Article by RTB Sponsor: Holly Pennington, PT, DPT/Outpatient Physical Therapy
If you are one of the 60% of cyclists suffering from neck pain, you have probably already gone down the bike fit road. Everything from the incline of your saddle to how your helmet fits can cause extra strain on the muscles and joints of the cervical spine. But what do you do when the angles on your bike are correct, your gear fits, and your neck still hurts?
Just like bicycles, our bodies are intricate machines that need fine tuning to operate at their optimal level. Due to the flexed position of the lower (lumbar) and middle (thoracic) spine while cycling, the demand on the upper (cervical) spine musculature is high. When muscles that were created to support the neck are neglected and/or joints below the cervical spine become stiff, pain arises. And, a tune-up is necessary!
Let’s look at three common musculoskeletal dysfunctions that contribute to neck pain in triathletes who spend a significant amount of time in the saddle.
Deep Neck Flexor Weakness
Most likely the phrase “core strengthening” brings planks, crunches and maybe even Kegel exercises to mind. Lower abdominals, deep low back muscles and pelvic floor muscles that support the lumbar spine dominate the “focus on the core” movement. But the reality is that there are core muscles of the cervical spine also. The deep neck flexors are a group of muscles with fancy names like longus coli and rectus capitus whose primary function is to support the neck. These small, neglected muscles traverse the front of the cervical spine and are the abdominals of the neck.
When was the last time you did a few sets of neck crunches? Unless in distress, these muscles rarely get exercise, so they shrink and become weak. When they are not strong enough to fulfill their purpose as support for the 11-pound head sitting above them, other muscles compensate. Specifically, the trapezius muscle (which runs from the base of the skull to the shoulder) is recruited to work overtime to support the weight of the head. Overworked muscles become tight and painful, so the trapezius muscle becomes a source of neck pain. Deep neck flexor training is needed to restore the muscular balance around the cervical spine.
Specific exercises (not neck crunches!) individualized for your unique cervical spine curvature build strength in these muscles and, simultaneously, relieve neck pain.
Thoracic Spine Stiffness
One of the key features of the cyclist’s position on the bike is spinal flexion. Both the lumbar and thoracic portions of the spine must be flexed (or rounded) to achieve aerodynamic positioning. This demand comes more naturally to the lumbar spine than the thoracic. Because the middle spine attaches to the ribs to protect key organs like the lungs and heart, the vertebrae in the thoracic spine naturally move less. They do not respond well to flexion for prolonged periods, so they stiffen with time. When this happens, more strain is placed on the areas above the tight areas (i.e. the lower cervical spine) to maintain the position needed to cycle. Just like our bikes, our bodies will get the job done somehow. The question is, how efficient are they?
Thoracic spine mobility exercises and joint mobilizations that address the specific stiff segments balance the demand for spinal flexion and relieve the stress on the cervical spine.
C/T Junction Strain
The area where the neck meets the middle spine is called the cerivicothoracic junction or C/T junction. You can easily find this important joint by feeling down your neck for the knob-like bone at the base of your neck. At the C/T junction, the natural curve of the spine changes from extension to flexion. Cycling requires exaggeration of the normal cervical and thoracic curves (more extension in the neck and more flexion in the mid-back than what is required for most activities), which puts extra stress on the junction where the curve changes. Think of it like a busy interaction – increased traffic means more accidents and more wear and tear on the roads. The C/T junction responds to increased strain by becoming restricted, which places increased loads on the areas above and below it, similar to thoracic spine stiffness. When the cervical spine above the C/T junction is required to move more, it also needs even more support from the deep neck flexors. The vicious cycle begins!
To restore motion in the C/T junction, manual therapy that focuses on joint mobilization combined with deep neck flexor training is necessary.
Optimal spinal health is of paramount importance for cyclists and is difficult to achieve without professional assistance. Remember, your body is the most complicated machine you have and care beyond smart triathlon training is needed at times. When your bike fits but your neck still hurts, get help!
Physical therapists at Outpatient Physical Therapy are specialists in deep neck flexor training and spinal joint mobilization. Call one of the 8 King/Pierce County locations to schedule your evaluation: www.outpatientpt.com
Dr. Chris Jones, DPM
Endurance Foot & Ankle
To understand the role of orthotics in cycling and running, first we need to make sure we have a good understanding of what an orthotic is and what its intended purpose is.
