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Fixing The WHY – Shoulder Pain in Cyclists

Smarter approaches to riding, training and recovery are what we are all about at Killer Coach Academy. Learning how to prevent injuries by building a strong foundation and good mind-body connection is the way to fix shoulder pain in cyclists.

With over 20 years of experience treating injuries and working with post-surgical patients as a Doctor of Physical Therapy, Coach Tricia can help you become a more sustainable athlete, limit your time off the bike and help prevent some of the most common injuries that cause shoulder pain in cyclists.

There are only Two Reasons for Shoulder Pain in Cyclists

acute injuries shoulder pain in cyclists
overuse injuries shoulder pain in cyclists

Acute Injuries:

We’ve all experienced a right of passage in cycling, the dreaded wreck, OTB or crash that usually starts innocently enough; just riding along, then out of nowhere -WHAM!

Your initial reaction is like any other human – to protect your head, so out go your hands to stop you from slamming into the earth. Dusting yourself off you then begin to notice the injuries:

  • abrasions (scrapes, scratches)
  • fractures (broken bones)
  • hematomas (bruises)
  • lacerations (cuts)
  • pulled muscles, damaged ligaments and tendons (dislocations and joint trauma)

All of the issues with acute injuries cause PAIN. The WHY behind this pain is obvious = damaged tissues, swelling and a pain response. This response is your body’s way of telling you not to do that again, and to allow the body to heal. 

Most of us understand that acute injuries from trauma need time, rest, ice and maybe even surgery or a sling to heal. The deeper why of the trauma may not just be bad luck. Perhaps, the accident could have also been prevented.

Were you riding over your skill level, gripping too tightly, not looking far enough ahead, losing concentration or just not strong enough to prevent the accident?

Prior history of crashing is not surprisingly highly correlated with risk of future crashing. (1) One crash can lead to another and another.

If you have experienced acute injuries, get the appropriate medical attention then dig deeper and keep asking WHY. Is there more you can do to help prevent another acute injury and put more “luck” on your side? Yes, there is!

Overuse Injuries:

These irritations are more common than you’d think in cyclists. In fact, 45-90% of mountain bikers report overuse injuries and these little niggles cause more missed riding days than trauma from acute injuries. (2)

Missed days equals less fun and less time enjoying mountain biking. Trying to puzzle your return to riding is always the most difficult element to proper recovery. Too soon and you are back on the couch in a heartbeat.

Figuring out the WHY behind the overuse injury takes time, and hard work and may require some help, but it is always worth it. Be sure you find someone who not only treats your symptoms of pain and swelling and someone who can evaluate: 

  • muscle imbalance
  • inflexibility
  • decreased range of motion
  • previous trauma
  • weakness
  • neuromuscular dysfunction (delayed or uncoordinated muscle firing patterns)

This type of deeper work is beyond the scope of current medical practice. Can you blame a system that makes more money from your need to visit them?

Here is where educating yourself on how the body works, from questioning the WHY and figuring out why it’s not working is invaluable.

Fixing the WHY – the root cause of the problem will allow you to enjoy more time on the bike with continual improvement with fewer injuries. Listening to and learning from your body will make you a more sustainable athlete. But, you gotta listen!

The WHY'S of Shoulder Pain in Cyclists:

Here is the short list of reasons WHY you might be experiencing shoulder pain. Remember to consider all possible why’s in order to prevent more issues with your shoulder. Perhaps it all started with an acute injury and now progressed into an overuse injury that you just can’t shake.  Consider each category below with regard to your shoulder pain, including bike fit, posture, weakness and muscle imbalance, inflexibility and decreased range of motion as well as improper training progressions. Leave no stone unturned. Get rid of your shoulder pain once and for all.

Bike Fit:

link fit

The bike is controlled over terrain from your “touch points” and of these, there should only be 2 or 3. These are the hands, the feet and occasionally the butt. The user interface on the bike is all-important to be able to get over obstacles, shift your weight properly and use terrain to your advantage for enjoyment. Vibratory stress combined with sustained postural stress warrants a properly fitting and functioning bicycle. (3)

FIX IT: Have a look at your cockpit and make sure you have just enough pressure on your upper body contact points to work the bike underneath you. Have a professional look at your reach, bar width, stem length and overall fit to make sure it fits you and your riding style.

Don’t have a good bike fitter in your region? Aaron at Link Cycling offers remote 3D fit and evaluation.

Postural Habits on and off the Bike:

Your grandmother was right! Good posture is important, especially with cycling. Spending too much time in any one position is not good. Screentime and sitting at a desk or in the car can put important muscles at a disadvantage, shortening and weakening them. Long rides with increased fatigue and flexion of the spine, and rounding of the shoulders and neck hyperextension can limit your ability to look ahead on the bike (increasing your risk for acute injuries) and decrease your performance by limiting chest expansion and breathing. Add to that,  pressure on the delicate tissues of the hands and wrist and you have a recipe for disaster = pain and numbness! 

