Maybe you are young now and feel invincible but think about what is happening to your parents. Are you someone in their 50’s or 60’s and still feel great and want to stay that way? What are some of the keys to a long life with cycling part of your regular recreation? What can anyone do to remain in peak form for the most years?
The picture to the left is of Paul Danhaus about half way into the RAAM (Race Across America) and the contraption he came up with to deal with neck problems from cycling 20–22 hours a day for days on end. Look closely at this picture and his neck position. The muscles and connective tissues are stretched in the front and compressed in the back. It doesn’t take a medical doctor or physical therapist to imagine what happens to the human body when held in this position for hours per week over many years.
In this example, the muscles in the front of the neck tend to weaken. The vertebrae in the neck get compressed. The muscles in the back of the neck shorten. The trapezoids start to over-compensate for the weakening in other muscles.
In an effort to relax muscles the cyclist feels are overused they allow poor positioning to occur. Shoulders can start to roll forward. We put more weight on our hands and stop using the abs as much. Maybe you start locking out your elbows because your arms are getting tired which transfers more force to the shoulders. On and on — hopefully you are getting the picture about the snowball effect going on in the body.
And, due to the remarkable adaptive ability of our bodies you might deal with these stresses for years seemingly with just a few sore muscles here and there. So what, you might say. Isn’t that what exercise is for? What doesn’t kill you makes you stronger! Push through the pain!!
I am here to tell you that pushing through the pain is not always a good thing. Just one example is the story of Navy Seal David Goggins who mastered the art of pushing through pain until he reached the point of a complete physical breakdown that almost killed him. Fascinating story I linked to above. This post deals with the more subtle breakdowns that happen and what we can do about it proactively and how to recover if you went too far.
For me, now in my mid-60’s and a life-long cyclist with a few breaks during my teens and 20’s, the slow breakdown manifested in neck problems most recently. I will get into the specifics of my neck problems and the array of steps taken to stop further damage and restore functionality.
First, it is important to cover common similarities of the various cycling related physical problems I have had, and, the common threads you will tread in the road to recovery. After that I will get into proactive ways the average athlete can beat back Father Time and keep an active and mostly pain-free life of recreation that can be applied to any sport.
The are common aspects of all my sports related issues with some trauma related and some where the trauma was the straw the broke the proverbial camel’s back.
- Loss of flexibility from holding set positions or the natural age-related decline.
- Lack of, or decline, in core strength
- Believing too strongly in the self-assessments of my physical condition.
- My faith in current preemptive conditioning programs I used to maintain flexibility and core strength.
For decades in some cases and at a minimum, many years, I have done different activities to maintain flexibility and core strength. Those included Tai Chi, Pilates, Foundation Training, Kettlebell training, light dumbell weight training, P90x, engaging in many recreational activities i.e. rowing boats, paddling inflatable kayaks, backcountry skiing, nordic skiing, alpine/resort skiing, mountain biking, road biking, bike touring, hiking, running, etc.
In addition, whenever I did injure myself I usually saw a physical therapist to ensure complete rehabilitation. I was not shy to try alternative medicine when I thought it was appropriate like chiropractic, acupuncture, chinese medicine, Bowen, and others. My home has the accoutrements of someone who has spent a lot of time doing physical therapy with a Bosu ball, exercise balls, exercise bands of all kinds, balance pads, ladder climber, stationary bike stand, etc. You get the picture?
In spite of all this, I still ended up with a couple major issues in the last five years. The first was a knee problem that resulted in significant enough pain and locking problems to make walking after a 40+ mile bike ride almost impossible due to pain and the inability for the knee to lock out. X-rays revealed minor arthritis in the joint. A series of PT visits, lots of core training, massage therapy and my own discoveries using a foam roller resolved the problem about 95%, but I need to use the foam roller after every ride now to stay pain-free.
