and Back Pain in Cycling
Asplund, MD from roadcycling.com
and back pain are very common in cycling.
Many riders experience occasional or
recurrent neck and back pain related to their
and back pain are especially common in the early
season when riders are increasing both their mileage
and time in the saddle.
In order to avoid early season overuse
injuries, riders should initially ride at high
cadence and low resistance and only increase
training mileage by 10% weekly, gradually building
to goal mileage.
pain can be exacerbated by several factors to
include riding position and technique.
Riding in drop handlebars for long periods
increases the load on the arm and shoulders as well
as hyperextension of the neck, leading to pain.
If the virtual top tube length (top tube plus
stem length) is too long for the rider, or if aero
bars are used, hyperextension of the neck is further
hyperextension of the neck and associated muscle
strain may lead to trigger points in the muscles of
the neck and upper back.
Trigger points are small rubbery knots that
form in muscle and adjacent muscle sheaths (fascia),
which may send pain signals to the brain and
contribute to a pain-spasm-pain cycle.
Trigger points are frequently caused by
direct blunt trauma, or by repetitive micro trauma,
as is seen in overuse athletic injuries.
suffering from neck pain should inspect the fit of
One way to reduce neck hyperextension is by
raising the handlebars, or using handlebars with a
Another method is to reduce the virtual top
tube length, by using a stem with a shorter
the saddle forward would also reduce virtual top
tube length, but the rider should be cautious as
improper fore/aft saddle position can lead to knee
to riding technique can also help with neck pain.
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
The rider may also alter his head position
during the ride, in essence stretching the neck
muscles while riding.
pain is also very common in cycling.
Cycling position leads to prolonged back
flexion, resulting in muscle pain in the
The low back is the primary muscle group
generating power and controlling the movement of the
the back is not well conditioned and flexible,
muscle fatigue and strain will lead to pain.
virtual top tube length, and the amount of spinal
flexion in the riders 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 in the lumbar spine.
If the top tube length is too short, the
sacral spine will flex, increasing pressure on the
Ensuring that the handlebar height and top
tube length are correct should help minimize back
position also contributes to back pain, as a
malaligned pelvis will cause strain to the back
quadriceps will tend to pull the pelvis forward,
while tight hamstrings predispose to backward pelvic
the strength of the abdominal muscles is critical to
maintaining stable pelvic positioning.
Pushing large gears, or extended hill
climbing may fatigue the gluteus and the hamstrings,
causing the pelvis to tilt backwards, aggravating
the back musculature and causing pain.
Core muscle group strengthening and lower
extremity stretching will help with proper pelvic
positioning and should lead to pedaling efficiency.
changes of riding position can help with back pain.
Moving hand position from the drops to the
brake hoods to the top of the handlebars allows for
changes in posture, reducing strain on the back.
When climbing or pushing a big gear, moving
slightly back on the saddle will decrease strain on
pain while sprinting can be helped by moving
slightly forward on the saddle.
whose neck or back pain is refractory to the above
techniques should decrease their weekly mileage by
10% until the back pain disappears.
During this period of mileage reduction, they
should also avoid climbing and sprinting, and use a
high cadence, low resistance spinning technique.
Ice and non-steroidal anti-inflammatory drugs
(NSAIDs) such as ibuprofen, may be used to provide
pain relief. NSAIDs
should be taken with food, and if the pain is not
resolving within 1 week, medical evaluation is
management may include continuation of NSAIDs,
trigger point injections, and possible a referral
for physical therapy to improve core strength and
summary, although neck and back problems are very
common, they can usually be managed by a combination
of bicycle adjustment, technique change, and minor