Common Injuries Encountered By Cyclists

Neck & Mid Back Injuries

• Causes – This problem is typically due to over exertion of the muscles that extend the neck and raise the shoulders. The cause of this is usually the rams-horn style of handlebars that cause the rider to hold the head and neck in a hyperextended position for prolonged periods of time. Some individuals have problems with this due to the loss of the normal forward curve (lordosis) in their neck.  This type of structural problem is best addressed with chiropractic care.
• Symptoms – Spasm, tenderness and soreness of the muscles of the neck and upper back. Pain is usually felt with extension and rotation of the neck.
• Treatment – Initially stretching and strengthening the muscles of the neck and upper back is advisable. If the problem persists, it maybe due to structural problems in your neck.  If the neck and upper back pain persists for more than a week you need to be evaluated.

Lower Back  & Injuries

• Causes – Lower back strain and pain can occur when an unconditioned rider rides too long with the back flexed forward.  Other causes are obesity, weak trunk muscles or biomechanical dysfunction in the form of lumbar and sacroiliac subluxations .
• Symptoms – Decreased mobility of the trunk and spasms of the lower back. Pain is usually felt with flexion and rotation of the trunk muscles.  In many instances, lower back pain will be felt more on one side due to asymmetrical loading of the sacroiliac joints. If not corrected the individual may begin experiencing Sciatica.
• Treatment – Strengthening and stretching of the torso, lower back and hip musculature will help remedy many of the lower back symptoms many riders experience due to muscular weakness. If the injury has caused pain due to misalignments in the lower back or sacroiliac area strength training will only irritate the condition. If this is the case, chiropractic evaluation is indicated.

Trochanteric Bursitis

• Causes – Trochanteric bursitis is an inflammation of the bursa on the side of the hip, typically caused by the gluteus medius or iliotibial band rubbing over the bursa and causing irritation.  The injury is most common in cyclists with a saddle adjusted too high, unequal leg lengths (possible sacroiliac subluxation) or weak hip muscles.
• Symtoms – There is a gradual onset of pain. Typically, the pain is on the side of the hip and will gradually migrate down the side of the leg.  If not properly treated, sleeping on the affected side and climbing stairs will begin to cause pain.
• Treatment – Resting and icing the area is always beneficial.  Trochanteric busitis is usuallly a symptom of riding with a saddle that is too high.  Consider lowering the saddle to limit hip extension with each stroke.  Once the pain begins to subside begin stretching the gluteus medius and the IT band.

As I mentioned in the beginning of this post it is very important to have a professional help you to set up your bike.  Ergonomics are not just for the office.  A properly set up bike will not only increase your bike riding enjoyment but it will also minimize your chances of overuse injuries. Below is a video of a professional setting up a riders bicycle.

I hope this post has been helpful.  If you live in the Cincinnati area and are still experiencing pain while riding, even though your bike has been professionally fitted to your body give me a call and schedule an exam.

Happy Riding,

Dr. Gould

Finding the actual cause is very important. Typically, people do things that simply “numb” the problem. Numbing the problem however, with various medications only allows the problem to continue, ultimately causing more pain, disability and degeneration. A thorough history and examination with the appropriate diagnostic workup is necessary to find the actual cause of low back pain.

Below are several causes of low back pain:

• Poor Posture – Causes an improper loading of the spine. Improper spinal loading, forces weight to be placed on structures that were not designed to carry weight. This type of compensation ultimately causes pain. In the majority of cases, poor posture is a symptom of years of inadequate exercise and improper sitting postures both at home and at work. Watch your posture. Watch your children’s posture. I tell patients all the time that proper posture in children is critical. I have a saying I use all the time… As the twig is bent the tree shall grow.

• Disc problems – See Disc Problems

• Facet Syndrome – See Facet Syndrome

• Lumbar Subluxations – Misalignments or subluxations are the true enemy of the disc and spinal joints. When your spine becomes subluxated the disc’s normal pumping motion is reduced or in severe cases, completely eliminated due to loss of motion. This pumping motion is needed to pull in nutrients and eliminate waste in both the joints and the discs.

• Osteoarthritis – If the subluxation is not corrected, degenerative processes begin leading to osteoarthritis. This is a degeneration of both the disc and the spinal joints at that same level. Once this happens, the areas above and below the affected area have to compensate for the osteoarthritic area. Over time these areas will begin to become problematic also.

