As you near the 300-mile mark of your long anticipated race all systems appear, go! Your legs feel strong, your breathing is controlled and your energy is good. There's just this little twinge in the back of your neck... An hour later your legs still feel ready for another couple thousand miles, but your head feels like a bowling ball and the best you can do is stare down at your front wheel. Meet Shermer's Neck!

Michael Shermer grudgingly gave his name to this malady during the 1983 RAAM on his approach to Harrier, IL, nearly 2,000 miles into the race. His head felt heavy and the back of his neck was increasingly sore. He described it as, "a quick melt down." His head dropped, making it impossible for him to look up. Cradling his chin in the palm of one hand with his elbow on the padding of his aerobars, he supported his head well enough to finish the race. Despite excruciating pain during the event, his neck was back to normal within two days.

In the 21 years since Shermer experienced the first reported case of Shermer's Neck, countless other ultra-cyclists have had the same problem. Shermer's Neck typically starts between 300 and 1,000 miles into the race. In all cases the onset is sudden. From the time of first pain and weakness, the neck usually gives out within two to three hours. Symptoms always start in the back of the neck. The head feels heavy and the cyclist can't look up without assistance from a mechanical device. Once a cyclist gets Shermer's Neck, it is unlikely to leave for the remainder of the race.

The list of mechanical devices that have been used to support the head reads like a shopping list for an episode of the MacGyver TV program. Water bottles, Pringles® potato chip cans, bungee cords, boxes, even a hockey stick and duct tape (you can repair anything with duct tape!) have been used. For those who are prepared, specially designed head gear and chin rests have been created. While these will work as first aid, some more successfully than others, Shermer's Neck is a recurring nightmare for those who have experienced it.

Until the 2004 RAAM the anguished cyclist had to endure great pain despite the techniques employed by massage, physical and occupational therapists and even EMT's.

Case #1: Allenn Larsen completed RAAM twice and won the event in 2003. In 1988, he was in a car accident and sustained injuries to his neck and chronic pain. Larsen's took third in his first RAAM in 2002 despite Shermer's Neck. Halfway through the event he began to have symptoms and within two hours he was unable to hold his head upright. His inventive crew employed a stick duct taped to his helmet to lift his head. Shermer's Neck has remained a constant concern ever since. In 2003 he used a mechanical device to support his head during acute flare-ups.

Case #2: In his first RAAM attempt in 2004, Randy Van Zee contracted Shermer's Neck just 700 miles and two days into the race. His finish in 11 days 16 hours is a testament to his determination and ability to block out pain. Van Zee had never suffered from whiplash or related neck injuries, but after watching Larsen's 2003 RAAM video, he had a neck brace created. It was dubbed "the neck wrecker" because the crane-like extension rising from his back to support his head from behind looked like a wrecking truck. With the brace, Van Zee withstood more than nine days of pain. Although the contraption provided some help it also caused difficulties - it was painful to wear and never provided sufficient lift to allow him to see the road completely. Van Zee also had two EMTs and a massage therapist on his team.

Case #3: George Thomas has completed RAAM six times. His first two races were on four-man relay teams; he then raced solo and twice on a tandem. In 2004 Thomas and partner Terri Gooch finished first in the mixed two person relay with a time of 7 days 18 hours. Starting with the solo attempt and in every race since, Thomas experienced the classic symptoms of Shermer's Neck. His support crew used an Evian® water bottle duct taped to his handlebars to support Thomas' head during his solo race. Thomas developed a variety of different mechanical devices to lessen the pain and stave off the condition; however, nothing worked until this 2004.

As Thomas and Gooch prepared for their 2004 RAAM, they invited Sue Morris, LMT, to join their crew. Morris immediately researched Shermer's Neck and found no existing knowledge. She consulted Walter Libby, a 30-year licensed massage therapist and instructor in kinesiology at the Oregon School of Massage. Libby interviewed Thomas and discovered he had been involved in a severe automobile accident years earlier that included a whiplash injury. A physical examination revealed soreness and numerous trigger points in the front muscles of his neck (sternocleidomastoid or SCM and scalenes).

Libby established a treatment plan with Morris providing two to three massages per week working specifically on the trigger points in the effected muscles. Myofacial trigger points are commonly referred to as knots in the skeletal muscle. In the case of Shermer's Neck they appear in long strings along the SCM and scalenes. Trigger points are sore even to a light touch; they cause referred pain, restriction of movement and loss of function.

By the fifth month of treatment the trigger points were gone. Morris continued treatment until the start of the race.

During the race she performed light trigger point work. She also used ice on the SCM and scalene muscles and heat on the trapezius muscles during each of Thomas' breaks off the bike. Although he began to develop small trigger points around mile 300, none of them grew large enough to cause a problem and the condition did not impede his performance or comfort level during the remainder of the 3,000-mile race.

The SCM attaches to the skull behind the ear and plays a role in supporting the head. There are three separate scalene muscles that run beneath and behind the SCM and perform a similar function. In an extreme cycling position the scalene muscles may be in strong contraction while extending the neck. These muscles are not accustomed to prolonged, sustained work when the head is in an aero position during a long race. If there has been a pre-existing injury these muscles may develop trigger points, fatigue and can ultimately fail. By eliminating trigger points in the sternocleidomastoid and scalene muscles, strength returns to these muscles and much of the pain and dysfunction of Shermer's Neck is reduced.

George Thomas & Terri Gooch at the finish of RAAM '04

For this article, Libby and Morris interviewed seven cyclists who suffered from Shermer's Neck during RAAM. Five have experienced prior injuries similar to whiplash. During RAAM 2004 three received treatment as described above with similar results. In all three cases, treatment to the front of the neck lessened the pain in the back of the neck and prevented the onset of Shermer's Neck symptoms. None of the other approaches for treatment were successful. A recent independent study from the University of Leuven in Belgium supports the conclusion that Shermer's Neck is avoided through treatment of the SCM and scalenes.

Preventing Shermer's Neck
With this discovery, Sue Morris advises ultra-marathon cyclists who have had trauma to the neck or who have experienced symptoms similar to Shermer's Neck to begin preventive care early. If possible start six months in advance and get an assessment from a licensed massage therapist (LMT) with training in myofacial trigger point treatment. Make sure the support team includes an LMT with trigger point experience. Be prepared with ice and heat packs. And just in case all else fails, have a mechanical device on hand or at least a roll of duct tape.