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.

hands in the drops, should be within an inch or two of your knees at the top of your stroke. [Lemond].  Finally, Bicycling Magazine recommends that while in a comfortable position with hands on the brake hoods, looking straight ahead, that a plumb bob dropped from the tip of the nose should intersect the stem.

As much as possible, forward lean toward the handlebars should come from the pelvis rotating toward the handlebar rather than the back bending.  Ideally, the back will be straight, pelvis tilted with no loss of breathing efficiency.

Handlebar Height

If the handlebars are too low, excess lordosis of the lumbar spine and increased hyperextension of the cervical spine occurs, leading to both low back and neck pain.  Measure the handlebar height by holding a yardstick on the seat so that the yardstick extends over the bars noting the difference between the seat and the bars. Ideally, the handlebars should be even with the seat or between even and 4 centimeters lower.  Extremely fit, flexible cyclists may have their handlebars up to 5-9 centimeters below the level of the seat [Lemond/Bicycling].  The competitive cyclist will have their bicycle adjusted to fit how they individually ride.

Stretching and Strength Training

Because cycling demands prolonged back flexion and neck extension, ensuring that your neck and back are flexible is very important.  The cycling process demands repetitive hip and leg flexion anchored by a stable pelvis.  Core strength and stability should be sought for all riders.  A physical therapist or a sports medicine provider can easily teach common back and neck stretches and back core-strengthening exercises.


Neck and back pain is a common complaint among cyclists.  By making a few select adjustments to the bicycle added to a core strengthening and stretching program, this ailment can be easily remedied.  Proper fit should be ensured; this is accomplished by relieving over extension by using handlebars with less drop, shorter stem, elevating the stem or adjusting the seat position.  Changing hand position frequently, relaxing the elbows, and varying head position will decrease the likelihood of developing neck and back pain.  As more people seek low-impact ways to improve and maintain their cardiovascular fitness, physicians will no doubt see more patients who have neck and back pain related to bicycling. By learning a few simple bike-fitting techniques, physicians can treat and prevent many common problems of this popular activity.


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Weiss BD. Nontraumatic injuries in amateur long distance bicyclists. Am J Sports Med 1985; 13(3): 187-192.

Dannenberg AL, Needle S, Mullady D, et al. Predictors of injury among 1638 riders in a recreational long-distance bicycle tour: cycle across Maryland. Am J Sports Med 1996; 24(6): 747-753.

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