Neck and Back Pain in Bicycling

News & Results

04/14/2005| 0 comments
by Chad Asplund, MD, Charles Webb, DO, and Thad Barkdull, MD

Neck and Back Pain in Bicycling

Improper bicycle fit can lead to dysfunction, impaired performance, and pain.

(TOS) is a less common, but important cause of neck pain.  TOS may present with tingling in the fingers; pain in the neck, shoulder, and arm; headaches in the back of the head; weakness of the arm and hand; cold or cyanotic hands.  These symptoms may worsen with such activities as elevating the arm to comb or blow-dry one's hair or drive a car.  TOS is most often produced by hyperextension neck injuries, typically traumatic, but may also be caused by repetitive over hyperextension of the neck.

Riders suffering from neck pain should inspect the fit of their bicycle.  One way to reduce neck hyperextension is by raising the handlebars, or using handlebars with a shallower drop.  Another method is to reduce the virtual top tube length, by using a shorter stem.  Moving the saddle forward also reduces virtual top tube length, but the rider should be cautious as improper fore/aft saddle position can lead to knee pain.

Changes to riding technique can also help with neck pain.  A rigid riding position transmits more shock directly to the neck and shoulders. Riding with unlocked elbows and changing hand position (i.e. from drops to brake hoods) can alter neck posture minimizing pain.  Although some handlebar materials provide a softer or stiffer ride, there is currently no evidence that changing handlebar material affects neck pain.  Educating cyclists to frequently stretch their neck during more leisurely parts of the ride may reduce the frequency and severity of neck pain.

Other factors contributing to neck pain are helmet fit and handlebar width. The helmet should be worn so that it is snug, stable, and level on the head with the front rim barely visible to the rider's eye.  Improperly fitted helmets may cause excessive neck extension in order to maintain visibility, resulting in further neck pain as described above.  Handlebars should be shoulder width apart (measured from acromion to acromion across the anterior chest) and comfortable.  Handlebars that are too wide may cause excessive trapezius and rhomboid strain leading to muscle spasm and pain. (Burke)

Back Pain

Back pain is also very common in cycling.  Cycling position leads to prolonged back flexion, resulting in muscle pain in the unconditioned back.  The low back is the primary muscle group generating power and controlling the movement of the bicycle.  If the back is not well conditioned and flexible, muscle fatigue and strain will occur, leading to pain.

The virtual top tube length and the amount of spinal flexion in the rider's back should be investigated in cyclists with back pain.  If the handlebars are too low, the flexion (lordosis) of the spine is exaggerated resulting in increased pressure on the lumbar spine.  If the top tube length is too short, the sacral spine will flex, increasing pressure on the intervertebral disks.  Ensuring that the handlebar height and top tube length are correct should help minimize back pain (discussed below).

Pelvic position also contributes to back pain, as a misaligned pelvis will cause strain to the back musculature.  Tight quadriceps will tend to tilt the pelvis forward, while tight


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