FIX IT: Keep your spine elongated (think tall) reaching through the top of your head, hinge at your hips and drop your shoulders down and back. Don’t have a death grip on your bars, just enough to do the job. Post reminders around the house, office or on the bike to focus your attention on your posture.

posture on and off the bike

Weakness and Muscle Imbalance:

shoulder pain in cyclists

If you are not currently doing anything active other than riding then you need to start now. Sustained postures on the bike as well as minimal lateral and rotatory motions for anything other than the hip and knee will work against your injury prevention plan.

A lot of cyclists suffer from upper crossed syndrome, cyclists’ palsy and thoracic syndrome as well as cervicogenic headaches. These are all related to muscle tightness and stretch weakness. Normally a muscle has an optimum length for maximal force generation, so if a sustained posture or injury changes this, then your body can not function the way it needs to. This leads to further imbalance and more pain. 

Take the scapular stabilizers, for example, those muscles that keep the shoulder blade fixed on your thoracic spine.  If one or more of these are weak from a previous contusion, tear or clavicle fracture you need to rehabilitate the strength and balance these to have the shoulder joint function properly. Think of the scapula as the anchor of your arm to your more powerful core muscles. These are what you need for power and control on the bike!  You wouldn’t hit a golf ball or baseball with just your arms if you wanted it to go far. Why would you expect to be able to ride well without connecting your core to your handlebars?

TRY THIS: Add a “core day” that incorporates scapular stability a couple of days a week. Try a plank on your elbows, a push-up plus, a side plank or try this workout here!

Inflexibility and Decreased Range of Motion:

As described above good posture, strength, and stability all play important roles in effective cycling. Shortened muscles and other soft tissues around your neck and shoulders can combine to really limit your range of motion and make you feel stiff and sore after a ride.

Sitting on the bike encourages flexion in the mid (thoracic) spine and hyperextension in the upper (cervical) spine. The rounded and hiked shoulders set them up for a perfect storm of injury by making it hard for the shoulder muscles (including the important rotator cuff) to do their job properly. Great stretches will counteract these limitations and allow for less stiffness, improved joint function, strength, posture and breathing as well.

Focusing on posture and strengthening weak muscles to avoid these postures will only work for so long unless you have good flexibility and range of motion of your spine, shoulder blades, neck and shoulders.

You don’t have to be Gumby, in fact, too much mobility can lead to instability. We want just the right combination of length, strength and stability in our muscles and joints.

TRY THIS: After a ride get into a routine of stretching. Think of it as money in the bank – you are making a deposit for more time on the bike.

Try the open book stretch pictured here. Keep your legs and hips stacked on each other and spread your extended arms apart like the pages in a book. Reach your head long, shoulders down and fingers apart. Hold at least 30 sec, try 3 on each side.

Stretching should not be painful, it should be progressive and improve slowly over time. Don’t force your flexibility. You need to breathe and relax into a stretch, focusing on the muscles you want to lengthen. Relaxed muscles will lengthen, this is why foam rolling feels good. Here is a good foam rolling routine.

shoulder and upper back stretching

Improper Training Progression:

training plan

Our bodies can take quite a lot – up until a point. Then all it takes is one little thing to make it all go wrong. Most of my clients say they don’t remember any one particular thing that brought them their overuse injury. The most common mode of injury is “just waking up” and noticing it. Assuming that injuries from sleeping are not that common we understand that overuse injuries just sneak up on us and when the “straw finally brakes the camel’s back” you are in pain.

Having a plan for riding and training is invaluable to monitor and track progress and get you to your big goals. Having a coach, plan and training diary (like this online software- Training Peaks) can help track your intensity, duration and overall demands on your body from cycling. Too much too soon without proper rest days and recovery strategies will set even the best cyclist up for an injury.

TRY THIS: Rest days are when the body builds back better, ready for the demands of your next ride. Get rid of your more is better attitude and give your muscles, joints and entire body the time it needs to regenerate.

If you ride 3 times a week, spread them out with rest days between. Try one skills ride where you focus on posture and cornering, the next ride could be hill work and one on the weekend to go long to build endurance.

References: (Because we love science!)

(1) Tin Tin, Woodward, Ameratunga. (2013) Incidence, risk and protective factors of bicycle crashes: findings from a prospective cohort study in New Zealand.  Prev. Med. (57):152-61.

(2) Campbell and Lebec (2015) Etiology and Intervention for Common Overuse Syndromes Associated with Mountain Biking. Ann Sports Med Res 2(3): 1022.

(3) Ansari, Nourian, Khodaee (2017) Mountain Biking Injuries. Competitive Sports 16(6):404-12.

Tricia Davis, DPT

With over 25 years of experience as a physical therapist Coach Tricia, DPT is over the revolving door of injuries and illness that are preventable. Through her work, she realizes that bodies do not come with an instruction manual and it's difficult to navigate health care as an athlete. Working in sick-care (the exact opposite of healthcare!) with injured athletes and non-athletes alike our founder Coach Tricia, DPT is inspired to lead the revolution of health engineering. By teaching people how to prevent injury and illness NOW, many days, weeks and months of healthy living can be protected. Coach Tricia is well-armed and inspired to keep athletes pushing their boundaries without setbacks.

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