by Alan Bragman
Question: It appears that I have a pinched nerve in my neck, probably between C6-C7 (according to my retired neuro nurse wife.) Sometimes the pain is really strong, radiating down my left arm and/or near my left scapula. I’m hoping this is not from riding! Obviously, when in the drops I am bending my neck back in order to see, which on most days does not bother me. On others, OUCH. So I’m left to sit up pretty straight, using the hoods or tops. I’m 66, considered in good shape and fairly flexible. What to do? I don’t like the idea of any neck surgery. Accupuncture? — Randy D.
Alan Bragman, D.C., Replies: Randy, the radiating pain from your neck to the upper extremity and scapula is defined as a cervical radiculopathy. It is generally caused by either a disc problem, degenerative changes or from compression or inflammation of the nerve root.
The areas of involvement you describe involving the left arm and scapula are from the C5-C8 nerve roots. The fact that cycling seems to exacerbate this condition strongly suggests that it may be a primary contributing factor.
The cycling position puts the upper body in an unnatural position by hyperextending the neck while flexing the upper back. Over time this can produce an overuse injury, causing compression and loading of joints, soft tissue and nerves.
The first step is to have a thorough workup from a physician who specializes in the diagnosis and treatment of athletic injuries. An MRI of the cervical spine would also be very helpful in diagnosing the extent and severity of this condition. Once you have a diagnosis and clear understanding of the extent of the problem, you can figure out how best to deal with it.
I would also recommend that you have a professional assessment of your position on the bike. To reduce the amount of neck extension, you should consider raising the handlebar height with an adjustable stem or one with a higher rise. Changing the handlebar reach by adjusting the stem length could also contribute to neck and upper back comfort.
Strengthening and stabilizing the neck, shoulders and supporting upper back muscles through exercise can also help prevent the strain that leads to trauma and inflammation.
Finally, if none of these suggestions helps, and your condition continues to deteriorate, consider riding a recumbent. I’m a part-time recumbent rider.
Alan Bragman is a chiropractor living in Atlanta, Georgia. He is a former Cat 3 cyclist and nationally ranked inline speed skater. He was on the medical advisory board at Bicycling magazine for 10 years and has written for other sports publications.