The 3 most common bike related injuries – Neck Pain

The final chapter – part three

In the final part of this blog series we are going to talk neck pain.

When all the power is being exerted through the legs, why, as a cyclist, would you experience neck pain? Let’s start with anatomy.

Attaching to the base of the skull, into the shoulders and down into the lower part of the spine, is the trapezius muscle (pictured below) which often causes a lot of discomfort for cyclists, but why?

In 1979 Dr Janda, a Czech physician, divided muscles into two groups; tonic and phasic muscles. The idea being that phasic muscles typically work eccentrically against gravity and are prone to becoming weak and inhibited by pain, stress, positioning, whereas tonic muscles are prone to becoming shortened and tight. An imbalance between these tonic and phasic muscles can lead to pain and instability in the body. Janda went on the classify certain predictable patterns of muscle imbalance. The ‘upper cross syndrome’ is an example of when tonic and phasic muscles become imbalanced with the facilitation of the levator scapula, upper fibres of trapezius, sternocleidomastoid and pectoral muscles and the inhibition of the deep neck flexors, serratus anterior and lower fibres of trapezius. These imbalances often lead to rounded shoulders and a forward head posture resulting in neck pain and often associated headaches.

So why do so many of us get into this pattern?

Again, it’s a multifactorial picture and accounts for a lot more than just what’s happening when you cycle. What we do with the rest of our day when we are not cycling has a huge impact on our mechanics when we get on the bike. Those with desk-based jobs are more prone to developing this type of postural pattern and with the rise of technology, we spend more of our time looking down at our phones or typing on laptops. After 8-10 hours of working in a poor desk-based posture, many will then get onto their bikes which can exacerbate the shortening of the tonic muscles including the upper fibres of the trapezius and the lengthening and weakening of the phasic muscles such as the lower fibres of the trapezius. No wonder so many of us suffer from neck pain. So, what can you do to prevent developing this posture and self-treat accordingly?

Prevention and self-care

Stretch and strengthen (Brugger exercise)
Stretch out those tonic muscles and strengthen those phasic muscles!
Stretches:

Pectoral stretch

Upper trapezius and levator scapula stretch

Suboccipital stretch

Latissimus dorsi stretch

Stengthening:

During your working day this simple stretch and strengthen routine can really help to open up the chest and exercise the back. It’s named the Brugger Exercise and is shown in the video below here.

TheraBand pull backs for the lower trapezius and rhomboids (remember to squeeze the shoulder blades together at end range)

Thoracic mobility and foam rolling

Often the trapezius and erector spinae muscles that run up the back can become tense if the joints in the back don’t move to their optimum range. In the cycling position, the thoracic spine (mid back) is often locked in a flexed position and this can cause stress and fatigue on the muscles running up into the neck. This is then exacerbated if someone also has a desk job where, for the most of their day, they remain relatively immobile in the thoracic spine. Below is attached a video from British cycling used in the previous blog to demonstrate some ways to mobilise your upper back. Running a foam roller up and down the mid back can also help to open up the chest and mobilise the thoracic spine.

Mobility Video here.

Ergonomics and desk position

Make sure if you are desked based that you have had an ergonomics check, it could just be a bad chair or desk position causing your neck pain! Try to take regular breaks from the desk position, even just rolling your shoulder backwards regularly can help keep muscles looser. If you find this hard to remember just put a post-it note on your laptop or a reminder on your phone to keep moving.

Bike fitting

Bike fit errors can cause issues with the neck, for example having a reach too long or a handlebar position too low can force your neck into extension and lead to irritation of the joints in your lower neck. If you haven’t already it may be worth looking into a bike fit, very small adjustments can make a huge impact on the body when cycling.

Osteopathy. How can we help?

As Osteopaths we are very good at taking a global approach to treatment. We won’t just look at your neck pain, but we will look at it in relation to the rest of your body. Look at any muscle imbalances that may exist between the tonic and phasic muscles, look at your spinal mobility whilst taking into consideration all the factors above that may be linking into the persistence of your neck pain. We are also very good at tailor making home care advice to suit the individual requirements from what has been flagged up in the consultation/treatment. Thinking about sorting out that neck pain that has been bothering you? Find osteopathy at The Good Health Centre Leeds, why wait?

