Cycling - Upper Back Pain
Ron Fritzke looks at the reason why cyclist experience upper back pain and provides some preventative solutions.
Go on a long enough ride and you will probably start to feel a fierce burning in your shoulders along with a tight neck. Maybe even a little numbness travels down your arms, hands, and fingers. Cyclists tend to have neck and upper back problems for several reasons which we will discuss in this article. I will suggest some good solutions as well, so keep pedaling and read on.
You are putting yourself in an awkward position
Walking upright on two legs is a defining feature that makes us human. A number of anthropologists, however, attribute many of our aches and pains due to walking upright. Cyclists, however, ride in a hunched over position which is more chimp-like and it definitely is not pain-free by any means.
Unfortunately, if you love to cycle, that is the position you will find yourself in. We contort our bodies forward, crimped at the waist. To see where we are going, we need to bend our necks up in a non-ideal position for up to several hours. Having the neck bent like this is called cervical hyper-extension in professional terms. A prolonged hyper-extension of the neck can lead to a lot of chronic discomfort and pain.
What is the news on the pain in my neck?
This boils down to an overuse injury. When a cyclist logs many hours of riding, there is repetitive sub-maximal loading on the upper back and neck which leads to damage.
Let me give some insight into what is really happening when the neck is bent in an upward position for a prolonged period of time. We will also review some ways to combat the problem (or avoid the problem in the first place). When a muscle has a sustained contraction for a long period of time, the circulation of blood into that muscle becomes compromised. This is because the muscle contraction puts pressure on the blood vessels where the arterioles and capillaries are squeezing themselves shut, thus reducing blood supply.
This is not a problem when a muscle is alternating between contracting and relaxing such as the muscles in the leg do when a cyclist is pedaling. When the muscles in our upper back and neck are contracted for lengthy periods of time, the blood circulation in this area is greatly reduced. This means muscles are asked to perform a continual workload but without adequate oxygen and nutrients. This typically will lead to painful muscle spasms and trigger points.
The part of a muscle fiber that performs the contracting is a microscopic unit called a sarcomere. Contraction occurs in a sarcomere when its two parts come together and interlock like fingers. Millions of the microscopic units have to contract in your muscles to make the smallest of movements. A trigger point exists when over-stimulated sarcomeres are chemically prevented from releasing from their interlocked state. A knot can develop, then a spasm, followed by lots of pain. At this point you have got problems. There are effective treatments for trigger points but they are outside the scope of this article. Instead, let us discuss what can be done long before trigger points develop.
Moving muscles makes for merry rides
It is important to describe trigger points and their origin. When you have a good understanding of what the problem is, you are more likely to understand the 'why' of what can be done to combat that problem.
Often, professionals prescribe a few stretches and manoeuvres to help combat neck and upper back tightness or injuries. The movements and stretches are mostly forgotten or never used by the patients when trigger points and the problems they cause are not described adequately to the cyclist. But, if you are given a basic understanding of the problem of sustained contraction, and the lack of adequate circulation that occurs when muscles in the problem area are under load, you are more likely to follow what needs to be done to correct or avoid issues altogether.
So what types of things can be done to help?
You probably already know that stretching is advantageous to avoiding muscle related injuries. In addition to the stretching the neck and upper back muscles, you can also vastly benefit from two exercises: reverse shoulder shrugs and elbow presses.
Reverse shoulder shrugs are great because they make the muscles in the neck and upper back region alternate between full contraction and full relaxation. Reverse shoulder shrugs are performed by shrugging your shoulders upward toward your ears and then back down toward the ground and behind you. It is important to do reverse shoulder shrugs (shrugging down and back) rather than regular forward shoulder shrugs.
This is because forward shoulder shrugs make the back hunch forward into that chimp-like posture you are trying to avoid. Being hunched forward prevents the muscles of the upper back from contracting enough to accomplish the desired "contract, relax, contract, relax" movement pattern. In fact, when I am doing this exercise properly, I have my chest sticking pushed up and forward like the proudest of Marines.
Doing this exercise properly and regularly will get the muscles in the upper back and neck pumping and cyclists will notice a positive difference within a few times of performing the exercise.