The term orthotics, or orthoses, can refer to a support, brace, or splint used to support, align, prevent, or correct the function of movable parts of the body. More specifically, custom foot orthotics are designed to correct or alter abnormal gait or walking patterns by impacting the forces, pressures, and or/motions related to the foot during walking or weight-bearing activities.
That being said, not all foot orthotics are created equally! An accommodative foot orthotic, for example, is -- in the simplest of terms -- a cushion. So when you step on that scanning device for your ‘custom’ Dr. Scholl’s orthotics, do not be deceived about what you are actually getting. You are essentially paying for an overpriced cushion. This is an accommodative orthotic.
On the other hand, a functional orthotic, which is made of semi-rigid materials, is one that may provide some degree of correction to your lower extremity biomechanics (mechanical laws relating to the movement of your legs and feet). A functional orthotic can be especially helpful for the treatment or prevention of things like symptomatic flatfeet, Achilles problems, heel pain, knee or low back pain, or many other lower extremity problems/injuries. Some over-the-counter products can be classified as functional orthotics, however, we should not confuse them with custom orthotics as these prefabricated devices are not designed specifically for your feet and your feet only. That is not to say that over-the-counter orthotics cannot be beneficial for you, however.
So what role could orthotics play in your training? First, let’s discuss running.
Running injuries in the everyday triathlete are all too common. If you’re one of the few who have avoided a running-related injury, hats off to you! If you are like the rest of us, however, and you are anything like me, you are likely desperate for a solution. Your injury could be due to overuse, your mechanics, shoe gear, terrain, or a number of other factors. However, if you are experiencing frequent injuries, a biomechanical evaluation for orthotics is something you should definitely consider.
Anecdotally, many swear by their effectiveness. And scientifically, the medical literature has demonstrated that custom, functional orthoses do alter the kinetics of the lower extremity during running. However, we do not know to what extent and is it significant enough to prevent or help injury. There is evidence to suggest that conditions such as Achilles tendinopathy (tendinitis), plantar fasciitis/heel spurs, bunions, hammertoes and others can benefit from the use of custom orthoses in running activities. Not to mention, it has been demonstrated that a semi-rigid, functional orthotic can help a softer, lower-stability shoe to act like a higher-stability shoe.
When it comes to cycling, the role for custom orthotics may be less apparent, but can be equally beneficial. As someone who uses custom orthotics in his cycling shoes, I can attest to their effectiveness. The key to an effective pedal stroke is a keeping the motion from your hips down to your toes in a consistent plane. Many triathletes and cyclists develop knee or foot pain due to inward/outward motion during the pedal stroke or an imbalance of distribution of pressure through the cleat and pedals. All issues that could possibly be corrected with a custom cycling orthotic (not to mention, a good bike fit).
When it comes to the medical literature, again, the jury is still out. It certainly demonstrates orthotics’ effectiveness in altering mechanics, such as increasing the force under the great toe joint and aligning the knees, but its direct impact on FTP is unknown. Suffice it to say, however, a custom cycling orthotic is a rigid platform which has the potential to increase power slightly just like rigid cycling shoes do.
A cycling orthotic should look and feel quite different from a running orthotic. Ideally, it will be very low profile, as to not take up too much space in your cycling shoes. It should also feature a more rigid material in the midfoot/forefoot to provide stiffness, for a more powerful and efficient stroke.
So if you are frustrated by recurring injury or just curious about what an orthotic might be able to do for your training, don’t hesitate to reach out to our clinic for questions or to schedule an appointment. At Endurance Foot and Ankle we offer in-depth, frame-by-frame, slow-motion gait and run analysis for our clients, as well as evaluation and casting for sport-specific, custom orthotics. For cycling, we also offer video analysis of your pedal stroke mechanics and evaluation for custom cycling orthotics.
Dr. Chris Jones, DPM
RTB welcomes Dr. Christopher Jones of Endurance Foot and Ankle in Issaquah. EFA helps athletes overcome and avoid injury, recover faster, and maximize performance.Services include Gait Analysis, Deep Tissue Release, Sport-specific custom orthotics, Recovery therapy (dynamic compression and cryotherapy), Sweat Analysis, and Diagnosis & Management of Lower Extremity Injuries.
Raise the Bar
Race reports, upcoming events, news, and more, from RTB.