Have neck and shoulder pain on the bike?

Have neck and shoulder pain on the bike?

You're not  alone.

Roughly 40% of my clients seeking a bike fit, have moderate to severe neck, upper back, and shoulder pain when they ride.

Some feel it at the base of their skull (and this can sometimes lead to head aches), others in the neck or in the muscles connecting the neck to the shoulder.

While there are many causes, there are often a number of small changes we can make to someone's bike fit to remedy this.  Of course, there are times when all the pain cannot be eliminated, like in the case of severe arthritis and other spinal disorders, and minimizing becomes the goal.  I would like to also note that bike fit changes aren't the answer alone, which I think I would make as a blanket statement for almost all problems on the bike, so corrective exercises are a very common component of my bike fits.

One of the best examples of how something small can cause a lot of trouble is a rider's wrist position on the bike.  Specifically, I'll address the road bike set-up with drop bars.  The culprit motion is called ulnar deviation.  Here's what ulnar deviation is:

Hold out your arm in front of you with your hand positioned like you're going to shake someone's hand.  If you move the wrist only and move your pinkie-side of your hand down toward the floor.

This is a very common hand position when the hoods are not positioned properly -- one common way is when they're set very low on the curve of the bar.

See how the lines drawn through the center of the forearm and hand deviate.

This is a relatively neutral wrist position

 More groundwork:  When our hands aren't attached to anything, this is called "Open Chain Position" for the upper extremity, when they are attached to something (the bars, the ground, whatever) it's called "Closed Chain Position".  So push-up position is closed chain for the arms.

So,

When we have to put our wrists into ulnar deviation in the open chain position, it's not a huge deal.  The hand is not attached to anything and we can bend our wrist.  The problem arises when we have to go into ulnar deviation when our hands are attached to the handlebars -- closed chain.

That's because Ulnar deviation + Closed Chain Position leads to Elbow Extension (straightening).

You can do this test on yourself:  Stand about 2 feet from a soft surface that's roughly 36 inches off the ground -- a tall bed or the cushioned back of the sofa works well.  Lean forward placing your fists on it like your holding the hoods of a bike (your thumbs should be pointed up toward the ceiling) BUT keep your elbows slightly bent.

Thumbs up, elbows slightly bent (beard not required)

Now push your pinkie side of the hand down into the bed going into ulnar deviation -- your elbows want to naturally straighten a little, huh?  Move the wrists back and forth in and out of ulnar deviation -- it's really tough to be in ulnar deviation and keep your elbows bent, right?  You can force it, but it isn't a natural position, or anything you could maintain for a long time.

Wrists in ulnar deviation, makes elbows straighten

Now stay with me because we have to take this one step further.

Ulnar deviation + Closed Chain Position leads to Elbow Extension, AND

this elbow extension creates another problem --> Shoulder Elevation (the motion you do when you shrug your shoulders).

Go back to that same test with your hands on the soft surface (and take a look at the two pictures above).  When you move into wrist ulnar deviation and that straightens your elbows, then the elbow straightening pushes those shoulder up slightly.  It's subtle in the test, but more pronounced on the bike, especially as we ride and "settle in" to our riding position.  Those shoulders creep up a little more, which has the tendency to tighten the muscles around our neck and shoulders, and can lead to the neck and shoulder issues.

So this certainly isn't the only cause of neck pain, but it's a great representation of how something little can multiply into something ugly.

Thought?  Questions?