Spine pain affects many people – it is one of the main reasons people come into the clinic. In a lifetime, 65% of people will develop neck pain and 25% of health care costs are related to low back pain.¹ ² Because these diagnoses respond episodically, meaning they come and go, a lot of people start to improve and, therefore, wait to see a medical professional.²
The problem is that people typically fall back into a flare up shortly after symptoms improve (no pun intended). This course of ups and downs can continue on for months, or even years. When I evaluate someone for pain in the lower back (lumbar region), mid back (thoracic region), or neck (cervical region) I base a lot on how people move (or have a lack thereof). The neck moves in more planes than the low back or mid back because it does not have as much responsibility to provide stability. Picture a see-saw: balances stability on one side with mobility on the other. On the contrary, our lower back is responsible for a greater deal of stability. Therefore, when I look at people’s response to movement, I expect different things in different areas.
Let’s start from the top and work our way down
The cervical spine has a variety of different joints that move in certain ways, depending on how you move your neck. I see a lot of problems in adolescents because they are typically on their phones more and have poor posture. That’s not to say that adults aren’t guilty of that, but typically it’s more teenagers. They also respond to treatment faster. There is another population that is at risk of this…yep, it’s cyclists!
The joints in our spine crave variability. Because cyclists have their head positioned in a protruded or forward head position for long durations of time, it places the neck at increased risk for joint problems . These can present themselves in a variety of ways, including shoulder pain (47.6%), elbow pain (44%), and wrist/hand pain (38.5%).³ Symptoms can include pain, numbness, tingling, decreased range of motion, as well as decreased strength in any of these areas.
The best way to determine if you’re experiencing these issues is a thorough history and examination, since not everyone responds the same. Additionally, here are some tips and a series of exercises to help to fix and/or prevent these symptoms..
Start with a brief screen of your neck. This includes range of motion and any perception of feeling other than a general stretch sensation. Each movement should be done as far as possible. Make sure to assess how you’re feeling during and at the end of the range of motion.
Chin to chest; look down.
This is sometimes called lateral flexion. Bring your ear towards each side (without moving your shoulder up). Make sure to do on both the left and right sides.
Turn and look over each shoulder. Take note what the furthest thing you can see is.
Poke your head forward, like a turtle coming out of its shell.
Pull chin back like you smelled something bad.
One thing to be aware of is the phenomenon of centralization. Centralization is the movement of your symptoms to their origin. If centralization occurs as you exercise, that is a good sign! It means you’ve found the correct exercise. Let’s think about it like this, if you have 100 units of pain spread from your neck to your hands, it might look something like this:
As long as the units are moving out of the area furthest from your spine, it is okay. This would be an example of a good change and a green light to continue.
The pain may increase in the spine and that’s okay, it will diminish and go away from that point
If these feel abnormal, try the following exercises. If you are noticing that you are getting worse, please reach out to me and I will be happy to help you further.
This exercise is a good place to start for prevention of symptoms. It can help counteract the position you are in during long bouts of cycling. Retract strain or pain is okay during the exercise as long as it is not worse when you are done (has to be either better or the same). Hold each repetition for 2 seconds and return to resting position. Complete 10 reps. Reassess neck movements.
If you are not worse or better, complete the same movement as exercise 1, but push your chin inward a little bit. This is called overpressure. It helps to keep your teeth closed so you aren't pushing back on your jaw. Follow the same assessment during the exercise.
If you remain no different- Retract neck and roll your head upwards into extension. Hold 2 seconds. Repeat 10 times, just as in exercises 1 and 2. Remember pain during the exercise is okay, but it shouldn’t get worse as you continue to exercise.
There are many exercises, positions and strategies to address neck pain and not all people are the same. Remember that I would be happy to help out further if these do not work.
What are some things that mean I can keep going?
When should I stop?
The lumbar spine or lower back is similar in nature to the neck and can be screened the same way – by measuring the range of motion. There are four main movements that come from the low back.
Bend forward to touch your toes.
Cross arms across chest in a standing position. Slide just your hips from the right to left.
If any of these movements produce stiffness or pain, begin with the exercise progression below. Compare the side glide to the right and left in terms of equality (do they feel the same when you go one way versus the other?). It is not uncommon to have low back pain for no apparent reason. We bend forward 3,500 to 5,000 times per day, but only achieve full extension less than 300 times per day. This creates a big mismatch in the way we move, and can lead to joint problems. In cyclists, that number can be even higher due to the nature of your positioning as you ride, especially in spin class. This means that you need to balance your movements throughout the day a little better .⁵ ⁶ ⁷
The same rules for centralization apply here, as well. Symptoms must move closer to the back as you exercise. Symptoms in the low back can also present as symptoms in the hips (71%), knees (25.6%), and foot/ankle (29.2%). In the same study by Rosedale and colleagues, they found that 45% of osteoarthritic knees were actually symptoms coming from the low back!³
Stand straight with feet shoulder width apart. Place hands on low back and lean backwards as far as you can, without losing your balance. Hold 2 seconds and return to upright. Repeat 10 times. Remember strain or discomfort is okay at the end of the range.
If Exercise 1 does not improve symptoms, attempt Exercise 2. Laying on your stomach, extend your arms while keeping your hips on the table. Try to extend your arms all the way so your elbows are straight. Hold 2 seconds and return to starting position. Repeat 10 times.
If Exercise 2 does not improve your symptoms, attempt Exercise 3. Prop on your elbows as if you were reading a book. It is okay to use pillows under your chest. I also recommend using the armrest of a couch to achieve a bend in your back. Build up pillows or surface under chest until strain is felt in the low back. Hold 3 minutes. Recheck motion in your back.
What are some things that mean I can keep going?
When should I stop?
In conclusion, I hope these exercises prove to be helpful in reducing any pain you may be feeling. Additionally, I am including my personal correspondence below for a resource. I am available through Facebook and via email to offer my expertise.
Your on the road PT,
Please remember that the following information is a general recommendation based on typical movements of cyclists and the most frequently used exercise to reduce symptoms in both the neck and low back. If you have any concerns, please reach out to me directly or follow up with a licensed provider to evaluate your symptoms.