Elbow presses are also a great blood pumping exercise that assists in nourishing the upper back with an optimal blood supply. This helps battle the sustained sub-maximal contraction that cinches down on the muscle's small arteries which occur with long bike rides. To perform elbow presses, bring your elbows out away from the body at the shoulder level. Then pull your elbows back as far as you can, causing the muscles around your shoulder blades and upper back to contract before you bring the elbows back to the starting point. Continue performing reps until you get a mild 'burn' in the muscles.Remember to use common sense when planning any shoulder exercises. Especially if you have or a susceptible to shoulder issues such as a rotator cuff injury.
There are some basic neck movements that may help neck range of motion as well. Here are the movements I like to use:
Another problem that commonly occurs in the upper back and neck area is Thoracic outlet syndrome or TOS for short. TOS accounts for much of the nerve-like discomfort in the shoulder region and down into the arms. Symptoms can range from muscle tension headaches, neck pain, pain in the shoulders, and arm pain. Weakness or tingling in any of these areas may be attributed to thoracic outlet syndrome.
Essentially, thoracic outlet syndrome is a compression of the bundle of nerves, arteries, and veins that go down into the arms. Over-development of the muscles in the area, such as the scalene muscles, contribute to this problem. Typically athletes in strength sports like football and baseball are most susceptible, but cyclists also experience thoracic outlet syndrome-type symptoms. The difference is that cyclists are more likely to suffer from muscle tightness or spasm at the base of the neck. Again, muscle movement and stretching are effective in relieving discomfort.
My bike is a pain in the neck. Or is it the cause?
I cannot state enough how important it is to have a properly fitted bike. Whether you are an experienced rider or a novice, get down to a local bike shop. They should have someone that knows a lot about proper bike fitting. Make good use of their expertise.
In the meantime, make sure you are not too 'laid out' on the bike. This creates the need to bend the neck further up. If this is the case, there are a few common sense changes that can be made. You can raise the handle bars so that you are riding more upright. Also make sure that your 'virtual top tube' length is not too long. While it is not practical to get a shorter top tube, since you would need a new frame, you can shorten the reach by getting a shorter stem. Make sure you do not go much shorter than 100 mm or your bike may ride squirrelly and give you problems you do not want to deal with.
I am sure most of you know about the basic measurement of correct reach, but I will review it anyway. When you are in your handlebar drops, your front hub should be obscured by your handlebars when you look down. Modern handlebars have a variety of degrees of drop, so it is recommended that you choose a bar with a shallow drop if you are trying to get more upright on your bike. If you do not spend much time in the drops at all, then this is a mute point.
Another equipment consideration is the helmet. Proper placement of the helmet is important. Road bikers typically do not have visors on their helmets because it necessitates having to bend the neck too far up in order to see ahead. Also, having the helmet too far forward causes neck problems. Again, the rider is forced to bend their head too far back to see. This will also defeat the safety benefits of the helmet.
Well informed and back on the road
As cyclists, we are constrained to the form of our bike and we need to be diligent when it comes to avoiding easily preventable injuries. We are susceptible to overuse injuries to the neck, upper back, and arms. Many of these problems are caused by an abnormal posture while cycling. Proper bike and helmet fitting are essential in that they will greatly reduce the chances of strains caused by an already problematic body position.
Diligence is also needed to keep our muscles as loose as possible and with the ability to perform with a full range of motion. Stretching and the exercises mentioned above will keep your upper back and neck muscles limber, relaxed, and ensure you have good circulation to the neck and upper back.
Following the recommendations in this article will translate into better performance, better comfort, and rides that are more enjoyable by the mile.
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About the Author
Ron Fritzke, D.C. currently serves as the chiropractor for the College of Siskiyous sports medicine team. He has also maintained a private practice in Mount Shasta, California for 22 years. He is a former marathon runner who sports a personal best of 2 hours and 17 minutes. His current sport of choice is cycling. He competes in bike races and writes about cycling related topics such the bike jersey, bicycle indoor trainers, indoor cycling shoes, and bicycle clothing on his website, Cycling-Review.com.
The following Sports Coach pages provide additional information on this topic: