Upper Back/Shoulder Injury
 

Not exactly sure how it happened but this weekend I woke up with a sharp pain in my back which made it very difficult to even move around much. I went to the chiropractor the next day and it turned out to be a big knot in my back and in my neck. He ended up working on those spots and loosened my back but now my neck and upper back muscles have been sore the last few days. I commute to work 5 days a week 20 miles a day on my fixed gear and have been unable to this week due to the pain. I'm guessing it's the fit of my bike (didn't get it professionally fitted) but am not sure what caused it. Has anyone else experienced this before? If so about how long did it take until you could ride again?

Are you lifting anything at weird angles? Sleeping in odd positions? Sat somewhere awkward like a bench?

I've never let back pain keep me from riding, then again i rarely have a choice. When all else fails, laying on a hard flat surface with correct posture for a spell usually helps.

- Andy

Nope, nothing that I can think of. The only thing I started doing different was I started riding with a helmet last week. I'm hoping to get on the bike this week, the pain is now mostly in my neck and upper back but hopefully some rest this weekend will help.

I have found that now that I have been riding my hybrid which has wider bars, and bar ends... that I use my upper back when riding up hills. I guess I grab the bars and when I stand up to climb, I tend to pull up on the handlebars... do you have a lot or big hill to climb? what kind of bike setup (flat bar or drops)? I have never been professionally fitted and haven't had a problem like that...

Let's recount what's happened so far. You woke up with sharp pain in your back. Pain so high that it was difficult to move. You had a massage and it improved things a bit, but now your muscles are sore. So sore that you are unable to ride a bicycle.

Sudden sharp pain is not due to a bad bike fit. See a real doctor.

Have a Dr. appt next week for it, hopefully it'll be much better by then.

This.

Try to think of anything different you had done. Was your sleep more restless? Different position when you woke? A few times a year I get immobilizing back pain. Keeping in shape with core workouts minimizes it, as does not driving for many hours on end and days on end.

Just keep hydrated & try to minimize re-strain activities & positions till you see doc. Could be nothing, could need surgical remediation.

- Andy

Do you ride "stiff" on the bike? Think about whether your shoulders were pulled together tightly the last few times you rode. Perhaps you've been stressed out by something, maybe even your commute?

He has seen one. If you suggesting he see someone with less training in musculoskeletal injuries who spent less time in the classroom taking almost exactly the same classes you're not doing him any favors. Especially if you're expecting a cure in one visit.

Sharp pains in that location that make it difficult to move (because of pain, not loss of strength) are virtually always due to muscle spasm. Ibuprofen, stretching, gentle massage, heat (hot tub, heating pad 20 minutes every couple hours) + time are your best remedies. Imaging? Surgery? Highly unlikely based on your symptoms/duration. Ask your doctor for bedtime Valium at your appointment. It is not too sedating and works wonders for relaxing injured/spastic muscles. - JP (who has an MD)

There's something called "Shermer's neck" which describes painful muscle spasms of the neck and upper spine. (more if you search).

Our bodies aren't evolved for bicycling posture, and holding he head up from a forward sloping posture strains structures not adapted well to the task.

Some people suffer these effects sooner than others, and some barely at all. The remedies can range from changing the fit (folks with bars too far away seem to suffer it worse/sooner), to raising the posture a bit, to preventing spasms with motion. Before changing anything try the easy fixes of stretching, twisting, or relaxing the neck from time to time as you ride.

Some of the techniques I use include scanning the road far ahead, and when safe relaxing and letting my head hang down for a while. I also have limited ability to turn my head far enough to see over my shoulder, so I try to stay within those limits whenever I can to avoid spasms. (yes a mirror might help, but it hasn't come to that yet).

If the problem persists, have a pro review your fit, paying special attention to whether you're reaching forward and lifting your shoulders because the bar is too far away. (the high shoulders with lifted head is a double whammy). Lastly try mixing a more upright posture into your ride when possible.

BTW- the various muscles involved do get stronger over time, and the problem might resolve entirely, or only arise afer much longer than average rides, so you might do nothing or the minimum and that might be all that's needed.

