Roundtable: Shermer's Neck - Part 1
21 November, 2022
Shermer’s Neck is a condition where the neck muscles fail from fatigue and can no longer support the weight of the head. It is an unusual phenomenon; after feeling the first symptoms the neck muscles can stop functioning quite unexpectedly and imminently. This can lead to a significantly compromised field of vision, an obvious safety risk when it comes to ultra distance cycling. Given the self-reliant nature of our sport, riders are expected to manage any injuries on their own terms alongside the rational judgement of when to scratch on the grounds of health and safety. However, should this responsibility be extended beyond the racer to the race organiser? Operating under a mentally fatigued state, can all racers be trusted to make the right decision on the grounds of safety for themselves and other road users?
As our sport continues to grow the issue of Shermer’s Neck has become a prevalent issue and reports of the condition seem to crop up on most ultra distance races. We believe that a lot more can be done to highlight it, increasing awareness and the overall safety of the sport. In the absence of a governing body, a community discussion is crucial. This two part roundtable is a collective conversation about whose responsibility it is to deal with and how it should be managed appropriately by race organisers and on social media. It also aims to shed light upon the condition from a physiological point of view. For this we have a contribution from Joe Le Sage, a NHS Physiotherapist for 18 years and recent convert to ultra distance cycling. Joe's words aim to bust the myth behind the condition alongside advice on how to take back control.
In addition to Joe, our panel for this roundtable includes: Adrian O'Sullivan, director of The TransAtlantic Way Race and ultra race veteran; Nikki Ray, ultra endurance cyclist with recent first hand experience of Shermer's Neck; James Hayden, experienced ultra endurance cyclist with back to back wins at the Transcontinental Race and director of L’esperit de Girona; Christoph Strasser, experienced ultra endurance cyclist, six-time winner and record holder for RAAM and winner of the TCRno8; Maximilian Schnell, Bike Adventurer and bikepacker of the three Grand Tours in 2021.
Joe, first and foremost please enlighten us on this condition dubbed 'Shermer's Neck'. What is it, and what is it not?
So, let me get this out the way first. I don’t like the name Shermer’s Neck. Scratch that, I don’t like it that “Shermer’s Neck” has a name. Sure, I understand the concept of naming things so we have a common language and other people know what we’re referring to, but it creates a problem. A quick Google search brings this up: The creepiest cycling condition: Shermer’s Neck. And there we have it: a myth is born. Who’s it going to strike randomly next?
Shermer’s Neck, if we’re going to call it that, is simply fatigue. It’s a hyper-accelerated version of what we see routinely in the general population: over-reliance on the neck extensors to support and move the head, leading to pain and fatigue. It’s common in people who are stressed, don’t sleep well or are over-sedentary. Ha, that’s us (yup, long-distance cycling is pretty sedentary from the hips up).
OK, so what should the typical ultra distance cyclist be aware of in relation to the condition and why is it such a limiter?
Endurance, and particularly ultra-endurance sport is all about management of fatigue. Managing neck muscle fatigue is no different to managing your legs or general tiredness. Every ultra-distance cyclist should be building it into their training plan and race strategy.
Imagine you’re carrying a heavy bag of shopping with your elbow at 90˚. Every so often you put it down, straighten your elbow, give your arm a shake, pick it back up and off you go. The problem is, we can’t simply remove our head and strap it to the tri-bars, so how do we off-load the muscles supporting the head? Before we get into that, we need to go back in time, to understand how our Musculo-skeletal system has evolved and what limitations that imposes.
Structurally, we haven’t changed much since we were walking around on four legs. Imagine us as a dog-to-human transformer. We have the same component parts, just arranged differently. A dog’s eyes are in the top of its head, so it can see forwards with the neck relaxed. The neck extensors only engage when they’re it’s alerted to something – danger or dinner. Dogs also sleep a lot, something long-distance bike riders don’t. We’re a bit too clever and we rely almost 100% on our eyes to make sense of the world around us. In the evolution from all fours to upright, our eyes migrated south and our brains became big (& heavy). The average weight of a head is around 5kg. So we’ve got these huge, heavy heads and our torsos are angled forwards. Our neck extensors are constantly in action, opposing gravity, so we can see the road ahead.
