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nerve injury, pain and recovery, and bike fit(6 posts)

nerve injury, pain and recovery, and bike fitbillg
Oct 22, 2001 10:52 AM
Help. I am 40 and recently started riding. I have primarily been using my road bike to commute to work (15 miles round trip, 4X/week since July). I recently developed sharp pains in my shoulder and upper arm. My MD, coincidentally a bicycle rider, believes that the problem is not in my arm, but is in a bunch of neves in my neck which then lead to my shoulder and arm. He believes that my condition is caused or aggravated by the normal road bike riding position: being bent over the handlebars and then tipping one's head back to see forward. I guess that looking at the ceiling for an extended period of time would give the same effect. He also suggests that the condition will be somewhat chronic for as long as I continue to ride. My questions:

Has anyone else experienced the same discomfort? If so, what did you do? How long before you rode again, etc.?

The situation he describes seems related to the normal riding position on a road bike, but I have never heard of others experiencing the same problem. Is there a bike fit issue that I am missing? Or is there some sort of exercise that other riders do to avoid this?

I finally start to get healthy, lose a little of excess around the middle, and now this. I really do not want to go back to jogging, or buy a recumbent. Thanks.
re: nerve injury, pain and recovery, and bike fitguido
Oct 22, 2001 11:19 AM
Hunched uppper back can be caused by handlebars being too low, or stem being too short, or both. When you're on the bike, you should have enough room to make your back flat. Only then can your rib cage expand, your spine stay reasonably straight, shoulder blades flat, and your arms extend properly from your shoulders.

So consider putting on a longer stem and raising the handlebars. As therapy to rehabilitate the shoulder and back muscles, very light weightlifting will do the trick.
neck/shoulder painTig
Oct 22, 2001 11:38 AM
Having done some sports massaging for my family and suffered similar pains, I'd say your neck is the primary source of the pain. Hyper extension of the neck can cause all kinds of wonderful muscle spasms that branch to the shoulder like falling dominos. The best cure I can think of is therapeutic massage. This may take several sessions. If it's really bad, a competent chiropractor might be needed. The tightened, spasmed muscles are pinching nerves and you feel the sharp pains. The affected muscles may have micro-tears. Once a muscle gets really sore like this, it needs to be loosened up and increase the blood flow to it. It won't heal very quickly without some help.

Most likely you need to adjust your bar position. If it's the standard quill stem type, make sure you don't extend it out of the fork so high that the "/////" marks show or the warning message stamped on the stem shows. That will cause a catastrophic failure of the stem and more injuries than we want to think about. Your neck will get stronger as you ride more, but there is no reason to cause injury to it now. You might be hyper extending your neck a little too much. Try riding with your head tilted down just a little and look up more with your eyes. There used to be a super-techie magazine that tested the aerodynamics of helmets among other things. Tests found that when a rider's head is slightly down and he is looking up above his sunglasses and under his eyebrows, the position of the helmet is at an aerodynamic optimum. Not that this is a concern to you, but it just points out you don't have to ride around with a craned neck to be effective.
Oct 22, 2001 12:24 PM
Help this guy out by relating your experiences, will ya? Sounds like he has some issues in common with you.
As somewhat of an expert on the subject of necks and nerves...Elefantino
Oct 22, 2001 1:40 PM
What you are describing and what your doctor has told you, in layman's terms, is almost certainly myofascial pain syndrome, or "trigger points." The study of trigger points and its therapy was pioneered by Dr. Janet Travell, who was Kennedy's White House physician. In fact, when people speak of JFK getting cortisone injections for his back, they are mistaken. He was given mypivocaine injections for his back and its associated trigger points.

In your case, and mine, too, your trigger points are quite likely the problem. They are in your neck and upper- to mid-back and affect your hands, forearms and neck. Once trigger points become inflamed, "in spasm," they must be worked on or the pain will continue. Most doctors know of Travell and her pioneering work and will prescribe physical therapy. Once you are worked on and healed — and you will be — you'll be shown how you can relieve trigger point spasms on your own. It usually involves a tennis ball (or a squash ball, even better) and you leaning up against a wall or rolling on the floor. Just go with me on this one; it works. (I have gotten so good at it that I can just reach behind and hit the trigger poits with my finger, hold it for about 30 seconds and I'm good to go.)

As for your bike, I would suggest you get a stem with at least a 10-degree rise, and rotate your handlebars so the drops point down at about a 30-degree angle. (That will raise the hoods.) Also, shorten your stem about 10 millimeters from what your currently use; it will take some of the stress off the afflicted area.

I understand the pain you are in. I was on disability for 10 weeks about 10 years ago, and I have an office job. We remodeled our office; I got a new desk and my typing position changed. As a result, I got what is commonly referred to as a "repetitive stress injury." The pain was real, and lasting. I had to stop riding, too. I was told I needed "carpal tunnel surgery" by an eager workman's comp doctor who knew nothing except how to cut. (He had performed surgery on two of my co-workers, both of whom never could return to work full-time.) But my wife, who's an R.N., let me use her hospital's medical library, and I discovered Travell. Then I found out that Stanford Medical Center had converted its entire fourth floor to myofascial pain treatment, and I located the name of an anesthesiologist in town who had studied there. Within two weeks I was back at work full-time, although the treatments continued for a while. But I have never had a lasting problem with trigger points since.

Well, that's not exactlytrue. I broke my neck in a roadie-vs.-tree branch cycling accident on July 7, and I had spinal surgery and was in a collar for three months. I got the collar off earlier this month and soon after the trigger points in my neck went into spasm because of the inactivity. But I am having PT for it now, and things are getting much better.

Hang in there. Drop me an e-mail if you have any more questions.

Ride on,
Don't despair, it will healKristin
Oct 22, 2001 2:55 PM
Sounds like the same problem I had. I bought a roadbike in May and the guy sent me out of the shop with a 6" drop from my seat to the bar tops. Way too much for a new rider who isn't athletic.

When you ride, do you feel like you are leaning forward and that a lot of your weight is on your hands? Get on your bike and ride slowly. Where do you feel the most tension in your back? Lower back? Through shoulder blades? Neck?

Check your seat to bar height differential:
* Stand bike upright and place book on seat (hard floor)
* Measure from bottom of book to floor
* place book on bar tops and measure
* do the same from the brake hoods (tricky)

What is the difference between the two? Most people recommend that the seat top and hoods be at the same level for new riders who are not athletic. Definately shouldn't be more than 2 inches. Once I reduced my drop from 6" to 2" I immediately got relief. At the worst point, I could only tollerate 20 miles. I've since ridden 77 miles in a stretch.

PS. I have a biker doc too. He brought in his trainer one day and watched me pedal. Cool, eh? See if yours will do the same!