Virtual Case Study: Upper Body Pain While Riding

Patient Presentation: History, Background, and Complaints

Jimmy N. presents to my office head down, shoulders drooping, and upper back the shape of a question mark,  barely able to muster an exhausted whisper when heard saying, “My head feels so heavy I can barely hold it up.”

He noted that the muscles in his upper back and neck feel as if they are in knots and that his arms become so tired that he has trouble holding himself up from the saddle.

In addition, he often experiences numbness in his hand and fingers later in rides, especially if not wearing his cycling gloves.

Physical Examination

Postural examination reveals that Jimmy’s head and neck are protruding forward, his shoulders are turned inward, and his upper back is excessively curved.  The muscles in his chest and the front of his shoulders are extremely tight and those in his upper back and arms are weak and easily fatigued. 

Diagnosis: What is it Called?

• Handlebar palsy or (Ulnar nerve neuropathy) is a compression of the nerve running on the inside of the hand which causes tingling, numbness, and weakness of the ring and little finger. 

• Carpal tunnel syndrome or (Median nerve neuropathy) involves the nerve traveling through the wrist, which when impaired involves the thumb, index, middle, and ring fingers and may also cause generalized hand weakness.

Etiology: What Causes It?

The vast majority of upper body-related pain and discomfort while cycling is due to improper position and poor posture.  Follow the simple upper body pain prevention tips shown below to make the corrections necessary to avoid arm and hand pain.

Treatment: What Can You Do About It?

• If the pain is the result of a recent injury or is acute (sudden onset within ~24 hours) with swelling, control the symptoms by following the ‘PRICE principle’ (an acronym which stands for Protect, Rest, Ice, Compression, and Elevation) immediately for the next 2 to 3 days.

• Check your bike fit and follow the simple tips below.

• Address muscle imbalances through a focused strengthening and stretching plan, making sure to only perform exercises that can be done pain-free and without residual soreness.

                   Find ‘The Zom’ Upper Body Pain Program complete with exercise descriptions here

Referral: When is it Time to Ask For Help?

• A proper bike fit performed by a certified professional is always a good idea, especially when the small incremental changes you have made to your setup don’t provide the results or eliminate the pain you are experiencing.

• A progressive periodized training and recovery plan is essential and when followed with the aid of a knowledgeable cycling coach there is a tendency to be more accountable and disciplined.

• If your upper body pain is persistent, worsens, or significantly interferes with your cycling, seek the assistance of a Sports Medicine Physician or Physical Therapist for an expert biomechanical and musculoskeletal assessment and treatment.

The Expected Outcome: Conclusion

A cyclist’s upper body is often overlooked and neglected causing the potential for injury, ride limiting fatigue, and pain which worsens over time.  

In order to avoid discomfort, and to protect your arms and hands from injury arising from weakness, improper positioning, and prolonged maintenance of persistent positions on the bike, it is important to ensure a proper bike fit. 

In addition, by following a consistent upper body flexibility program, the long-term effects of poor posture can be corrected.

What about you? 

Have you noticed that your posture off the bike is affected by your position while on it?  If yes, what have you done to address this issue?  Your fellow virtual cyclists would like to know.