Should race organisers have any safety measures or procedures in place to regulate rider safety in case of Shermer's Neck, and if so what should these be?
Christoph Strasser: Yes, I absolutely vote for a control of Shermer’s Neck by race organisers. Even if the most important philosophy of self-supported racing is riding self-sufficient and with personal responsibility, there are some important rules. Race organisations control (and penalise) if participants are riding dangerously: For example cycling without proper lighting or without warning vests. Riding while suffering from Shermer’s Neck is definitely very dangerous! The rider is not able to look ahead, can risk a crash or cause accidents.
My proposal is that organisers should check the basic safety requirements at every Checkpoint when stamping the Brevet Card. When a rider does not comply with safety requirements, he is not allowed to continue, even if he was fine at the start. This is not about limiting the freedom of a participant in an unsupported race, but about enforcing safety on the road. Since I know and ride a lot of supported races, I am used to race organisers enforcing strict rules, controlling them via lots of officials and penalising or disqualifying racers if they do not follow the rules. I think this is a good and important strategy.
Another difference is that in supported races like RAAM, most riders have a doctor in their support crew who can monitor a rider's health and treat medical problems like Shermer’s Neck. A crew in a follow vehicle can also watch the rider closely and ensure his safety. In unsupported racing treating Shermer’s Neck is nearly impossible and riding lonely becomes even more dangerous than in a supported race.
Nikki Ray: I recently had to scratch from the Trans Pyrenees Race because of Shermer's Neck, but at the time I had no idea about the condition. This was pretty terrifying as my neck locked whilst descending in the dark on single track. I continued throughout most of the following day before realising that something was very wrong and the margin of riding off the side of a mountain was increasing by the second.
I think race organisers must inform participants in their race manual/pre ride communications about the condition of Shermer’s Neck and the risk it poses to a rider’s safety and physical ability to continue the race. By not doing so it is assuming prior knowledge, which is risky, and is not making the sport more inclusive. I also think that, if race organisers are serious about the wellbeing of their riders, they should take a stance on riding with Shermer’s Neck. Race organisers could make a policy of, if they hear of a rider developing Shermer’s Neck, that rider will be encouraged to leave the race. Or, that the rider won’t be able to receive an official finish if they choose to continue riding after developing the condition.
James Hayden: This is a huge can of worms, and really if you were to discuss event organisers implementing 'fire breaks' for rider safety, you'd have to go wider than Shermer's Neck. I think this is dealt with in two ways; 1. We are all adults and can hopefully make sensible decisions. 2. 'Race Director's decision is final'. This second rule covers so much, and clearly covers the race director being able to withdraw someone from the race/event on any grounds they see fit. I think we must keep things simple and thus the situation is covered, it's just down to the race director.
Maximilian Schnell: Races call themselves self supported. How can yourself claim a self supported finisher if your body is not able to support a part of itself, and needs external help to do so? Race organisers should indeed, in my opinion, take a participant out of the standings if his or her security - and above all, if other rider's and people's security - are at risk.
Adrian O'Sullivan: Having raced in many ultra cycling events both supported and unsupported and having organised hands on for many years the Transatlantic Way Race, experience leads my thoughts and actions. If a rider wants to risk his life I'm OK with that, like free climbers, potholers and wingsuit jumpers to name a few. This argument breaks down for me when we introduce the public. We ride on public roads and so I believe we have a duty to said public.
