Roundtable: Shermer's Neck - Part 2

Roundtable: Shermer's Neck - Part 2

9 December, 2022

This roundtable is Part 2 of a two-part feature on Shermer's Neck. In Part 1 we aimed to shed some light upon the condition, with a collective discussion concerning responsibilities and appropriate action. If you missed it, you can catch up on Part 1 here.

Various contraptions have been documented showing methods used by riders to support the head after developing Shermer’s Neck. During an ultra race, should this be documented and shared by the media team, or what is the most appropriate action?

Christoph Strasser: Why not? I think the media reports should be as objective as possible. Making a bigger drama than a situation actually is, just to get more attention is not good. But on the other hand, hiding a racer’s struggles would also be not good. Making Ultracycling seem easy, portraying only happy riders without pain, generating the illusion that even beginners and inexperienced riders can achieve a finish in a long ultra race is careless and dangerous. It must be very clear that a serious physical preparation is necessary to avoid long-term damage on your health. Problems and pain should be shown to the dotwatchers and the spectators. By this, the stories of the racers can be understood on an objective basis, and potential future participants realise what can happen if they are not prepared well enough and underestimate the challenge.

Strasser SN

Pictured: Strasser's 'worstcase-scenario backup'. This construction was custom built with an orthopedist, the strategy being to use it from time to time if any small signs of neck trouble appeared during a race. Thus, supporting the head as a preventative measure before suffering from Shermer's Neck. Luckily, Strasser has never needed to use it.

James Hayden: Why not document it? Sure there are limits, if someone broke their leg and it was bleeding and they were trying to ride still then no. But if someone has Shermer's Neck and they have a working solution and feel OK with it, cover it. If I was going to push to cut coverage of something, firstly it would be the fetishism with sleep deprivation, especially on tarmac events.

Adrian O'Sullivan: It’s embarrassing to our sport to see solo self-supported riders risking their safety and the safety of others unchecked, with any manner of self rigged supports. Ban it.

Nikki Ray: After seeing recent photos from an ultra-race essentially celebrating a rider for creating a contraption to hold their head up whilst suffering from Shermer’s Neck I really feel strongly that these contraptions should not be documented and shared by media teams, in a celebratory way. By doing so it is signalling to others that it is common practice to do the same, that it’s not dangerous and will not cause long term/worse problems. It also trivialises the condition and downplays its severity especially for a rider’s welfare. Media teams should report that a rider has developed Shermer’s Neck and their personal experience, including symptoms i.e. inability to look forwards on the bike due to neck muscles failing preventing the head being held up, otherwise the condition could become invisible. But media teams should not advertise, and as such, condone and encourage reckless behaviour like this to the masses. I don’t imagine that such riders who are featured using these contraptions receive follow up coverage about their physical (and mental) wellbeing weeks after the race has finished, this is short sighted and unethical.

Maximilian Schnell: Documenting it is promoting it! It will give ideas to others to imitate those methods and it puts the documented rider into the light. In a sport that is getting more and more attraction and people tending to professionalise it more and more, documenting those kinds of behaviour is encouraging the riders to do so. Appropriate action is inaction, ignoring that rider.

Max Schnell on SN

In your opinion, how well is Shermer’s Neck known and understood by the cycling fraternity? What more could be done to raise awareness of the condition and the associated risks?

Nikki Ray: From a personal perspective, I knew nothing about the condition before I developed it. On conversing with (male) TPR riders after the race, it seemed to be relatively well known. However, it is never wise or inclusive to assume prior knowledge of any condition, and in doing so we are making the community more of a clique or a “club” that only certain people are members of. Ultra cycling is quickly growing as a sport and in doing so the “community” holds a responsibility to inform and look after those newly entering the sport. Additionally, ultra cycling still has a massive diversity problem and the participation of women and especially people of colour is still incredibly low. In our quest to encourage participation from across our society we need to information share as much as possible about conditions such as Shermer’s Neck otherwise we risk putting riders entering the ultra cycling scene in danger. I have yet to hear about another woman experiencing Shermer’s Neck, this is important as our experiences may be different to male riders. Written pieces such as this one, talks discussing race preparation and wellbeing during ultra races; and case studies of riders experiences and recovery from Shermer’s Neck are good places to start.

