Ouch! My Neck Hurts!

Bicycling is a great non-impact sport that can be enjoyed by many, no matter the age.  I have been an avid bicyclist since I was a resident physician at the University of Utah.  When I started commuting to work, my low back pain improved, as did my overall health and endurance.  I loved the alone time and the beautiful scenery I would otherwise  miss if I drove to work.

After a few years I developed neck pain.  I tried switching bikes and used a bike rack instead of a backpack, but to no avail.  Neck pain is a common complaint

for bicyclists and affects up to 50% of regular cyclists.

When you ride a traditional bike, the rider leans forward to grasp the handlebars and this increases the kyphosis (or flexion) of lumbar and thoracic spine and hyperextends the neck.  This results in overloading of the small joints in the neck and the paraspinal muscles that hold the head up.  Hyperextension of the neck can also cause pinching of the nerves from the neck to the arms, thereby causing arm pain, numbness, and tingling.  If a rider has poor midback flexibility and strength, then the upper neck muscles (upper trapezius, levator scapulae, scalenes, sternocleidomastoid) can become overactive and put additional stress on the neck.  Dr. Janda, a renowned neurologist, referred to this as “upper crossed syndrome”.

Treatment must address appropriate exercise and proper bike fitting.  Cross-training is essential to work on antagonistic muscles and movements to oppose the sustained posture of bicycling. In my case, I should have strengthened my deep neck flexors and mid-back muscles and worked on flexibility of the anterior and upper neck muscles.

I recently took advantage of a professional bike fitting service at a local bike shop, East Coasters.  I saw a dramatic difference in my posture and neck pain while on my bike immediately after the fitting.  At East Coasters, the athlete is carefully measured and examined while on a bike in order to ensure proper seat height, arm elevation and reach, and other factors.

Neck pain that lasts more than a month or results from trauma should be a red flag to go see a doctor for further evaluation.  Severe cases may require a neck injection, manipulation, or even surgical consultation.

Good Luck!

Valley Sports & Spine Clinic

Giving you Back your Life

Dr. Ethan Colliver

 

 

 


Your back hurts… because of your ankle!

No, I am not disregarding the earlier post about toilets. Let me explain. After my freshman year in college, I worked as a housepainter for two weeks. That career choice came to a screeching halt after I fell off a roof and shattered multiple bones including my left ankle. I now have a very stiff, arthritic ankle. It doesn’t even dorsiflex to neutral. In my twenties, I began having back pain and didn’t know why. I was sedentary but thin and very busy with my medical training.  I eventually realized that I had a lumbar disc herniation with occasional right leg pain. Why?

Disc herniations  happen when you have excessive flexion or twisting through a disc.  We bend over more than a thousand times a day which requires squatting.  Squatting requires full hip flexion, knee flexion, and ankle dorsiflexion.  The picture below shows a natural full squat with a lot of ankle dorsiflexion.

lady squattingNotice her degree of ankle dorsiflexion. Also, note how upright her lumbar spine is.  Her upper body is leaning on her thighs thus taking the stress off the lumbar spine which is in essence “hanging” from  her thoracic spine and not taking any significant torque.

Below is an example of a Western squat, in which the person comes up on their toes in order to get down.

Note her degree of ankle dorsiflexion.  Also, note how perpendicular her spine is to being upright.  This creates more torque on the lumbar discs than the upright posture and thus more stress on the discs.

I believe taking the weight off the heels leads to increased calf muscle activity, which leads to hamstring overactivity and inhibition of the hip muscles (ie- gluts), which lead to overactivity of lumbar paraspinal muscles and increased stress on lumbar spine.  This aligns with the work of the great Neurologist, Dr Janda.

 

 

In the above picture on the left, lack of ankle flexibility prevents her from squatting further.  If she squats further with same angle in her ankle, then she will have to lean back and thus lose her balance (also, her lumbar spine is now more parallel to the ground and thus more stressed).  In the picture on the right, having a lift under her heels allows her to keep her center of balance forward (and her lumbar spine more upright) and do a deeper squat.  This is a happier lumbar spine!

In short, healthy backs require full range of motion and strength of the whole chain.  From the lumbar spine, pelvis, hips, knees, ankles and feet.  When you have back pain, the whole system must be assessed.  The back pain is often a result of a problem elsewhere in the chain.

Good Luck!

Valley Sports & Spine Clinic
Giving you Back your Life
Dr. Ethan Colliver

 


What is your Fitness Age?

Here is a video featuring a colleague of mine who is the Director of Sports Medicine at Columbia University.  video on Fitness Age

The fitness calculator can be found here : Fitness Calculator

It was eye-opening to calculate my “Fitness Age”, which was 25.  Not bad, considering my 4 kids and full time practice make me feel 55, at times. … but I know I can do better.

I was discussing with our Physician Assistant, Holly, how I would rather sleep in every morning in stead of waking up at 5:30am to exercise.  Those extra 10 minutes in bed often will lead to 20, 30, …. oops, got to go to work. But, it is amazing how just after a few minutes of exercising I can say “This feels good.  I needed this.”

I workout 3-4 days a week now but I could improve by exercising 5-6 days a week.  It could be hikes with my family or biking to work in stead of driving. What could you do?  It does not have to be a fancy.  In fact, you don’t need any gym.  One trick, if you have kids, is to make up silly “races” back and forth in your living room: crab walks, bear crawl, hopping, skipping, etc.  Everyone has fun and you get your exercise.

Good Luck!

Valley Sports & Spine Clinic
Giving you Back your Life
Dr. Ethan Colliver