The second more recent issue was what first started as a feeling of being a bobble-head when riding my bike and going over bumpy road. I felt like I had become the old person whose head bobbled uncontrollably in some situations. Maybe you have observed older people who look so inflexible when they walk, bike, or ski that their heads sort of bobble around and it looks like it happens from holding it too tight. That is what mine felt like though my riding partners assured me it didn’t look like that. Then I started getting cracking noises in the occipital area of the neck when cycling or skiing loud enough to become annoying. And, possibly related though not confirmed, at the same time I started experiencing tinnitus and was diagnosed with hearing loss predominantly in the left ear which is also the side I had lost the most flexibility turning to.
After complaining to my MD during an annual physical, he provided a Physical Therapy prescription. The PT diagnosed me with constricted mobility turning side-to-side and also looking down. I couldn’t believe it. He explained how our minds allow small incremental changes to go unnoticed while we learn compensatory behavior. In my case, I couldn’t turn my head to the left far enough to see behind me when making a lane change when driving so I had started turning my whole body. But, until faced with the evidence and doing a new self-assessment armed with new data, those compensating actions were not apparent to my everyday consciousness.
Where am I going with this story you might ask? I’m trying to set the table for a group of recommendations other people can take to hopefully not allow themselves to become as enfeebled as I got. Even though at 67 I am very healthy as compared to many, I have still had my problems. A hernia operation six years ago and my rehab from that affected my conditioning considerably. And, then a broken wrist and surgery a couple years later also sidelined me for several months. All these things along with aging pile up on us and in spite of rehabilitation using PT for the post-wrist surgery, other complications set in. On my surgeons advice I didn’t get PT after the hernia surgery and that was a big mistake by me — I should have insisted.
What can you do? Unfortunately the health-care system in the US is geared towards treating illness and physical degradation. There is little to no emphasis on prevention. Only after you have a high cholesterol result does your doctor maybe discuss diet. Most don’t even do that and just prescribe the latest/greatest statin.
While I think my program of self-assessment and activities I adopted like TaiChi, Pilates and Foundation Training helped me in many ways, they were not a be-all/end-all. The main issues were: 1) self-assessments were not accurate 2) the program I had devised was incomplete because of #1 and because I am not a trained PT. 3) poor form in doing certain exercises, stretches or activities either reduced effectiveness or caused problems.
What to do? I brainstormed with a friend who is a chiropractor and ART practitioner. My vision is to have a more holistic approach to maintaining health. The definition of holistic being used here is “characterized by the treatment of the whole person, taking into account mental and social factors, rather than just the symptoms of a disease”.
Some professional athletes like Lebron James and Tom Brady are doing this with unlimited amounts of money to spend. They have a personal staff of dieticians, PT’s, athletic trainers, doctors, sports psychologists, etc. to help them with every facet of maintaining optimal physical health. What can an average person do who is willing to spend a moderate amount of their own money along with what insurance and/or Medicare will pay for?
You cannot expect this to be a free ride paid for by insurance or Medicare. That is unrealistic. However, we may be able to find a way that gets us 80% of what Lebron and Brady have. We are going to do or contract out our own investigation and work.
Here we go!
- Pick the sports and recreation you like to do. For me that is mainly cycling, walking, skiing and TaiChi. Get a coach or coaches — this is critical and not to be minimized! If you don’t do this you will not identify all your weaknesses. For instance, though I have been doing TaiChi for 30 years, up until the pandemic I was still taking lessons. This last year I signed up for a Masters Ski Racing series that was very reasonably priced at less than $300 for a series of 8 gate training days along with coaching. I used to be a bicycle tour guide and had the benefit of feedback from the other guides but that ended a few years ago and I need to get something else in place. The coaches consistently give me new ways to think about a physical activity I’ve done for decades. At the very least get someone to video tape you and then analyze the video. Be forewarned this can be very humbling watching yourself so don’t get discouraged.
- Diet. There are a million out there. Find one that works for you and then stick to it. Make it something moderate that doesn’t lead to boom and bust. In my mind, diets like Keto are too much for most people. Time Restricted Eating (TRE) is easier for many people. The Mediterranean Diet is very flexible and has a good history of success. But, pick something you can do and adhere to it. Then change when it becomes mentally too much. Keep doing your own research.
