Cycling until your neck hurts? A professional cyclist experienced neck tension radiating to the elbow. We identified compensatory patterns in the pelvis and cervical breathing through movement assessment.
【Case Background】
The individual is a female, approximately 45–50 years old. She is a typical sedentary office worker but maintains a very disciplined exercise habit, with cycling training five days a week.
About a month ago, she suddenly felt significant discomfort in her shoulder, neck, and upper back, which even radiated all the way to her right elbow.
She has already sought medical attention. The doctor interpreted her X-ray and believed the issue was a “straightened cervical curve” and that the muscles around the cervical spine were very tight. She was advised to undergo standard physical therapy.
After doing therapy for a while, she felt the improvement was not as expected, and it also affected her training schedule. She wanted to look for other professional perspectives.
She is worried that if the nerve compression becomes more severe and leads to hand numbness, she won’t be able to train anymore.
My initial thought is: she is an office worker, and combined with the cycling posture, both are unfavorable for releasing pressure from the cervical spine.
Besides finding her body’s compensatory patterns, in the future, she also needs to learn how to relax and perform posture-correcting training as daily maintenance.
Simply put, if her “cervical spine” were an office worker: besides the daytime job, it also has to work “overtime” to handle the cycling training. With such a heavy long-term burden, it wouldn’t be surprising if the cervical spine encountered health problems one day.
【Assessment Findings】
- Compensatory Systemic Alignment Imbalance:
- Significant difference in balance between the left and right legs.
- The pelvis habitually rotates to the right, accompanied by a posterior pelvic tilt (likely related to cycling and office posture).
- When standing, the cervical spine habitually turns to the left (possibly a compensation for the pelvic tilt).
- Obvious tightness and discomfort during cervical flexion and extension.
- No significant scoliosis was found.
- Key Muscle Weakness:
- The hamstrings are significantly weak.
- Habitual cervical (neck) breathing and breath-holding to maintain core stability (this may represent long-term stress and core weakness; no wonder the neck is so tight).
【My Recommendations】 Based on the results above, I will give her a three-stage plan to help her maintain a long-term balance between work and high training volume:
- Corrective Exercises:
Relax high-tension muscles and induce weak muscle groups. The short-term goal is to return the pelvis to its position. To be precise, the goal is not the “pelvis” itself, but optimizing the tension of the muscles surrounding it (such as the hamstrings) so that when her lower limbs move, pelvic tilt is reduced.
Common Misconception: Correcting the pelvis directly without adjusting the control habits of surrounding muscles will eventually lead to the pelvis tilting again. The position of skeletal structures is related to the tension of soft tissues.
Enhance lower limb balance to reduce the gap between both legs. The smaller the gap, the less likely the pelvis will lose balance. If the neck issue is caused by pelvic tilt, the pressure on the cervical spine will naturally decrease after training. - Core Training:
After alignment is optimized, training for spinal proprioception and the core will be more efficient. The focus of the core is breathing control ability, followed by core muscle strength.
That is, first learn an efficient and effortless breathing pattern, then learn how to use respiratory muscles to strengthen intra-abdominal pressure (core stability).
This reduces the burden on the cervical respiratory muscles and helps with posture correction. - Functional Training:
My purpose for strengthening is not to improve the cycling training program, but to help her improve her ability to return to a correct posture. After all, both work and cycling require slouching and posterior pelvic tilt.
she needs functional recovery of posture, such as the back muscles having the ability to pull back the spine and scapula.
It’s like a table tennis player needing non-dominant hand training—one purpose is to help systemic muscle balance and avoid the phenomenon where the more you train, the more crooked the posture becomes.
One more thing:
Improving workplace stress can also help. Reducing stress can help improve neck and shoulder stiffness, and even issues affecting the endocrine system, as psychology affects physiological performance. However, this part belongs to the fields of functional medicine and psychological counseling; different fields require professional cooperation.
Note from the Author:
This category features ‘Consultation Case Studies‘ involving individuals who have not received exercise training intervention. As such, the clinical analysis and recommendations are based exclusively on movement assessment findings. Because every kinetic chain and compensatory pattern is unique, these notes are provided for clinical reasoning reference only.This article was originally composed in Chinese and translated to share these clinical insights with the global athletic training community. Our goal is to bridge the gap between movement science and practical application across languages.
About the Author｜Andy Hsu, MS, Athletic Trainer
Train Smarter After Injury.
Precision Movement Optimization & Return to Play (RTP)
- Former Athletic Trainer, Landseed Sports Medicine Center
- Former Athletic Trainer, National Sports Training Center (Taiwan)
- Former Athletic Trainer for National Teams (Table Tennis, Volleyball)