Neck, Shoulder and Hand pain
Many cyclists will suffer to some degree from neck and / or shoulder pain. During a fitting, many clients will not think to mention it without prompting, often saying “well everybody gets a bit of discomfort there don't they”. If a minor irritation, then fair enough, but some people can suffer debilitating pain that limits their enjoyment of cycling. Hand and wrist pain shares many of the root causes of neck / shoulder discomfort, with some unique reasons as well.
Neck and Shoulder Pain
There are two principle hypothesis for Neck and shoulder discomfort, excessive weight on the hands and over-reaching. In both cases the shoulders tend to hunch up and the arms straighten or lock out.
Excessive Weight on the Hands
This is most likely due to the saddle position being wrong. In Saddle Fore-Aft we discuss the classic Knee Over Pedal Spindle (KOPS) and Hip Location guidelines for fore-aft location, but also stress that what actually matters is that you are well balanced on the bike. Ideally you should be able to hover your hands above the hoods without sliding or falling forwards. If you struggle to do this, first check the saddle tilt. If too low at the front, you will tend to slide down it, using your hands and arms to keep you in the right place. Once the tilt is correct, the most common method to reduce weight on your hands is to move the saddle back. This can be counterproductive though if moving it back means you have to lean further forwards to reach the bars in the first place. Try moving the saddle back and forth until you feel well balanced and hovering your hands is easy. Bike fitters often advocate lifting the handlebars to reduce weight on the hands but I find that if the bars are too high, people tend to lean on them. If (and only if) you are well balanced, lowering the bars is the best approach as more weight is transferred onto your core and off your hands. This sounds counter-intuitive, but if you imagine the bars are so low that you can’t reach them, but you are well balanced to prevent falling forwards, there won’t be any weight on the bars will there?
Over-reaching to the hoods.
The next most common culprit is reaching too far forwards to get to the hoods. The hoods are an excellent place to put your hands as they encourage a neutral wrist posture and give good access to the shifters and brakes. This may only be possible though if you roll your shoulders forwards, creating tension across the upper back and neck muscles. Some people only get neck pain whilst riding in a group, largely due to having to cover the brakes and so reaching forwards onto the hoods. On their own, their hands fall back to a more natural position behind the hoods (and they might be a little less tense as well). If cyclists find their hands falling short of the hoods, the immediate response it that they feel they need a shorter stem, but in many cases it is their saddle position causing the problem. High or low saddles will pull or push the pelvis back into an anterior tilt, making it harder to lean far enough forwards.
Other Reasons for Neck Pain
Unfortunately, people can still struggle with neck discomfort with a well set up bike. We don’t always realise that our heads can weigh as much as bowling balls and the poor neck muscles are working hard to maintain posture and ensure we can see where we are going. Poorly fitted or thick rimmed sunglasses can sometimes exacerbate the issue by requiring a stronger tilt of the head to see through the glass rather than over the rims. Sacrificing aerodynamics and adopting a less aggressive torso angle may be the best approach here, as will just spending more time on the bike to help condition the muscles.
Hand and wrist discomfort can share many of the same root causes as neck and shoulder discomfort, especially when there is too much weight on the hands. Other factors local to the hand / bar interface can also be very significant.
Cyclist's or Handlebar Palsy is very common and can best be described as a tingling or numbness of the hand along the ulnar nerve. The nerve is compressed in the heel of the hand and is usually first felt in the little or ring finger. Cyclists can also suffer from Carpal Tunnel syndrome, where the median nerve is compressed in the wrist, manifesting as discomfort in the thumb, index and middle fingers. The first consideration when trying to resolve hand pain is to make sure there is not too much weight on the hands. The detail of the shifter position and the width of the bars are also very important. Older style brake hoods or upturned shifters can create pressure points at the front and back of the palm as shown top left. By ensuring a smooth transition from bars to shifters (bottom left), loads are spread over the entire width of the palm, reducing pressure on the ulnar nerve. The median nerve is compressed when the wrists are cocked, so they should be kept as straight as possible. Bars that are too wide will encourage a bent wrist, as will shifters that are too high or rotated too far around the bar bends. Thicker handlebar tape with gel inserts can help and mitts are essential. Be careful with some gloves though as the pads placed to cushion the ulnar nerve can sometimes be counter-productive.
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