Neck pain in road cyclists - Why and what can you do?

To tie in with the Tour of Britain coming through Tiverton today I thought I would write a post about a topic I know well; neck pain in cyclists. This happened to be the topic of my Masters thesis and it felt like it consumed my life for a year. For those interested in the study itself the abstract is in the box below and i'm more than happy to email it to people if the wish. In Lehman’s terms my research measured the movement of the base of the neck (cervico-thoracic junction) in road cyclists and compared this to normal movement. It then looked at those cyclists with and without neck pain. Due to one anomaly in my small sample of people, one finding (increased mobility leading to increase neck pain) was the opposite of what I had expected and is the opposite of what I see in clinic pretty much every day!

What is more relevant to cyclists, and most readers of this blog, isn’t the study itself but the research and reading around the topic that I did and how I have developed treatment and management of cyclists in the years since….

What causes neck pain in cyclist?

The most common structures involved in neck pain for cyclists I see is either the facet joints at the back of the spine which get compressed or the levator scapulae muscle that runs from the neck to the top of the shoulder blade.

The cause of the pain in cyclists can be due to any number of things but the most common are as follows. It is worth noting that it is normally a combination of a couple of these factors:

• Neck hyperextension

• Vibration from the road transferring from the bike into the arms and meeting centrally at the base of the neck.

• Looking over your shoulder for traffic

What can be done about it?

If we look at those three main causes of pain then you can only really do something about the first two.

To limit vibrations you can double up on handle bar tape and make sure you wear cycling gloves. It is also important not to ‘lock-out’ your elbows when cycling so that your elbows act as shock absorbers.

The main point to talk about is the hyperextension as I feel this is the major cause of pain, and can cause issues in both the facet joints and the musculature, in particular the Levator Scapulae muscles.

If you look at the angle of the back compared to the angle of the neck, riding a bike puts the neck in a similar position to walking along looking up at the sky. Now, obviously this is not the same, as gravity plays its part, and with arms to support you, being on a bike is a much more comfortable position, but you can see how it can irritate your neck.

Increased extension can be caused by over-reaching for the handlebars, having the seat to high (or the handlebars too low) leading to a more aggressive riding position but a sharper angle at the base of the neck.

A good bike fit is key to riding pain free and getting the correct frame size that fits you is a big part of this before you even consider seat height and reach. If you feel this might be causing you neck pain try riding in a less aerodynamic position for a couple of weeks, get going with some exercises or treatment (ideally both) and then gradually change your position back to the one you want to be in whilst maintaining the exercises.

Top Tips to get rid of neck pain/avoid neck pain

• Change your hand position on the handlebars regularly during a ride

• Keep your elbows slightly bent

• Double up on handlebar tape and wear gloves

• Get a good bike fit and make sure your bike is the right size

• Raise your handlebars or shorten your reach (only in the short term)

• Regular stretches before and after exercise

• Seek medical treatment

Stretches to try

None of these stretches should be painful so if they are don’t do them. If you are not sure please consult a professional first.

Cat stretches to keep the mid and upper back mobile

Chin tucks (really attractive) to open out the facet joints

Levator scapulae stretch (gently pull head towards the opposite knee)

Trigger point tennis ball work against a wall (this may hurt a bit but that’s okay)

If these stretches don’t help or clear it completely you may need some treatment. This tends to be very affective quite quickly so it’s worth a thought.

I hope you have enjoyed the read and that you can take something from it. What a summer of cycling, don’t let injury set you back over the winter! Look out for my posts in the future as I will be doing a blog on general stretches cyclists should do after a ride to avoid injury.