Cyclist's Neck

Original Editor - Lucinda hampton Top Contributors - Lucinda hampton, Vidya Acharya, Kim Jackson and Tarina van der Stockt

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Cyclist's Neck

Neck and back 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 Process

Most commonly neck pain arises from poor riding posture on the bike, poor technique or a poor bike fit. This includes

• While cycling, the position of the neck is in extension and thoracic back is flexion for prolonged time which causes pain and fatigue
• Riding in dropped position of handlebars for extended period, saddle tipping increases the load on shoulders and arms resulting in hyperextended neck and muscle strain
• Hyperextension of the neck is further increased if the virtual top tube length (top tube plus stem length) is too long for the rider, leading to trigger points in the muscles of the neck and upper back.

• Weight of the helmet and poor placement of the helmet with helmet placed too low in front forces the rider to extend head upward to keep the helmet from blocking the view forward.
• Poorly fitting glasses, especially loose ones that slide down the nose, result in an extension of the cervical upper spine to look through the lenses instead of over them.
• The terrain bumps and high pressure in tyres resulting in lesser absorption of forces.

Clinical Presentation

The cyclist will present complaining of neck pain arising when on the bike. Research suggests that cyclists frequently present with pain in their left levator scapula caused by frequently looking over their left shoulder for oncoming traffic. Older cyclist complaim of radicular pain; though thoracic outlet syndrome is less commonly seen in cyclists it could be an important causative factor leading to neck pain, shoulder, and arm pain, tingling in the fingers, headaches esp in the back of the head, weakness of the arm and hand; and cold or cyanotic hands.

So, 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.

Subjective Examination

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

Objective Examination

Observation

Assess the client's cycling position noting:

• extended reach causing excessive forward lean
• forward saddle tilt increasing upper body loading
• locked elbow joints preventing shock absorption
• reduced thoracic spine flexibility with rounded upper back

• hyperextended cervical spine to maintain forward vision

Spinal assessment

• 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.
  • 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

Outcome Measures

• Neck Disability Index
• Neck Pain and Disability Scale

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

Conclusion

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.