Nikki Ray on SN

Maximilian Schnell: I think Shermer's Neck is a setback the cycling community doesn't really understand as only just a few already experienced it for themselves. In my opinion, there's not a lot that should be done to raise awareness, as when your body sends you a signal, you should just be adult enough to listen to it.

Adrian O'Sullivan: It should be brought to the riders attention in pre-race emails with links and information. This also goes for other potentially dangerous injuries like hand palsy where riders find it difficult to pull the brakes or change gear. So if the rider starts to suffer from it they are 1: Aware of the condition, 2: Know they have to stop.

Christoph Strasser: I am just wondering, how participants can prepare themselves for a race and not know about this problem? To my mind, preparing for a race also means reading books and blogs, watching movies, listening to podcasts and finding out about all possible problems which can happen, like Shermer's Neck. I think riding unsupported and self-reliant also means to prepare to be self-reliant. Advice from the community is important, but still, it is not our duty to educate rookies. We should do, of course. But a rookie also has to inform themselves and not enter a race carelessly.

In supported races like RAAM this is one of the main worries among athletes, since in this race the chance to develop Shermer’s Neck is much higher (Michael Shermer, who gave the name to this condition, was a well-known RAAM rider and ultracycling pioneer). In RAAM most racers ride for 23 hours a day and only stop for a one-hour sleep and never stop for resupply. So, the stress on the neck muscles is much higher in RAAM. Even if there are only 30 to 50 participants each year, almost every year there are cases of Shermer's Neck. Talking about it, showing stories, and establishing a race rule (or at least advice in the race manual) could help to raise awareness.

James Hayden: I don't think it's something people have on their list of possible issues, it does seem to be getting more common. Whether that's because there are more people doing the sport, more new people coming in (who don't have the neck strength developed over years) or else. Perhaps event manuals can have a helpful section on common medical issues and some links to guides on how to address them - this could be on the Dotwatcher site.

Joe, as ultra distance cyclists what can we do to keep neck extensor fatigue at bay?

There are 2 key elements to managing neck extensor fatigue:

  1. Changing our normal head position;
  2. Building in constant micro-breaks from mile 1.

Firstly, changing how we hold & move our heads. It helps to learn how the neck and head move. It’s hard to describe, but try to elongate the whole neck by retracting the head and tucking the chin in slightly. Our muscles don’t work well in a lengthened position (think stretching your hamstrings when you get cramp), so keeping the back of the neck long will prevent the neck extensors from being overactive. Support the head by creating tension in the front of the neck – we have muscles called deep neck flexors that are effectively the neck’s “core”. They only need a slight amount of tension to activate and you can still move your head when they’re switched on. In this position, practice doing very small nods of the head, generating the movement from the front of the neck. Contrast this with an exaggerated neck bend – doing micro-head movements in this position isn’t possible as the neck extensors generate a gross neck movement. Practice this as much as you can: on the turbo, at work, when you’re on the loo or talking to your Mum on the phone. Drill this position and movements on the bike, so it becomes your normal.

You need to be aware of this stuff in your daily life too, and particularly in the build up to an event. Just as we don’t want to start an event with fatigued legs, we need to ensure our neck muscles are fresh before we get to the start line. This may be particularly relevant if you spend a lot of time at a computer or driving.

Lead with the eyes: look out of the top of your eyes and think about how much of the road you really need to see. You certainly don’t need to see the sky, so get used to just seeing as much as you need to. Cap peaks down looks cool but is a definite no-no, as it wrecks your field of vision. Similarly, some glasses will obscure your view, causing you to lift you head further. Even tiny changes have a big impact over a long period of time.

Relax: relaxation is key. Tune into your shoulders, neck, upper torso, jaw, muscles in the face. Tension anywhere in the whole system increases tension everywhere in the system. Raise your pads and widen them if you need to. It may be less aero, but comfort is king. Remove lights from the front of your helmet during the day. Incorporate the pelvis and lower back: learn how your pelvis moves. You can raise your head by tilting your pelvis when everything else is fixed. Keeping your pelvis, and hence lumbar spine moving is important for reducing low back pain too.

