post ride neck pain/headache

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post ride neck pain/headache

Postby shakes » Sun Feb 09, 2014 9:08 pm

Only on the roadie. Post ride (typically either harder rides or 2.5-3hrs+ my neck tightens which gradually turns into a headache.
It is definitely worse if I'm just riding somewhere flat like beach road as opposed to getting out into the hills.

It seems I tend to hunch or slouch my shoulders forward when riding, but even paying full attention to it on big rides doesn't seem to help. I've also changed my glasses so I'm craning my neck as little as possible. Sinus' don't let me ride without them.
Making sure post ride I stretch my pecs and traps helps slightly but not much. As does regular yoga classes.
I've had a couple of 'shop fit' from guys that do have quite alot of experience, but never a full in depth fit from a physio or similar. (and the bank doesn't stretch that far atm unfortunately)

Does anyone have any tips or tricks to help me out, from what I understand it's mostly a fit/posture issue? I know part of the answer will be getting a full pro fit done - any suggestions for melbourne?
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by BNA » Mon Feb 10, 2014 5:31 am

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Re: post ride neck pain/headache

Postby kb » Mon Feb 10, 2014 5:31 am

Lie on your back with a foam roller vertically along your spine. Arms out sideways to let the chest open up. Relaxing into it sometimes works better than forcing the stretch. A little rolling side to side in that position is also good for loosening the trapezius a little.
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Re: post ride neck pain/headache

Postby Stefan_A » Mon Feb 10, 2014 5:59 am

review hydration before, during, after.
get your neck joints mobilized by a physio. the top 3 jts either side are the source of most headaches of this type. it's a very common problem and easily settled. they should give you some self stretching exercises too.
you also might need to raise the bars until you adapt more so to using drop bars.
and don't neglect your diet. not eating enough veges and fruit results in higher levels of systemic inflammation, which predisposes to sore inflammed joints.
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Re: post ride neck pain/headache

Postby matagi » Mon Feb 10, 2014 6:29 am

I agree with StefanA about seeing a physio.

If you are Bayside, I can recommend Physiosports on Nepean Hwy, Brighton. They do bike fit assessments.
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Re: post ride neck pain/headache

Postby shakes » Mon Feb 10, 2014 7:07 pm

Stefan_A wrote:review hydration before, during, after.
get your neck joints mobilized by a physio. the top 3 jts either side are the source of most headaches of this type. it's a very common problem and easily settled. they should give you some self stretching exercises too.
you also might need to raise the bars until you adapt more so to using drop bars.
and don't neglect your diet. not eating enough veges and fruit results in higher levels of systemic inflammation, which predisposes to sore inflammed joints.


Thanks, I'm confident hydration is good.

Interesting point on the fruit and vegies, I eat plenty of vegies. But fruit I really struggle with. I get a small handfull of dried fruit in a trail mix each day but thats really almost it.
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Re: post ride neck pain/headache

Postby TheBikeShed » Tue Feb 11, 2014 8:47 am

Seeing a physio is always a good idea, and I definitely recommend that. Foam rolling, too, can solve a surprisingly large number of problems. The other thing that I recommend is doing some yoga or yoga-inspired stretches for loosening up the muscles in your back, shoulders, and neck. I've started using this routine lately, and it seems to help quite a bit: http://www.fitsugar.com/Best-Yoga-Poses ... ning-slide . Of course, it depends a lot on exactly what's causing your issues, but stretching probably won't hurt. Start stretching now and see a physio when you can.
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Re: post ride neck pain/headache

Postby eeksll » Tue Feb 11, 2014 3:35 pm

No direct experience here.

I have another thread talking about headaches and as part of my reading for my headaches I came across "exertion headache".

Some had suggested this could be caused by straining the muscles around the head too much. The suggestion was to do a massage those muscles around the neck and scalp directly after a ride.
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Re: post ride neck pain/headache

Postby Eleri » Tue Feb 11, 2014 8:35 pm

A few years ago I used to get a lot of neck and shoulder pain and often a headache coming out of that after a long ride.

I've been working on my core strength for about 4 years now and I've progressively less pain until now I get none. My fit on the bike is good, and has been throughout and I'm certain it's that my posture has improved because of core strength. Not a quick fix though.
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Re: post ride neck pain/headache

Postby shakes » Wed Feb 12, 2014 7:28 pm

Already try get to 1 yoga class a week, and do a bit of climbing/bouldering so 'core' is also reasonably strong.
Foam roller helps relieve to an extent but doesn't remove it.

eerle - I do get exertion headaches, but it's more from change of temps afterwards, IE working in a hot gym, going out into cold air = guaranteed headache. I also need to be very careful not to clench my jaw on a hard ride, or hold my breath while pushing hard.