• Pelvic Problems – The pelvis is actually made up of three separate bones. Two side bones or iliums and a center bone called the sacrum. These bones come together and form joints. There are actually three joints in the pelvis. There is a single joint in the front of the pelvis and two in the rear. These joints allow motion to occur when we move and walk. On occasion these joints become misaligned or subluxated. When this happens the lower back can respond by tightening muscles, shifting vertebrae which in turn can cause a stretching of spinal joints. All produce pain.

Eight out of ten people in the Cincinnati area will experience back pain during their lifetime. There are really only two choices of treatment when it comes to back pain. 1) If you choose to treat the symptom you are allowing the problem to get worse. Remember… Eliminating the pain with drugs does not eliminate the problem. 2) If you choose to treat the cause you will be working on eliminating the problem for good. A large percentage of my practice is made up of people that have had low back pain.

Did you know there are times when your feet and ankles need to be adjusted?  Yes, misalignments and fixations can and do occur in your feet.  Far too often foot pain is ignored as simply being tired feet.

Your feet are a very unique, dynamic and complex structures. Each foot contains 26 bones and 33 joints. Together the feet make up more than 1/4 of all the bones in your body.

The average person will take between 8000 to 10,000 steps per day and cover approximately 115,000 miles in a lifetime.  Walking is a natural activity and should not cause discomfort.

Even if your feet do not hurt, an underlying foot problem can cause discomfort or pain in your leg, hip, back and neck due to structural compensations. What exactly do I mean by structural compensations? By design your feet are the foundation of your body.  So how can foot problems cause a headache or neck pain?

Have you ever noticed how a foundation problem in a house can cause cracks to form in the walls or cause doors and windows to not open properly?  This happens because the house is actually shifting or “compensating” due to the changes in the foundation.  Your body actually will do the same thing.  In your body, the muscles, ligaments and skeletal structures will shift to overcome the stresses that originate in your feet. It is this shifting that ultimately leads to soft tissue swelling and pain in other areas of your body.

Foot Problems Commonly Cause:

• Foot Pain
• Ankle Pain
• Leg Length Deficiencies (Short Leg)
• Shin Splints
• Knee Pain
• Weak Ankles
• Low Back Pain

If you are currently experiencing any of the above symptoms, give me a call so that we can schedule an examination and begin correcting your foot problem.

Yours in Health, Naturally!

Dr. Gould

Since opening my practice in 1988, I have had the privilege of teaching many local companies both big and small, the importance of Work-Station-Fit. What do I mean by Work-Station-Fit? I teach people how to make adjustments to their work environment so that the work environment fits their body, instead of their body trying to fit their work environment. By making a few simple changes comfort and fatigue are greatly reduced. This is what Ergonomics is all about.

Regardless of what you do for a living, having a simple understanding of Ergonomics can prevent a lot of pain syndromes and health problems. Improper ergonomics can lead to a variety of problems. Here are the most common problems: headaches, neck pain, shoulder and arm pain, carpal tunnel syndrome, upper back and lower back pain, varicose veins in the lower legs.

I’d like to give you a brief simple lesson in body mechanics.

First of all, our body is very efficient when it comes to energy consumption when we maintain an ideal posture. This ideal posture has a name, it is called the Neutral Position. Our body is said to be in a neutral position when all the weight of our body is balanced on the boney structures of our body, allowing it to be transferred into the seat pan of a chair (if we are sitting) or into the floor (if we are standing).

However, when we deviate from this neutral position our energy consumption goes up due to our weight being transferred away from our bone to the muscle. Going from the sitting position to the standing position requires us to get out of the neutral position. Imagine trying to stand in a position that is halfway between sitting and standing. I can tell you you would not last long. Why? Your muscles are now primarially responsible for holding all of your body weight up, not your bones. The load gets transferred from the boney structures of your body to the muscles.

So now you understand why you should try to obtain this neutral postition. So what does the neutral position look like? Here are a few guidelines:

If you are standing…

Stand straight up. Legs and feet symmetrical. Your head is looking straight ahead. Your arms are at your sides or if you are working at a table your elbows can be bent at a 70 to 90 degree angle. If you are working with your hands and eyes the table top should be elevated.

