Neck & Shoulder Pain From Cycling: A Closer Look

Originally published in the Capital Bicycle Club’s February 2012 Newsletter.

One of the more common ailments that can arise from cycling is pain in the neck and shoulder region. In fact, a number of sports medicine research studies have shown that neck/shoulder pain can occur in approximately 10-50% (or more) of amateur cyclists. With the exception of acute trauma from a particular event, such as a crash, these symptoms generally arise from overuse injuries. Fortunately, in most cases, treatment can be very effective and will often lead to a better overall experience on the bicycle. In my office, these are some of the things I keep in mind when treating a cyclist for neck pain. Hopefully, you find some useful info that you can use yourself, or pass along.

Understanding Overuse Injury: Understanding the type of injury is important. Overuse injury describes the degenerative condition of the body that occurs from micro-trauma of the joints, tendons, ligaments, muscles, etc. An example of this on the bicycle is when a rider is positioned on a road bike with bars that are too low. This forces hyperextension of the neck in order to see up the road. Perhaps the rider can tolerate this for the short term, but over time, but eventually the muscles fatigue from the stress and become symptomatic with pain, stiffness, weakness, etc. The longer the stress is there, the more tissue damage develops, and the chronic pain/dysfunction gets perpetuated.

Technique: In terms of technique, some of the most common associations I see in riders with neck pain is that they tend to have a very tight grip on the bars, ride with rigid elbows, and tend to spend a lot of time in the drops of the handlebars. Similarly, they may also be newer riders who have started putting on longer and longer miles/hours on the bike. Good weather early in the season, is also something that I associate with neck pain on the bike because enthusiastic riders may spend a LOT of time on the bike without the benefit of progressive adaptation after a long winter.

Bike Fit: Bike fit can play a major role in neck/shoulder comfort. In particular, I tend to look to the positioning of the handlebars relative to the saddle, and the positioning of the saddle itself. Among other things, if the front of the saddle is tipped down, a rider will end up placing too much weight on the hands to keep from sliding forward. Handlebars that are too low, or a saddle that is positioned too high can force excessive hyperextension of the neck. Bars that are too far away or too wide can cause hyperextension of the neck and increased weight-bearing on the hands. These are some of the main areas of bike fit to consider, but not all.

Underlying Pathology: Underlying pathology may also be a strong consideration, especially with someone who may have a longer history of upper back, shoulder, and neck pain. Arthritic/degenerative changes of the neck are a physical manifestation of underlying problems of regional stability and control of movement. These riders will often also lack basic core strength and have problems with flexibility in the neck and other areas of the body. In other words, a pre-existing dysfunction carries over to the bike, and the repetitive nature of cycling amplifies the problem.

In many cases, a careful look at the location/type of pain, rider equipment, and habits of riding will make a solution obvious. Don’t be discouraged, though, if it doesn’t. Bodies and bicycles are complex and often, more than one factor is involved when it comes to our comfort on the bike. I hope that this article has given some new tools and insight into the relationship of you to your bicycle and makes your next ride more comfortable. See you on the road!

Asplund, et al. Neck and Back Pain in Bicycling. 2005.
Weiss Non-Traumatic Injuries in Amateur Long Distance Cyclists. 1985.
Wilber, et al. An Epidemiological Analysis of Overuse Injuries Among Cyclists. 1995.

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