Bicycling with Neck Pain?

Neck and upper back pain is one of the most common pains a cyclist will experience, especially when riding longer distances, starting off on a new bike, or with prolonged climbs.

These symptoms include:

  • Pain at the base of the base of the head and neck, often causing headache
  • Burning, cramping and aching of the back of the neck, top of shoulders (upper trapezius, levitator scapulae) and into the upper back, in-between shoulder blades (scapulae)
  • Tingling and numbness extending form the neck down the arms — generally a sign that nerves are getting compressed.

Although there are many factors related to neck pain on the bike, one of the most common causes is related to reaching too far to your handlebars.

How can I tell if I’m reaching too far?

Quick self-check on a road bike: When assessing your reach, sit on your saddle, and position your hands on the brake hoods. Theoretically our hands should be in this position for roughly 70–80% of the time cycling, should feel comfortable, and allows for quick access to your brakes and (index) shifting.

In this position, the goal is to have your shoulder angle (the imaginary angle between your trunk and your arms) at, or slightly less than 90 degrees (see Fig A); Essentially a right angle between your trunk and your shoulders when riding, and with a slight bend in the elbows:

Fig A Note the 90deg angle between shoulders and trunk, as indicated

The amount of reach is affected by your stem length/height, handlebar size, saddle height, the brake hoods/shifters position, your general body flexibility/fitness, experience, your understanding proper cycling posture, and even your core strength- LOTS to consider!

As a general rule, anytime the shoulder angle exceeds 90deg, the likelihood of upper back and neck symptoms skyrockets due to to the additional stress and torque placed on these tissues in this position.

OK, so what can I do about it?

Start with the ‘low-hanging fruit’. There are 2 simple things to consider before going out and buying new equipment such as a shorter stem, or one with a more upright angle:

1) Consider saddle height- An all-too-common scenario is someone who’s saddle is too high, which leads to a greater reach. This happens because the angle of the seat tube: as you raise the saddle, the distance between the handlebars and saddle increases. Conversely, by lowering your saddle, you can oftentimes decrease your reach enough to make up that 0.5cm to 1cm reach differential. Try it out: Lower your saddle in 5mm increments, and re-check your shoulder angle, but also consider your cycling posture . . . read on!

2) Check your posture- This is always a biggie, even in highly-trained, seasoned cyclists. A rounded lower back brings your weight backwards, and puts your lumbar spine in a more vulnerable, flexed, weakened position, ultimately leading to greater reach. Correct it: rotate your pelvis forwards, and think of lifting “up” with your chest, with the aim of having a flattened lower back, and a more upright head and neck posture.

Fig B: Note the shoulder angle and neck position between ‘slouched’ (LEFT) and better, flat back (RIGHT)

This postural influence is also commonly why neck pain comes on towards the second-half of your ride, or with challenging hill-climbs: As you fatigue, your spinal and core muscles get tired, and you end up ‘slouching’ on your bike, leading to a greater shoulder angle, and thus a greater chance of neck/back pain while riding.

Give these few ideas a try, and if your neck symptpms continue to limit your cycling, it might be time to ask for advice from a bike-centric Physical Therapist and/or professional bike fitter in your area to assess your bike (vs body) as to the underlying cause of your symptpms.

Kevin Schmidt, MSPT, CMP, Bike PT is the Founder of Pedal PT: Bike Friendly Physcial Therapy in Portland, Oregon.

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