Cycling – a pain in the neck, back and bottom – Part One

Cycling – a pain in the neck, back and bottom – Part One

In his next blog John Phelan highlights all the common aches and pains experienced by cyclists and how we can correct them. “Now this is my thing. Over the past 4 years, I’ve put a lot of eggs into the bike basket when it comes to the continual professional development of my physiotherapy career. In this blog, I’d like to put down on paper some of what I’ve learned.

Cycling is supposed to be a carefree and enjoyable experience, yet people knock on my clinic door with a list of complaints as long as your crank arm. Here’s a list of just a few:

  • Tension between my shoulder blades
  • Low back ache after 2 hours cycling
  • Numbness in my left hand
  • Pain to the outside of my ankle
  • Numbness to my nether regions after 40mins
  • Pain on the inside of my knee
  • Pressure and pain in and around the right sitting bone area
  • I could go on!

I hear enough stuff to write 3 to the power of 3 blogs, but I’ll start with this two-part piece. And I’ll start with this sentence; cycling is and should be a carefree and enjoyable experience. There is a reason for each of the above symptoms and for every painful experience on the bike. You just need to be able to see the wood from the trees in order to sniff out the problem and correct it.

Neck pain: A really common area of discomfort when cycling is the neck and top of the shoulder area. This is mostly because of a “poking chin” posture on the bike. The other common reason for neck and shoulder tension on the bike is when not enough pressure/force is going through the pelvis onto the saddle, meaning too much pressure is going through the arms. Let’s look at both of these in more detail.

Neck pain secondary to “poking chin” posture

It is very easy to see in this pre-bike fit picture why this client, GD, complained of neck pain. (Plus low back and knee pain!) He has a significantly rounded upper back posture, so once he lifts his head to see up the road, he will adopt the “poking chin” posture, which can be irritable on the joints in the neck, causing discomfort. We will get to the reasons for his low back ache in the next section, but worth noting here is the sub-optimal knee angle. Research tells us that the knee angle should be somewhere between 138-142 degrees when in the 6pm pedal position.

Judging from this, we now know that the saddle height is too low. We also know that a knee which is too bent/flexed at 6pm will also be too flexed at 12pm, and this will cause increased forces to the knee cap when pushing the foot over the top of the pedal stroke. This can cause knee pain when cycling. By increasing the saddle height, we can improve the knee angle, and also give more space for GD to lengthen his spine and address his “poking chin” posture.

What we did: By increasing the saddle height by 1cm, we have brought GD’s knee angle closer to the optimal range. The reason we didn’t go higher with the saddle, is because GD’s left hamstring needed more work on lengthening it, to allow for the higher saddle height. He was advised to increase the saddle height by 0.5cm in 3 months after the bike fit.

We inverted his stem (the thing connecting the handlebars to the bike) to help increase the torso angle and allow a flatter upper back posture. He could now look ahead without jarring his neck.

Can you see how GD’s low back is less bent in the 2nd picture compared to the 1st? We know that the most common reason for low back ache in cyclists is because of an overly flexed low back when on the bike. By increasing the saddle height, we effectively increased the distance from the saddle to the handlebars allowing GD more room on the bike. This meant he could flatten his lower back a little more and avoid that banana shaped posture.

What you can do: To get your saddle height in a reasonably optimal position, here’s what you do. Rest your bike against the wall, climb aboard and place your left heel on the pedal and bring the pedal into the 6pm position. Your left knee should be pretty straight but your pelvis should not be leaning over to the left side, it should be comfortably positioned on the saddle. Adjust your saddle height to allow this to happen.

In the next blog we will dive into the bottomless pool of saddle symptoms and explain how and why they occur.”

John Phelan runs a clinic in Cork by the name of Life Fit Physio. He also goes under the alias of The BikeFit Physio, specialising in physio-led bike fitting.

More info at www.lifefitphysio.ie and www.thebikefitphysio.com