Neck Pain with Cycling - Treatment Advice

Neck pain with Cycling

Ever since the Tour de France set foot in our fair isle (and Yorkshire in particular) in 2014 there has been a boom in cycling that has rolled on and on. During the coronavirus lockdown, bikes became as sought after as milk and toilet paper. The gyms had to close their doors, but people found the allure of traffic free roads and the enjoyment of nature was there to be enjoyed. And one of the best ways to experience this was on two wheels.

Cycling is a sport and pastime that can be easily enjoyed by many. It is relatively safe with a low risk of injury. That is not to say, there isn’t any risk at all. Aside from the obvious problems which may occur with taking a fall, neck pain in cycling is a common complaint.

The Problem

As humans, we are naturally built to be bipedal and stand, walk or run. Cycling is a foreign posture for our body to adopt. It changes our weight distribution and muscle activity through the entire body. Your hands and arms have to acclimatise to bearing some of this weight for sustained periods of time. If your muscles and joints aren’t used to this, and if your posture is incorrect then aches and pains can occur. If you have the incorrect position on your bike, this may force your neck to have to compensate and hyperextend (to allow you to look and see where you are going). If you don’t have the flexibility before you start, you may put overdue stress on your muscles and joints, which can result in pain. Commonly this can occur in the neck region.

The Cause

The idea of the ‘core muscles’ is fairly well known now. This describes the deep stabilising muscles of the body and is more commonly associated with the hip and pelvic region. A similar stabilisation process needs to occur in the neck and shoulder area. We have deep neck stabilisers and scapula stabilisers, which are important postural muscles here.

If you are not conditioned to regular cycling then your deep neck muscles may not have the strength and endurance to support your head for long periods of time. In this case other muscles, commonly the upper trapezius muscle (running from the base of your skull down to the top of your shoulder blade) may have to work harder, and can cause discomfort from overworking. The superficial muscles may become tight, uncomfortable and develop tender trigger points.

If you cycle on a bike that is not correctly fitted for you this can put extra strain on your neck muscles. Tension can also build up in this area if you tense up when riding over difficult terrain or when going faster than usual.  Poor technique can add to the problem, so if you are swaying more from the back and pelvis the upper body will compensate by bracing more than it should. A further risk factor comes from having a poor fitting helmet or an old one that is heavy and increases the muscle work in the neck and shoulder region.

Rehabilitation

If you experience neck pain during or after cycling we recommend a review of the areas identified above which may be leading to the problem. A discussion of these issues with a physiotherapist is a great place to start. We can identify areas of stiffness in the joints or regions of the muscles which are too tight or have trigger points causing the pain. Joint mobilisations, soft tissue massage, trigger point release and acupuncture can all be helpful in aiding your recovery. Home exercises, usually in the form of deep neck flexor strengthening and stretching are often beneficial. These are best prescribed after a discussion with your physiotherapist, as every individual is different, and can therefore require slightly different exercises to help.

Conditioning

You may benefit from a strengthening programme that focuses on the postural / stabilising muscles in the upper body. These include the middle and lower trapezius muscles and the serratus anterior muscle. Exercises using resistance bands, gym balls and TRX can all aid strength and improve upper body posture. If you have neck pain, then consulting with a physiotherapist is recommended to get the best exercises for you and to ensure you are doing them correctly. They can also discuss other areas which may have an impact as well, such as your ergonomics as you work or drive. Sometimes small changes to your workstation setup, driving position or daily tasks can make a big difference in neck posture and pain management.

A further consideration regarding conditioning is to give yourself time to get used to riding a bike, or to an increase in your mileage. As with many other sports and training, the increase should be incremental as a big jump in what you are used to can cause pain and discomfort.

Bike Set Up

A bike set up that leads to a poor posture is a common cause for discomfort when cycling. Take a look at your position on the bike (taking a photo is a good idea) to see if you are reaching too far forwards on the handlebars or if they are too low. If you are not sure, then consider a bike fitting to get the best position. These are offered at some bike retailers. A more upright posture may reduce the stress on your neck and shoulders as you will avoid overreaching. It’s also a good idea to sit up a bit taller for short periods while out cycling, especially if you are out for a long time. Check also to see if you have a poorly fitting helmet (which can restrict your visual field) or an older heavy helmet which puts more strain on the neck muscles. A decent quality lightweight helmet can make a significant difference.

The physiotherapy team at the clinic are always happy to offer an assessment and discussion around the subjects raised in this article. And if you are unable to make it to the clinic we can offer a video assessment as well.