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 Breakdown
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.
The Neck
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.
Flexion
Chin to chest; look down
Extension
Look up.
Side Bending
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.
Rotation Right and Left
Turn and look over each shoulder. Take note what the furthest thing you can see is.
Protusion
Poke your head forward, like a turtle coming out of its shell.
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:
- Neck: 60 units
- Shoulder: 20 units
- Elbow: 10 units
- Hand: 10 units
Rotation Right and Left
Pull chin back like you smelled something bad.
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.
- Neck: 70 units
- Shoulder: 25 units
- Elbow: 5 units
- Hand: no pain
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.
Exercise 1
Retraction in a Seated Position
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.
Exercise 2
Retraction in a Seated Position with Overpressure
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.
Exercise 3
Repeated Retraction with Extension
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.
To summarize
Symptoms:
- Numbness
- Tingling
- Pain in the neck, shoulder blade, arms, and/or hands
- Loss of motion
- Loss of strength
- Headaches
- Dizziness
Exercises:
- Retraction
- Retraction with overpressure
- Retraction with extension
What are some things that mean I can keep going?
- Symptoms move closer to your neck (pain in any part of the arms decreases or goes away)
- Pain decreases
- Range of motion increases
- Strength increases
- Symptoms go from numb to pain
When should I stop?
- Symptoms increase
- Pain moves away from your neck
- Range of motion decreases
- Symptoms go from pain to numb
The Back
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.
Flexion
Bend forward to touch your toes.
Extension
Bend backwards.
Side Glide
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
Exercise 1
Repeated Extension in Standing Position
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.
Exercise 2
Repeated Extension in Lying Position
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.
Exercise 3
Prone Lying in Extension
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.
To summarize:
Symptoms:
- Numbness
- Tingling
- Pain in low back, legs, and/or feet
- Sciatica
- Loss of motion
- Loss of strength
Exercises:
- Repeated extension in standing (x10)
- Repeated extension in lying (x10)
- Prone lying in extension (x3 minutes)
What are some things that mean I can keep going?
- Symptoms move closer to your back (pain in any part of the legs decreases or goes away)
- Pain decreases in your low back or in any part of your legs/feet
- Range of motion increases
- Strength increases
- Symptoms go from numb to pain
When should I stop?
- Symptoms increase
- Pain moves away from your back
- Range of motion decreases
- Symptoms go from pain to numb
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,
Easton
Email me at osbornphysicaltherapy@gmail.com
Find me on Facebook here
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.
References
- Cerezo-Téllez E, Torres-Lacomba M, Mayoral-Del-Moral O, Pacheco-da-Costa S, Prieto-Merino D, Sánchez-Sánchez B. Health related quality of life improvement in chronic non-specific neck pain: secondary analysis from a single blinded, randomized clinical trial. Health And Quality Of Life Outcomes. 2018;16(1):207. doi:10.1186/s12955-018-1032-6.
- Frogner B,Harwood K,Andrilla C, Schwartz M, Pines J. Physical Therapy as the First Point of Care toTreat Low Back Pain: An Instrumental Variables Approach to Estimate Impact on Opioid Prescription, Health Care Utilization, and Cost. Health Serv Res 2018:53:6
- Rosedale R, Rastogi R, Kidd J, Lynch G, Supp G, Robbins S.A study exploring the prevalence of Extremity Pain of Spinal Source (EXPOSS), Journal of Manual & Manipulative Therapy, DOI: 10.1080/10669817.2019.1661706
- Treat Your Own Neck. New Zealand: Spinal Publications New Zealand Ltd: p34. Chapter 4
- Clare HA, Adams R, Maher CG. A systematic review of efficacy of McKenzie therapy for spinal pain. The Australian Journal Of Physiotherapy. 2004;50(4):209-216. https://search-ebscohost-com.ezproxy.daemen.edu/login.aspx?direct=true&AuthType=cookie,ip,uid&db=mnh&AN=15574109&site=ehost-live&scope=site.
- Edmond SL, Werneke MW, Young M, Grigsby D, McGill T, McClenahan B. Directional preference, cognitive behavioural interventions, and outcomes among patients with chronic low back pain. Physiotherapy Research International: The Journal For Researchers And Clinicians In Physical Therapy. 2019;24(3):e1773. doi:10.1002/pri.1773.
- Garcia AN, Costa L da CM, Hancock M, Costa LOP. Identifying Patients With Chronic Low Back Pain Who Respond Best to Mechanical Diagnosis and Therapy: Secondary Analysis of a Randomized Controlled Trial. Physical Therapy. 2016;96(5):623-630. doi:10.2522/ptj.20150295.