If you are sitting…

As you sit down push your bottom all the way back into the back of the chair, that way when you straighten up a natural curve will form in your lower back. Your head should be looking straight ahead. Not looking up or looking down. Now position your monitor, so that if you brought it to your face the center of the screen would touch your chin. Remember the 90 degree rule, elbows and knees should be at 90 degrees. Your feet should be flat on the floor. The edge of the seat pan (the part directly underneath your knees) should not be putting pressure on the back of your legs. Pressure on this area prevents the blood from returning from the lower leg, this can cause varicose veins. If your chair allows you to make and adjustment, make the adjustment. If not, put something under your feet to eliminate the pressure on the back side of the knee. If you use a keyboard keep your hands and wrists straight. Any deviation from this can lead to carpal tunnel issues.

Below is a humorous example of both good and bad ergonomics. Pay attention and learn.

I hope this has been helpful.

Yours in Health!

Dr. Gould

So what causes our spine to become antalgic? The simple explanation for this is weakness of the spinal muscles. Specifically the (paravertebral) muscles located on either side of the spine. This weakness allows more of the load of your body weight to be transferred away from the boney structures of the spine to the soft tissues around the spine. Specifically the disc.

A disc is made up of two parts. The ball like center is called the nucleus. Wrapping around the nucleus, in concentric rings, is a ligamentous structure called the annulus. By design, the disc allows the vertebra to tip on one another. This tipping allows us to bend in all directions.

Imagine watching two kids on a teeter-totter. When one goes up the other goes down. What allows this to occur is a center pivot point or fulcrum. The nucleus does the exact same thing, it allows the vertebra to tip or teeter on the other. When you bend to the right the nucleus actually shifts to the left in each disc. This causes a wedging of the disc. When you straighten back up the nucleus migrates back to the center.

The spine becomes antalgic when the nucleus does not migrate back to the center position. Within a short period of time the muscles that surround that area go into spasm which inturn causes more pain.

Correcting the problem requires isolating where it is occurring and then a series of spinal adjustments to reposition or center the nucleus. Once recentered, exercises are provided to strengthen the paravertebral musculature to prevent future occurrance.

I hope this has been helpful. If you should have a question or would like to make a comment please do so at the bottom of the page.

Yours in Health!

Dr. Gould

The typical older mattress causes what I call “hammocking” of your body. Imagine what your body would look like laying in a hammock. Your feet and head are higher than your bottom. Lying like this for several hours can cause a variety of things to happen to the spine. In your lower back it causes the forward curve of the spine to flatten out. This in-turn causes the spinal joints in your lower back to spread apart, in many cases causing muscle spasm to occur.

If you suffer from back pain it may be due to your mattress and box-springs. Check to see if your mattress has lost its ability to support your body weight. Have someone stand at the side of the bed while you lay in the center of the mattress on your back. Ask them if you are hammocking. If so, it’s time to shop for a new mattress and box-spring.

People always ask me what is the best type of mattress and box-spring. I always tell them that it is a very individual thing. You can spend several hundred, to several thousands of dollars on a mattress and box-springs and find yourself very dissatisfied after several nights of use. Just remember, all mattresses and box-springs have pros & cons.

What you are looking for is a mattress that is both comfortable and offers adequate spinal support. In the majority of cases, a medium to firm mattress with a pillow top usually does the trick.

When you are shopping go to a variety of stores. Don’t be in a hurry and do not allow the salesman to sell you, allow your spine to tell you. When you lay on a mattress and your body and spine go Ahhhhhhh! You know you have found a good one.

Let me know if this has been helpful?

Yours in Health,

Dr. Gould

Our spine has four curves. It is these curves that give us amazing flexibility. However, if the curve flattens out or increases problems can occur. Facet syndrome is usually seen in the lumbar spine or lower back. It happens when there is an increase or an accentuation of the lumbar curve. This increased curve is called a hyperlordosis. A hyperlordotic spine is predisposed to this type of syndrome due to the increased load it puts on the facets and joint capsule.

I have treated many people in the Cincinnati area that have had facet syndrome. Spinal adjustments coupled with home exercises are very effective at eliminating this syndrome. Like most neuromuscular problems, it is best to seek out treatment early. The longer you wait the more difficult your case becomes.