I think Stefan is on the money with a couple of tight spots and regular massage. Keep the idea's coming, much appreciated.
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Re: post ride neck pain/headache

Postby rodneycc » Wed Feb 12, 2014 8:27 pm

You know might be something as simple as a shorter stem length. I shortened mine and it made a huge diff to my neck and shoulders.

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Re: post ride neck pain/headache

Postby ValleyForge » Wed Feb 12, 2014 8:39 pm

EIH (exercise induced headache) would be high on the list. Pre-exercise NSAID - usually something simple like Nurofen.

Cheaper than a physio (I have several physios in my family!)
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Re: post ride neck pain/headache

Postby Stefan_A » Thu Feb 13, 2014 9:25 am

ValleyForge wrote:EIH (exercise induced headache) would be high on the list. Pre-exercise NSAID - usually something simple like Nurofen.

Cheaper than a physio (I have several physios in my family!)


The cost effectiveness of seeing a physio is to get the diagnosis right, which taking NSAIDs won't help. An experienced clinical physio's assessment is an essential component of differentially diagnosing headache cause, whether an intermittent intracranial bleed or hydrocephalus (due to mild Arnold Chiari malformation), tumor, cardiovascular complication, or musculoskeletal cause such as brachial plexus neuromechanical sensitivity.
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Re: post ride neck pain/headache

Postby eeksll » Thu Feb 13, 2014 1:43 pm

Stefan_A wrote:
ValleyForge wrote:EIH (exercise induced headache) would be high on the list. Pre-exercise NSAID - usually something simple like Nurofen.

Cheaper than a physio (I have several physios in my family!)


The cost effectiveness of seeing a physio is to get the diagnosis right, which taking NSAIDs won't help. An experienced clinical physio's assessment is an essential component of differentially diagnosing headache cause, whether an intermittent intracranial bleed or hydrocephalus (due to mild Arnold Chiari malformation), tumor, cardiovascular complication, or musculoskeletal cause such as brachial plexus neuromechanical sensitivity.


Not sure physios are particularly qualified in that area. If you go down the route of professional help, I'd be going to a sports doctor first. For me atleast, thats cheaper than a physio. Mind you they will probably shoot you off for some scans and things like that, so that will cost you.
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Re: post ride neck pain/headache

Postby Stefan_A » Thu Feb 13, 2014 4:40 pm

eeksll wrote:
Stefan_A wrote:
ValleyForge wrote:EIH (exercise induced headache) would be high on the list. Pre-exercise NSAID - usually something simple like Nurofen.

Cheaper than a physio (I have several physios in my family!)


The cost effectiveness of seeing a physio is to get the diagnosis right, which taking NSAIDs won't help. An experienced clinical physio's assessment is an essential component of differentially diagnosing headache cause, whether an intermittent intracranial bleed or hydrocephalus (due to mild Arnold Chiari malformation), tumor, cardiovascular complication, or musculoskeletal cause such as brachial plexus neuromechanical sensitivity.


Not sure physios are particularly qualified in that area. If you go down the route of professional help, I'd be going to a sports doctor first. For me atleast, thats cheaper than a physio. Mind you they will probably shoot you off for some scans and things like that, so that will cost you.


how long do you recommend someone take NSAIDs before going down the sports doctor path?
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Re: post ride neck pain/headache

Postby ValleyForge » Thu Feb 13, 2014 5:42 pm

Standard teaching is three weeks of pre-exercise NSAIDs. If it's not dramatically better, then usually a GP visit - blood pressure, look in eyes, few other things. Obligatory CT head for the lawyers.
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Re: post ride neck pain/headache

Postby eeksll » Thu Feb 13, 2014 10:10 pm

Stefan_A wrote:
eeksll wrote:Not sure physios are particularly qualified in that area. If you go down the route of professional help, I'd be going to a sports doctor first. For me atleast, thats cheaper than a physio. Mind you they will probably shoot you off for some scans and things like that, so that will cost you.


how long do you recommend someone take NSAIDs before going down the sports doctor path?


no idea. I'd be seeking medical opinion pretty soon if I planned to take tablets/meds before every ride. But I one of those people who don't like pill popping too much.

My suggestion simply meant that from my experience physios are not particularly good at getting a diagnosis right. A sports doctor has a medical background and the ability to send you off for medical scans.