Brit Tate (Osteopath at The Good Health Centre Leeds. Ex-cyclist now triathlete.)

The 3 most common bike related injuries – Back Pain

Part Two

In part one we spoke about knee pain; today is about lower back pain.

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Anyone out there a cyclist who has had or is currently suffering with lower back pain?

Well don’t worry you are not the only one! An interesting piece of research conducted by Norwegian scientists found 94% of the 116 professional road cyclists they investigated had suffered an overuse injury during the previous year, 45% of those injuries being lower back pain. This as actually more than those suffering with knee pain which came out at 23% of all overuse injuries during that period. So, with cycling being a low impact sport why do we have so many problems with our lower backs?

Now it must be noted, like we said in part one, that injury is multifactorial. Lower back pain can stem from factors such as poor technique, poor bike fit, lack of conditioning for the back, glutes and tummy muscles, lack of mobility in areas of the spine or most likely a combination of a few of these. Having your stem too long or having your saddle to handlebar drop too large can increase the chance of developing lower back pain. However, what is interesting, a study investigating the percentage of professional cyclists suffering from lower back pain showed, although the cyclists had access to advanced facilities, including bike geometry set up’s, a percentage still suffered or had suffered with lower back pain. So, can we blame it all on the bike? Let’s look at some of the other factors, how they may prevent lower back pain and how-to self-treat accordingly.

Technique – Cyclists can often overpull with the back and arms rather than power through the glutes. Make sure your switching on your glutes rather than pulling into your back when your cycling, particularly when cycling up hill. You can practise this by squeezing your glutes as you push down and pull up on the pedals.

Conditioning – Often the reason cyclists’ power more through their back rather than through their glutes is that the muscles in the glutes are poorly conditioned therefore the strain is distributed into the lower back. Or it may be that the glutes are firing but it’s the tummy muscles that aren’t engaging to support the lower back or just that the deep lower back stabilising muscles are not conditioned enough to cope with the load being place upon them. Below is a link to some simple exercises, recommended in cycling weekly, that are great for strengthening the lower back, glutes, core and hamstrings to build tolerance to load.

Mobility and stretching– Sometimes lower back pain may not be due to strength issues but rather mobility issues. Restrictions higher up in the thoracic spine can place excess load into the lumbar spine causing a build-up of compression in the lower back. Restrictions in the lower back itself can cause a build-up of tension in the muscles of the lower back causing pain and discomfort. It is important for the whole spine to move freely and to be balance with the rest of the body. Stretching is also important, particularly the hip flexors. The hip flexors include the tensor fascia late and the iliopsoas which are often very tight in cyclists due to the position on the bike. Tight hip flexors can pull into the back creating more tension in the joints and muscles. Stretching the glutes is also important as they attached into the joints in the back so the more flexible these are the better your spinal mobility will be. Below are some links to British Cycling spinal mobility videos which are a great way to keep the spine mobile and also a picture of how to stretch the hip flexors and glutes.

Upper body mobilisation routine here.

Hip Flexors:

Glute stretch:

What we do the rest of our day – it’s important to remember we might spend 1-3 hours on a bike a couple of times a week but there are 168 hours in a week. So, what we do with the rest of our time has a big part to play with our physical well-being when cycling. Think POSTURE. At work, if you are desk based, make sure you have had an ergonomic check on your chair, your back pain might just be down to a bad chair at work! Make sure your getting enough sleep, lack of sleep can affect the ability of the body to heal and repair tissues. Think WATER and FOOD – what are you eating, how much are you drinking? Check these areas and you may find some areas of deficit that may be affecting your body’s ability to recover from training sessions and repair damaged tissues.

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Osteopathy – How can we help? Well as Osteopaths we are very good at taking a global approach to treatment. We will not just look at your back pain, but we will look at it in relation to the rest of your body. Look at any muscle imbalances that may exist, look at your biomechanics, look at your mobility whilst taking into consideration all the factors above that may be affecting your ability to heal. We are also very good at tailor making home care advice to suit the individual requirements from what has been flagged up in the consultation/treatment. Thinking about sorting out that lower back pain that has been bothering you? Find osteopathy at the Good Health Centre Leeds, why wait – book in to see myself or one of my fellow practitioners.