- Body Assessment. “What gets measured gets done” was a saying you heard a lot in the high tech manufacturing world. a. There are the normal things most of us are familiar with that your MD orders up like cholesterol, triglycerides, blood pressure, colonoscopy, liver profiles, etc. These are good to have done routinely according to your doctor’s advice to find issues and establish a baseline to compare to later. b. Routine dental exams. Don’t skimp on your teeth. There are many studies showing links between teeth health and heart disease though it is not understood. I’ve had problems twice now of serious issues that were manifesting like the flu or whooping cough in one case and in another like some kind of gut problem that had my doctor looking for gall stones, that both ended up being infected teeth that needed root canals. Neither tooth had pain and were only discovered during routine x-ray’s.
- Body Assessment — The Game Changer. Here is what most of us need desperately. This is going to cost you out-of-pocket and is going to seem possibly wasteful. Remember, we need to take a holistic approach. We have talked about diet, tooth/mouth health, exercise and organ/cardiovascular health through MD visits. The place everything falls apart for most people is an assessment of muscle balance, tendon strength, core strength, and overall balance. This is where we need proactive assessment by a Physical Therapist for preventing issues instead of waiting to see the PT after we are injured. I want a PT to partner with that will assess the areas of the body where I am starting to lose flexibility and strength. Then give me a proactive program to address these issues before they manifest as neck pain/cracking, knee locking/pain, etc. and overuse injuries. Heading these off before advanced degeneration takes place is the goal.
This is the missing component that I discussed with my friend to having a holistic approach to health management. And, we discussed some possible Physical Therapists as candidates to engage that practice in the small rural city I live in. But I couldn’t even get an appointment for months out to the guy I wanted to approach. Now, I have found a new PT that is helping me with my neck and he agreed to this idea.
Over a couple appointments he assessed me head to toe and the results were heartening and surprising. Being a cyclist it was not surprising that my glutes, quads and hamstrings are fairly strong. So you would think, the legs are fine. Not so fast! I have weaknesses in the hip flexor muscles and inside adductors of the leg. Also, weakness in the muscles and flexibility of the shoulders were identified. My lower back is surprisingly strong! I’m not going to list all the items here for the sake of brevity. Overall, it was a fun and interesting process and I highly recommend this approach.
Now, we are developing a game plan of how to move forward targeting the areas of greatest weakness and that limit any activities. At the end of this I may end up with having good upper body posture for the first time in my life — haha! All these years of my dad telling me to stand up straight and that not being enough information to actually do it, might come to fruition.
What do you, the reader of this article think? Will you try this? Besides spending money on a PT for advice that your insurance is not going to reimburse you for, are there any downsides? Please leave your comment whether pro or con or you cannot decide.
Post Script regarding my neck (if you are interested) — after months of PT, Bowen (my dime) and massage therapy (more of my $$) for my neck issues, neck mobility as measured by the PT is almost back to normal. The cracking in my neck which really drove me crazy when riding and skiing has been eliminated (yeah!). The strengthening of the neck muscles and interestingly, ab muscles has given me some tricks to use when riding my bike that lessen or eliminate the neck cracking. My tinnitus has not changed. Likely though, my PT has said that kettlebell swinging may not be something smart to do ever again. Oh well, there are worse things.
The PT included neck stretches, neck strengthening, core strengthening from obliques to the rotator cuff and many in-between especially the ones around the shoulder blades. A side benefit is that my TaiChi had somewhat of a break-through because my trapezoids have relaxed allowing a more fluid upper body. TaiChi has become more of a diagnostic tool lately which has been an unexpected positive use. After about 4 months of PT, doing the exercises, spending about $700 of my own money on massage/Bowen/ART, I am feeling much better and seeing real significant improvement. A proactive approach may actually cost less in the end and prevent me from going through these kinds of more specific rehabilitations.
