Cycling - Upper Back Pain
Ron Fritzke looks at the reason why cyclist experience upper back pain and provides some preventative solutions.
Cyclists tend to have neck and upper back problems for several reasons, which we will discuss in this article. Going on a long enough ride, you will probably feel a fierce burning in your shoulders and a tight neck. Maybe even a slight numbness travels down your arms, hands, and fingers. I will also suggest some solutions, so keep pedalling and read on.
You are putting yourself in an awkward position
Walking upright on two legs is a defining feature that makes us human. Cyclists ride in a hunched-over position that is more chimp-like and is not pain-free by any means. However, several anthropologists attribute many of our aches and pains to walking upright.
Unfortunately, if you love to cycle, you will find yourself in that position. 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 turned like this is called cervical hyper-extension in professional terms. A prolonged hyper-extension of the neck can lead to chronic discomfort and pain.
What is the news on the pain in my neck?
It 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 happens when the neck is bent upward for a prolonged period. When a muscle has a sustained contraction for an extended period, blood circulation into that muscle becomes compromised. The muscle contraction puts pressure on the blood vessels where the arterioles and capillaries are squeezing themselves shut, thus reducing blood supply. We will also review ways to combat the problem (or avoid the situation in the first place).
Muscles are asked to perform a regular workload without adequate oxygen and nutrients. When the muscles in our upper back and neck are contracted for lengthy periods, the blood circulation in this area is significantly reduced. It typically will lead to painful muscle spasms and trigger points. It is not a problem when a muscle alternates between contracting and relaxing, such as the muscles in the leg do when a cyclist is pedalling.
Millions of microscopic units must contract your muscles to make the slightest movements. The part of a muscle fibre that performs the contracting is a tiny unit called a sarcomere. Contraction occurs in a sarcomere when its two elements merge and interlock like fingers. A trigger point exists when over-stimulated sarcomeres are chemically prevented from releasing from their linked 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 make for merry rides
It is crucial to describe trigger points and their origin. When you have a good understanding of the problem, 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 patients mostly forget the movements and stretches or are never used 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 related muscle injuries. In addition to stretching the neck and upper back muscles, you can vastly benefit from two exercises: reverse shoulder shrugs and elbow presses.
It is vital to do reverse shoulder shrugs (shrugging down and back) rather than regular forward shoulder shrugs. Reverse shoulder shrugs are great because they make the neck and upper back muscles alternate between full contraction and complete 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 because forward shoulder shrugs make the back hunch forward into that chimp-like posture you try to avoid. Being hunched forward prevents the upper back muscles from contracting enough to accomplish the desired "contract, relax, contract, relax" movement pattern. When doing this exercise correctly, I have my chest sticking up and forward like the proudest of Marines.
Doing this exercise regularly and adequately will pump the muscles in the upper back and neck. Cyclists will notice a positive difference within a few times of performing the exercise.
Elbow presses are also an excellent blood-pumping exercise that nourishes the upper back with an optimal blood supply. It helps battle the sustained sub-maximal contraction that cinches down on the muscle's small arteries, which occurs with long bike rides. To perform elbow presses:
Another common problem 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, contributes 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 muscle tightness or spasms 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. Get to a local bike shop, whether you are an experienced rider or a novice. 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. It creates the need to bend the neck further up. If this is the case, a few common-sense changes can be made. You can raise the handlebars so that you are riding more upright. Also, ensure that your 'virtual top tube' length is not too long. While getting a shorter top tube is not practical, since you would need a new frame, you can shorten the reach by getting a shorter stem. Make sure you do not go much below 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 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, this is a moot point.
Another equipment consideration is the helmet. Proper placement of the helmet is essential. Road bikers typically do not have visors on their helmets because it necessitates bending the neck too far up to see ahead. Also, having the helmet too far forward causes neck problems. Again, the rider must turn 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 bikes, and we must be diligent in 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 significantly 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 and relaxed and ensure 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 as the bike jersey, indoor bicycle trainers, indoor cycling shoes, and bicycle clothing on his website, Cycling-Review.com.