youtube.com/watch?v=5OvuxEkv6x4 (last accessed 4.9.2019)