Secondly, building in micro-breaks from mile 1. Free-wheeling up to junctions, on short (safe) downhills, when you’re off the bike: really exaggerate pulling the chin in and stretching out the neck (and rounding off the lower back by tucking the pelvis under). Try to use the times you’re not pedalling to relax as well. Going up long steady drags, you don’t need to be aero and you don’t need to see far ahead: sit up straight, tuck the chin in. Get the scapulae moving – big arm circles, do the breast-stroke, sit up with your hands off the ‘bars and stretch upwards, roll the shoulders. On the tri-bars retract & protract the scapulae, arching the back and sinking down between your shoulders. Do these off the bike as well, when you’re sat use the backrest of the chair and slump, let your chin hang down – you need your muscles to switch off.

Joe Le Sage on SN

OK, so what immediate things should I do if the condition strikes me during a race?

First of all, you need to check in regularly with your neck muscles, just as you do with your legs. That way you know when tension is building, which will lead to fatigue. Distraction is a very powerful pain killer so get in the habit of periodically paying attention to what’s happening around the neck and shoulders, so you can pre-empt problems before they become catastrophic.

Counter-intuitively, really scrunching the neck muscles tight and then relaxing them can help. It can be exquisitely painful, but you can break the muscle tension by tightening first. It’s also a good way to check for tension. We seem to bypass the ‘pain phase’ (probably because the brain is so absorbed in everything else), so we don’t feel it coming on, but you’ll soon know if you shrug your shoulders hard. Shrug your shoulders up & down to get some movement going. Self-massage can help. If you need to stop, again, relaxation is key. Ice is almost certainly pointless. Get comfy and make sure your neck and jaw are relaxed. Eat ice cream. It might not help, but you’ll feel better for it.

Try not to stress – it increases tension and will exacerbate the issue. If you’ve previously suffered with this, do an event without worrying about average speed, daily mileage or what position you’ll finish. Smile, enjoy what you’re doing. Let the experience of being out on the road with no other cares wash over you. Ring someone you love and get it all out. Cry. Sleep. And don’t forget the sun screen.

If all else fails and you scratch? It’s probably going to be the best decision safety wise, and not the end of the world. You don’t have a ‘problem’ – you just didn’t get it right this time. There’s no failsafe recipe for success, so like all other aspects of our crazy little sport, self-awareness, experimentation and hours and hours of practice are the only way to find what works for you.

To summarise, our panel showed mixed views on how Shermer's Neck should be conveyed appropriately via social media. Ignoring the issue won't make it go away, nor help to educate the cycling community on the issues and risks. As mentioned by Nikki it seems obvious that cases of Shermer's Neck should not be documented and shared by media teams in a celebratory way, or misinterpreted in this way. Therefore where images are shared, it is important to be prudent in the choice of words. The message should be clear: the use of a contraption to support one's head whilst cycling is not to be encouraged, noting it as a reckless approach towards personal safety.

Shermer's Neck is one of a number of physical issues which could occur during an ultra race. Christoph points out that problems and pain should be shown to the dotwatchers and the spectators. By this, the stories of the racers can be understood on an objective basis. As above, care should be taken not to trivialise dangerous conditions and downplay their severity. Sharing the trials and tribulations of a rider's experience presents authenticity to the Dotwatcher, allowing future participants to understand the challenges and risks and be better prepared for all eventualities.

Our guest Physio Joe helped us to understand that Shermer's Neck goes much deeper than simple muscle fatigue, and that every ultra distance cyclist should be building specific neck exercises into their training plan and race strategy to prevent long term damage. As with any injury, recovery from Shermer's Neck is a sliding scale. We caught up with Nikki to see how her own recovery was going: she is still very much in recovery mode months later, and it seems she is building her neck strength back up from scratch. She is also having to re/learn how to hold her neck well which is also tiring, whilst mobility is still a little limited. Also, the muscles of her right shoulder and top of back are very tight.

Ultra distance cycling is a fast growing sport, and the community holds a certain responsibility to inform rookies on the challenges, risks and best practice. We anticipate that this feature will go some way towards this. Education is particularly necessary for Shermer's Neck which is largely unheard of outside the cycling community, with very little scientific research to go by. In supported races such as Race Across America the stress on the neck muscles is much higher therefore the likelyhood of developing the condition also higher than in self-supported races. However, the same approach should be taken by race organisers whether self-supported or supported. This includes pre-race communication with riders, advice in the race manual and establishing a race rule which acts as a policy for dealing with cases of Shermer's Neck.

Christopher Claris SN