What risk does a bicycle travelling 20mph pose to a car weighing two tonnes and travelling double the speed? So picture this: someone you care about and love hits a cyclist and kills them. They don’t understand how. Maybe they didn’t give enough room while overtaking, maybe the cyclist swerved, maybe they were on their phone, nobody knows. Then it becomes clear that the rider was in an ultra endurance race and it appeared on social media that they were suffering from Shermer's Neck or had only 3 hours of sleep in four days. How would you feel then? The Transatlantic Way Race has an automatic scratch for any rider suffering from Shermer's Neck. Since 2017. And to encourage riders to basically give up, a free place for the following year is offered, as we cannot police it nor do we want to. It has no place in our sport and should be banned for any rider who suffers with it to continue. This is made clear at the start.
During an ultra race who has the ultimate responsibility over whether a rider has to stop/rest or continue: the Rider or the Race Organiser? Should the nature of the race (supported / self-supported) and severity of the issue play a part in this decision?
Adrian O'Sullivan: The Race Organiser absolutely, as I believe fatigue, ego, competitiveness and peer pressure are all very real factors that can and do effect rider judgement.
James Hayden: During TCR no.3 I went from my neck being fine to not working in a very short timeframe (circa 1h) – the pain then got progressively worse. A race director cannot be omnipresent and thus the responsibility firstly falls to the rider, then the director - defer to Q1 answer. Ultimately this could be covered by 'don't be a dick', if you're in medical distress you need to think beyond the here and now, to the future, don't be a dick to your body.
Christoph Strasser: Since this case of Shermer’s Neck influences the safety of a rider and all the other people on the road, this should not be an individual rider’s decision, but one from officials or organisers. If racers are suffering knee pain, sleep deprivation, sickness, saddle sores, breathing problems, numb fingers or other health issues, it is okay to let everybody make their own decisions. However there are some inevitable requirements to be allowed to keep on racing: reflective tapes and vests, lighting, and the ability to keep your head up. I would also like to discuss if a check of mental clarity would be a good idea. If a rider is too sleep deprived, maybe race organisers should have the right to enact a mandatory sleeping break.
Maximilian Schnell: The rider has the ultimate responsibility to choose to go on or stop. Race organisers have the responsibility though to make sure the rider respects the rules of the race. In all races though, one rule is to follow the law of the given country. As far as I know, cycling with a binded head to the saddle is not legal, as it is just not safe and also puts the other road users in danger.
Nikki Ray: As my cycling physio has said, Shermer's Neck should always end in a scratch. I understand that this could be a controversial subject, but for both supported and self-supported races my opinion remains the same, Shermer’s Neck = scratch. Once a rider loses the ability to look forwards (and to the right and left) their race is over and I think that only riders who have this experience first-hand, or medical professionals should be given a platform to talk about it. I couldn’t look round mountain corners whilst descending with Shermer’s Neck, when I cycled into a parked car I knew I had to scratch. I bumped into a race organiser just before scratching, they didn’t insist that I scratched but did stress that my safety was paramount. I think there should be equal responsibility of the rider, because of prior information shared to them by the race organisers, and the race organisers to ensure a scratch is the only outcome. I really don’t want it to take a case of someone losing their life on the road because of a Shermer’s Neck condition that was encouraged by race organisers and our community, for us to change our opinions about it.
As a brief summary, we have a better understanding of Shermer's Neck as over-reliance on the neck extensors to support and move the head, leading to neck muscle fatigue and ultimately failure. From our panel, we gathered the holistic opinion that race organisers should at least communicate the dangers of Shermer's Neck to racers, with the consensus that those developing the condition should be removed from the race. As noted by James the organiser cannot be omnipresent and thus the initial responsibility firstly falls to the rider, and then to the race director. Our panel share the collective opinion that Shermer's Neck influences both the safety of the rider and other road users, therefore it is the ultimate responsibility of the race director to remove riders from the race on the grounds of safety. This is supported by the fact that several factors can affect rider judgement as noted by Adrian; fatigue, ego, competitiveness and peer pressure to name a few.
Stay tuned for Part 2 of this feature on Shermer's Neck. In this we will discuss how it should be dealt with appropriately on social media, and future actions to raise awareness of the condition within the cycling community. Our guest physio, Joe, will also provide some practical tips on how to manage neck extensor fatigue both on and off the bike.