Brit Tate (Osteopath at The Good Health Centre Leeds. Ex-cyclist now triathlete.)

The 3 most common bike related injuries – Knee Pain

Part one

Are you a cyclist?

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Do you have neck pain? Lower back pain? Knee pain?

These are the 3 most common complaints that cyclists bring into our clinic. But why?
With the UCI Road World Championships coming to our doorstep in just less than 2 weeks time many of us keen cyclists will be eager to get out on our bikes and enjoy the last of the summer sunshine whilst being able to spectate one of the most prestigious events on the cycling calendar. But worried about being in pain when you get on your bike? Maybe time to shed some light on these common areas of complaint.

There will be 3 parts to this blog. Part one; knee pain.

Pain is usually felt at the front of the knee and above, below or medial to the kneecap. So let’s talk anatomy. Below is a picture of the muscles attaching to and around the knee joint.

The most predominant muscle group being the quadriceps. As the name suggests by ‘quad’ meaning four, there are four muscles within this group that powerfully drive the knee into extension. We use this muscle group to power us up hills and drive us along the flat. This muscle group is one of the main culprits behind most cyclists with knee pain. But just because it’s the culprit doesn’t mean it’s all to blame. Many factors link to the quadriceps becoming an issue for cyclists. It can be due to the muscle group being too strong, being partly weak, poor technique on the bike, a poor bike fit or biomechanical issues above or below the knees that load the quadriceps and the knee joint itself. This blog could be turned into a 5000-word essay but let’s try to keep it simple and to the information you want to know: how to prevent it becoming an issue and what to try to do if your experiencing knee pain. Although prevention and treatment do overlap in a lot of ways, I have tried to split these into two categories to make it a little clearer.

Prevention

  • Make sure you have had a bike fit – saddle too high usually leads to posterior knee pain due to overstretching of the hamstrings, too low you load up the knee joints and shorten through the quadriceps. Issues with cleat positions often cause issue with the knees as well.
  • Strength and conditioning – Quadriceps are often over-dominant, strengthen your back, glutes, hamstrings as these are lengthened in a bike position and often get a bit lazy leaving all the work to power your bike to your quadriceps, then hey presto…knee pain!
  • Stretching – Cyclists (myself being one of them) are notoriously bad at stretching! We tend to ride, café stop, get back on the bike ride home then get on with the rest our day. Stretching the quadriceps, glutes, hamstrings, calves, lower back regularly can have a profound effect upon the maintenance of knee pain.

Self-treating

  • Ice!- Often the knee joint or the tendons/muscles around the joint have become inflamed when your experiencing pain in the knees, ice is a great way to calm down any inflammation and help aid the healing and recovery of the effected tissues
  • Foam rolling – Foam rolling the front of the quadriceps can lengthen through these tissues and ease the pressure they exert onto the knee joint.
  • Cadence, gearing and terrain – Most cyclists will not want to stop and rest whilst suffering with knee pain, so if your one of these people who doesn’t like to rest why not alter the gearing and cadence to off load the joints. Make the gearing lighter and spin the cadence higher and keep to the flat. This will take some load out of the muscles and joints and give more emphasis onto your cardiovascular system; you will feel like you’ve had a great workout without the detriment to your knees.

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Osteopathy – So where does this come in? Well, all the information above is useful but it’s very generic and is a worth a go if you are looking to prevent any knee issues or to ease your knee pain at home but it important to really understand what the root cause of the pain is. Osteopaths will take the whole body into consideration. Whilst it might be your knees causing the problem it may actually be coming for your back, for example. Or it maybe not be a muscle issue but more of a joint and cartilage issue. In an Osteopathic consult we will take into consideration all the factors above and tailor make home care advice to the individual in order to specifically target your requirements. We will also provide hands on treatment to help off load muscles and joints under stress and rebalance the body. So why wait any longer? Inspired by the professional cyclists at the UCI World Road Race Championships who often seek regular medical advice to combat bike related injuries, why not seek some help yourself?

Contact the Good Health Centre in Leeds for more information regarding Osteopathy and injury prevention and management.

Thanks for reading, if you enjoyed part one, part two will be on lower back pain.
Brit Tate (Osteopath at the Good Health Centre Leeds. Ex cyclist now turned triathlete).