Dealing With Shoulder and Abdominal Pain While Riding

by Richard Ellin, MD, FACP

Question:  I’m 59, play hockey twice a week and ride a Lemond Revmaster. In my indoor training (the only kind available here this time of year) I’m experiencing abdominal pain, usually the day after, for 12 hours or so.  I’ve had an angiogram and my heart is fine.  I have some of the symptoms of gastroesophageal reflux disease (GERD), but this only seems to be initiated by aerobic activity. Does this make sense? — Dale S.

Dr. Richard Ellin Responds:  Dale, the shoulder/arm pain, in someone 59, certainly suggests some degenerative disk disease or arthritis in the neck, or a problem in the shoulder. Some tweaking of your riding posture might make a difference.

Further evaluation would consist of shoulder and cervical spine X-rays, though they probably can’t confirm or rule out the neck or shoulder as the cause. An evaluation by an orthopedist who specializes in shoulder problems would be worthwhile.

The abdominal pain is more difficult to understand. It is possible that your riding position is exerting enough pressure on the stomach to cause some acid reflux, but this should resolve within 1-2 hours after cycling.

It is also possible to have arterial blockages to the GI tract that can cause abdominal pain, but this is very uncommon and also should not last nearly this long.

Another condition to consider is acute intermittent porphyria. This can cause intermittent episodes of abdominal pain precipitated by stress and/or low glucose levels. It is relatively uncommon, and typically by age 59 you would already know you have this, but it’s easy for an internist to check for this.

Beyond these possibilities, a general evaluation of abdominal pain is the best way to arrive at a diagnosis, so that is what I recommend.

In sum, see a shoulder orthopedist and an internist.

Richard Ellin, MD, FACP, is a board-certified specialist in Internal Medicine who practices in Alpharetta, Georgia. He received his medical degree and completed residency at Emory University, and has been in practice with Kaiser Permanente for more than 26 years. He is also an avid cyclist.