I had a arm issue, went to the physio. In short after 2 sessions he said he had no idea what it was. Sent me off to the sports doctor. I talked to the sports doctor about what I should do first next time. He said a Dr would give you a proper diagnosis of the issue and send you to the physio if that is the best course of action. So seeing him first is best.

now of course he is biased. But putting my un-biased hat on (as best I can) the sport dr cost me $35 ish ($70'ish then medicare gives me back $35ish). The physios first appt costs me $50 ish (after some money back from private health). I think thats $35 well spent, if the doc sends me off for scans cause he isn't sure, then not seeing the dr and going straight to the physio may just well be pot-luck that the physios exercises has solved my issues.
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Re: post ride neck pain/headache

Postby trailgumby » Fri Feb 14, 2014 5:45 am

Definitely see a sports medico first. You need him to be able to order the scans and get them bulk billed. A competent physio would insist on them before starting treatment anyway.

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Re: post ride neck pain/headache

Postby Stefan_A » Fri Feb 14, 2014 11:14 am

From what I've been told, Medicare has clear guidelines on when they'll cover scans. Public health isn't about covering MRIs for acute musculoskeletal pain. GPs tend to let many conditions go chronic before they order them. Regarding diagnosis, I suppose it comes down to personal experience. My physio sees over 80 musculoskeletal conditions a week, and has over 40 years experience manually handling tissue and differentially diagnosing. His hands on assessment skill and explanations are the most comprehensive of any I've experienced from all health profressionals, possibly partly because appts are longer.

I've never experienced a GP, orthopod, or sport physician assess as comprehensively and quickly, and get it right more often without scans. However scans, even mri, don't override the results of a comprehensive orthopedic assessment. Each is given due respect. I think the pros (and cons) of physios is they have to treat in addition to diagnose. I've seen sports physicians 5 times and have never been prescribed and trained in exercise, or had soft tissue treatment of any kind. It was brace, RICE, anti-inflamms, steroid injection, return to sport without regard to injury recurrence.
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Re: post ride neck pain/headache

Postby Dr_Mutley » Fri Feb 14, 2014 3:54 pm

Interesting views of the referral pathway.... Personally, dork general sports and MSK things, I would have a good physio or sports doctor on top of the pyramid, with bad physios, all (most) GPs, and some sports docs on the bottom...

BUT for cycling related things, I can't think of one sports medicine, or orthopedic doctor I would refer a cyclist too... So whoever inferred earlier, that it is best to go see a sports doctor because they have a medical background is probably being a little generalistic... Maybe I'm just sheltered and don't know any decent sports med docs who have a thorough appreciation of cycle specific stuff... If I am please PM me some names!

Personally, someone has a cycle specific problem, the best practitioner to see is a MSK therapist (physio etc) who thoroughly appreciates bike fit, and it's associated mechanics... If u think u have a uncommon, or genetic problem like previously mentioned, then go see your GP and get your head scanned.

With regards to Medicare criteria for scans, as long as u have an appropriate provider number and sign the form, there won't be an issue in terms of Medicare rebates. MRIs are a little more policed, but rarely is there issues with Medicare rebates as for MSK scans as long as it's ordered by the appropriate person...
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Re: post ride neck pain/headache

Postby eeksll » Fri Feb 14, 2014 4:29 pm

A Sport GP won't fix the problem. But if he gives you a correct diagnosis he can send you off to the correct professional, whether that be a surgeon or physio.

The thing I was trying to say is one needs to know its a "cycle specific problem" first and not something else.
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Re: post ride neck pain/headache

Postby Dr_Mutley » Sat Feb 15, 2014 4:08 pm

eeksll wrote:A Sport GP won't fix the problem. But if he gives you a correct diagnosis he can send you off to the correct professional, whether that be a surgeon or physio.

The thing I was trying to say is one needs to know its a "cycle specific problem" first and not something else.


True but u can normally work that out yourself to exclude non bike things like a Toooomur....

Are the HAs exacerbated by riding? Do they settle somewhat if your not riding? Are u palpably sore in any particular spots?... These plus more basic and intuitive questions will exclude most non-bike related causes... Granted, not all, but we need to take a sensible approach...

A bit like the hydration recommendations above. That is unlikely to cure headaches on the bike, but is a sensible approach regardless given the nature of the exercise, and may reduce some of the symptoms
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Re: post ride neck pain/headache

Postby shakes » Mon Mar 10, 2014 2:57 pm

Thought I would update this.

Saw a physio - They massaged out my pecs/traps/neck/jaw and referred me onto a Myotherapist.

The Myo said I was simply full of knots and tightness and it was impossible to tell the root cause, a couple of very painfull massages later and it's potentially a mix of tight glutes and pecs from work/riding/running/climbing/pillow/life in general. A couple of regular massages and some extra time with the foam roller and spiky ball seems to have it nailed.

Now to work out the root cause.....

Thanks for the comments.
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