Replace the symptom suppression from the drugs with ice PRN and sleep posture recommendations and you've got your typical Chiropractic home care recommendations. But even though we both know it's not an effective one, the previously used metric for success was limited to what happened during the initial office visit. And I don't see that happening.

Ice at this point would likely cause more spasms. Valium is therapeutic, as it has muscle relaxing properties. Ibuprofen is anti - inflammatory. I'm not just making this **** up; I have seven years of postgraduate education and thirteen years of experience. Of course, everyone is entitled to his own opinion.

Woke up on Sunday without any pain for the 1st time in a week, after a week of ice/heat/rest. Did a mellow 10 mile bike ride and stretched before and after. I noticed when I rode before I had my arms straight/locked while riding which seemed to make my neck/shoulders tense. On Sunday's ride I messed around with different handlebar positions with my elbows bent slightly and did not have any pain after the ride or the next day. Gonna start exercising my core muscles some more as well as daily back/shoulder/neck stretches. Thanks all for the good advice.

Everyone is entitled to their own opinion, but not their own facts. Research shows that ice is helpful for some patients at this point, and the patient should be able to determine quickly whether ice will benefit them or not without encountering enough anxiety to need a Valium. Valium will help treat the cause of the problem if the spasming is caused by anxiety, otherwise it's suppressing the symptoms. Ibuprofen is the safest of the NSAIDs and there's not much to debate there.

Hopefully in the couple of extra years of postgraudate education and couple of fewer years of clinical experience than me you've noticed that what happens during the initial visit is rarely enough to provide lasting relief to the patient. And since that was the metric used earlier for success, neither style of care is going to be able to solve the problem without additional care of some sort.

Sounds good man!

What happens if suspension is too rigid? stuff can break. Sounds like that's what happened to you.

- Andy

Glad to read you are all better!

I am not sure why my offer to the OP of appropriate generic medical advice justifies your criticism. Valium is FDA-approved for treatment of muscle spasm; see the third paragraph under "Indications" in this document. It's been around for over 50 years, it is inexpensive, low-risk, and works well for situations like this for many of my patients. Of course, at this point, it's academic, but other cyclists with similar symptoms in the future may benefit from knowing this. Cheers.

I take it you're a chiropractor? While there are some good ones out there who don't pretend to be medical doctors, there are a lot who do, and people end up in worse shape than if they had just seen their family doctor in the first place. My father is a physician and has seen way too many patients that were really screwed up by chiropractors.

OP: Glad your back is feeling a bit better.

Yes, I'm a DC and regularly treat patients with complaints like the op. And I've helped a lot of people who were "really screwed up" by MDs, as well as a lot who just suffered for way too long under the care of a MD before they came to see me. Every profession has it's own strengths and weaknesses, and the musculoskeletal issues aren't the strength side of the profession trained to treat patients using drugs and surgery.

And while I too am glad the op is feeling better for the time being, time will tell the effectiveness of the treatment.

I used to have what sounds like the same pain that you are describing. Was getting to be a regular thing, get the pain, see the chiropractor, 2-3 weeks later repeat. I'm a commuter and I was carrying a laptop, bicycle tools, clothes, and lunch in my backpack, on my back. Moved the backpack to a rear rack on the bike and the problem went away.

That could be the issue. I do carry a backpack with about 10-20 lbs on my commute. Started stretching mire and started moving my hands to different positions of the handlebars during my ride which seems to have helped a lot. Also started doing more core exercises. Once I started commuted I kind of stopped all my other exercising I was doing.

Get a pro bike fit, work on core and stretching exercises. WOW, 20 lbs on your back and you have back and neck pain? Try a pannier or 2 with a rear rack. I also like my bars 2" higher than my saddle. YRMV

You are weak and underrecovered.

Short term solution: Rehab. Roll/massage, stretch, mobility.

Long term solution: Get overall strong(er). Squat, bench, deadlift, press. And/or gymnastics style strength for upper body. Stronger = less fatigue = shorter recovery.

In my experience, i used to do much conditioning and little strength training, after massaging people and after carrying luggage for a whole day (travelling), i used to get much DOMS in my traps even though i was already strong enough for the tasks. After doing much strength training and little/no conditioning, the DOMS are gone.

Herman Chauw
Movement coach, strength & conditioning coach, rehab therapist