How to Eliminate Neck and Back Pain in the Aero Position

A proper bike fit is the first place to start for a pain-free aero position, but there are a few things you can work on physically to ward off the hurt.

Progress Slowly

Start with a comfortable position, then slowly build strength and flexibility using the guide below to move into a more aggressive position.

Get Flexible

Flexibility is essential for riding in aero. If you’re stiff, your aero setup may not only be painful but inefficient, so loosen up with the following stretches. Do them post-workout for three sets, holding each for 30 seconds to 1 minute.

Hamstring stretch
Why: For most triathletes, lower back mobility and hamstring flexibility are often an issue.
How: Lying flat on your back, hold both ends of a bed sheet with your hands and place the middle of the sheet around the center on your foot. Raise your leg up towards the ceiling by pulling on the sheet. Continue to pull until you feel an intense, yet comfortable stretch. Be sure to keep your opposite leg straight and flat on the floor.

Cobras
Why: In addition to muscle flexibility, it is important for triathletes to have increased range of motion and mobility at the joints themselves—specifically within the vertebrae that make up the joints of the spine.
How: Lying on your stomach with your hands in front of you as if performing a push up, push through your arms to lift your entire upper body off of the floor until your elbows lock out, while keeping your hips flat on the floor. Return down to the starting position.

Quad stretch
Why: Keeping your quadriceps flexible will prevent your lower back and pelvis from being misaligned, causing pain in the aero position.
How: Lying on your stomach, use a bed sheet with the middle looped around the front top of your foot. Pull on the sheet with both hands to bring your foot towards your buttocks. Tip: To get a more intense stretch, prop your upper body up onto your elbows.

Upper trapezius stretch
Why: The base of the shoulders and neck often hurt in aero because the upper trapezius muscles and scapular stabilizers are weak and tight. Pain can present from the middle of your shoulder blades to the top of your forehead.
How: Sitting upright, side bend your head so that your ear moves towards your shoulder, then rotate your head so that your nose is moving towards your armpit on the same side. You should feel a stretch on the opposite side of your neck.

Foam roller angels
Why: These will also help alleviate shoulder and neck pain.
How: Lay on a foam roller, parallel with your spine, knees bent, feet on the floor, with your head supported by the foam roller. Place both arms on the floor to your side with your palms up. Keeping elbows locked, drag your knuckles on the ground to move your arms towards your head (similar to a snow angel motion). Hold the stretch if/and when your knuckles lift off of the ground, otherwise hold the stretch at the top of your range of motion.

Get Strong

Weakness can also cause pain in the aero position. Specifically, weakness of the abdominal, gluteal, hamstring, lower back, neck, and shoulder–stabilizing muscles. To efficiently strengthen these areas,
add the following simple exercises to your workouts: planks, weighted squats, and deadlifts. As a bonus, squatting and deadlifting teaches triathletes how to use their glutes, helping to improve cycling power and hill running. A little more advanced, but just as helpful for aero issues, are scapular stabilizers and chin retractions. All strength exercises should be performed with high reps; try two sets of 15 repetitions.

Scapular stabilizers series
Lying on your stomach, with your arms in a ‘T’ position, lift both arms up from the floor while keeping your palms down. Return back to the starting position. For the second exercise, repeat the same movement with your thumbs pointed down to the floor. Finally place your arms in a ‘V’ position (45 degrees from your head) with your thumbs up and lift both arms up from the floor.

Chin retractions
Seated upright, retract your chin backwards as if you are trying to make a double chin. Be sure that your head is moving backwards upon your shoulders—not moving your chin towards your chest.

Dr. Abigail Smith is a board-certified sports physical therapist. Her practice, Forward Motion Physical Therapy located in Westport, Conn., focuses primarily on treating endurance athletes.