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Team Interviews | 22.04.2022

Neck pain in cycling

When jumping back on the bike after the winter break, there are probably three areas that will have caused problems for just about every rider at some point: the neck, back and knees. So here’s a quick guide from Dr. Christopher Edler on how amateur and hobby cyclists can try to avoid neck pain. 


Chriss, how common is neck pain in cycling?

We can assume that about half of all cyclists suffer from neck pain on a regular or recurring basis. However, the intensity varies significantly. For some, it’s just unpleasant, but for others it’s actually painful, which is why training breaks must be taken or rides even interrupted.


Does this also apply to professionals?

Professionals can also have problems with the neck, but usually less so than amateurs. As far as the neck area is concerned, it often has to do with habituation and routine or the long-term adaptation of the postural muscles. In principle, the professionals ride and train all year round, which means that, in the best case scenario, the neck muscles are used evenly throughout the entire year. If you take longer breaks, such as over the winter, the strength of the neck muscles quickly decreases again if they are not exercised, which leads to neck pain as soon as you get back on the saddle in the spring. Neck muscles are used differently on the bike than in our everyday upright posture, so they are weakened if they’re not used. Professionals are likely to experience neck pain more often on a time trial bike because in this position, the cervical spine and surrounding muscles are put under even greater strain. This is because the smaller the angle between the thoracic and cervical spine, the greater the strain on the vertebral joints and intervertebral discs. Therefore, problems occur more easily in the aero position on the time trial bike. 


How can we think about that exactly?

Since the head is aerodynamically very important, the optimal head position is also trained accordingly. However, this is usually quite an unfavourable position as far as strain on the muscles is concerned. You have to pull your head between your shoulders, bring your cervical spine forward and then recline your head, in other words, tilt it backwards. This is a very unnatural posture and leads to increased tension and the unnatural distribution of pressure in the spine. 


If there are problems in the neck area, how do they arise?

It makes no difference whether you are a professional or an amateur rider. Normally the head is straight above the spine, and in this position, little holding work is required from the muscles. The head only has to be moved in different directions. On the bike, however, the head is in front of the torso - seen from the side - and the carrying of the head is mainly transferred from the passive, bony structure of the spine to the active structure of the muscles. So that’s then called upon more and also in a different way. Actually, small muscles in the neck generally stabilise the head in its natural movement, but in this position on the bike, the shoulder muscles with the trapezius and shoulder blade lifter enter into a support role which also has to help pull the head back. Even a few minutes in this position will cause tension in the untrained. 


Are there other causes of neck problems?

If the problems are muscular, then you can address this relatively quickly with massage and physiotherapy. Here we also have strong support from the therapists in the team who are familiar with movement patterns and treat the riders. If the muscles are strengthened accordingly, the problems rarely come back, unless the seating position is changed. However, neck problems can also be caused by the structure of the spine. So it doesn't necessarily mean that cycling is the cause, but rather that these "signs of wear and tear" only become symptomatic in the position on the bike in the first place. The vertebral bodies are connected to each other via small joints. Arthrosis can develop at these facet joints. If this is the case, you will probably feel a more localised pain that occurs mainly at the beginning of training and may improve as you progress.

If, however, the intervertebral discs of the cervical spine are affected, there is usually not only localised pain in the neck area, but often also pain that radiates into the arms and hands. Either the pain travels via the spinal nerves and the brachial plexus to the upper extremities, or you have a tingling or numb feeling. If this sensation in the arms and hands persists for a long time and does not go away quickly after exercise, you should see a doctor to assess the extent of the herniated disc in the cervical spine. 


Treatments are probably also more difficult in these cases, right?

In general, conservative therapy is definitely the first option for the problems mentioned - unless the doctor decides on the basis of often imaging diagnostics to do otherwise and there is a structural injury that must be addressed surgically. However, this is rather rare with the problems we’re talking about here. Conservative therapy in this case means above all, physiotherapy to strengthen the strained muscles. But there are also other things you can do, such as improving riding comfort. Examples of this are using wider tyres that you can ride with less tyre pressure, which improves damping, padded cycling gloves or thicker handlebar tape. 

I would advise against taking painkillers in this case, at least in the course of the sporting activity. If the neck problem cannot be controlled by strengthening exercises and physiotherapy, you should consult a doctor and find a solution to the problem together with him or her.  


Let's move from causes to prevention. How can neck problems be prevented?

As already mentioned, the sitting position is crucial. As a hobby athlete, you should not necessarily take the professionals as a guide. Aerodynamics are becoming more and more important in professional sport and seating positions are therefore correspondingly more aggressive. But professionals train a lot, not only on the bike, but also in general athletics, which is also becoming more important for us. As an amateur, you should adopt a position that is a little more upright so that the angle between the cervical and thoracic spine is not too small. Basically, however, the main thing is to improve your posture in general by strengthening your muscles in general - even away from the bike. 


Why is the targeted strengthening of the neck muscles so important?

In everyday life we tend to neglect our back muscles, including the neck. In most everyday postures, we are bent forward with our eyes down, our upper back rounded and our shoulders slumped forward - a typical posture when sitting at a desk or when driving. This shortens the muscles in the chest area and weakens them in the back and neck area. This can lead to tension, which is often already noticeable in everyday life. If the back muscles are put under particular strain during sport, this can quickly lead to overstraining. If you consciously counteract this posture with balancing exercises and strength training, the risk of tension and pain also reduces.


What exercises or types of training can you recommend?

As already mentioned, strength training in the area of the neck muscles - and there especially the stabilisers of the cervical spine, specifically the erector spinae, the multifidiae and the small muscles that move the head - is recommended. Beyond this base, the larger muscle groups such as the trapezius and rhomboids as well as the rotator cuff and also the posterior shoulder muscles should also be strengthened. Ideally, you should have your deficits identified by a sports physician or physiotherapist and then address them using specific exercises. In addition, mobilisation and stretching exercises are also very helpful to maintain mobility and flexibility.


BORA – hansgrohe´s athletic training partner Corox by Hansi Friedl provides you with a set of exercises to prevent neck pain:


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