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.


Participation in cycling has steadily increased over the past ten years. Individuals looking for a low-impact alternative to running and other aerobic activity have found cycling to meet these needs.  In fact, the American Bureau of Transportation Statistics estimates that more than 49 million Americans ride bicycles at least monthly, with over 5 million people riding at least 20 days/month. [BTS] As a result, the number of cycling-related injuries has also risen, with the majority due to overuse.  Improper bicycle fit, technique, or training patterns may either cause or exacerbate these injuries, and can lead to dysfunction, impaired performance, and pain.

Neck and back pain are common in cyclists because of the body's positioning during riding.   Several studies have demonstrated that neck and back injuries are the most common overuse injuries evaluated following six to eight-day distance bicycle tours (Figure 1). [Wilber/Weiss AJSM/Dannenberg] Wilber, et al. found that 44.2 % of male and 54.9% of female recreational cyclists presented for medical treatment of neck pain, while approximately 30% presented with back pain. [Wilber] Weiss also reported that 66.4 % of recreational cyclists reported neck and shoulder symptoms following an 8-day, 500-mile bicycle tour. [Weiss]  The prevalence of such injuries, especially in recreational riders, suggests that more understanding is needed by riders and their health care providers to prevent such injuries by proper education and fit, and treating these injuries when they occur.  A better understanding of the pathologic mechanism of musculoskeletal overuse injuries, specifically in cyclists, is key in developing good preventive and treatment strategies for the neck and back injuries they frequently experience.

Overuse Injuries

Overuse injuries occur when a tissue accumulates damage caused by repetitive sub-maximal loading. Repetitive activity fatigues a specific structure, such as tendon or bone. Without adequate recovery, micro trauma stimulates an inflammatory response, causing the release of vasoactive substances, inflammatory cells, and enzymes that damage local tissue. Over time, this trauma leads to clinical injury. Continued activity produces degenerative changes that result in weakness, loss of flexibility, and chronic pain. Thus, in overuse injuries, the problem is often not acute tissue inflammation (tendonitis), but chronic degeneration, or tendinosis. [Khan]

Pain in overuse injuries typically has an insidious onset.  However, it may also have an acute-on-chronic presentation. Overuse injuries most likely occur when an athlete changes the mode, intensity, or duration of training. Biomechanical (intrinsic) factors and equipment or training regimen (extrinsic) issues are the main contributors to overuse injuries.  It is the extrinsic issues that cause most of the overuse injuries in cyclists. [Mellion, Team Physician]

While problems such as fractures, dislocations, and ligament ruptures usually only occur after major trauma, overuse injuries are much more common.  Thus, these factors should be considered when evaluating neck and back pain as well as all cycling-related  injuries and one must consider bicycle fit, training distance and intensity, and anatomic factors to determine the exact mechanism.  Often, adjustments in the bicycle or the individual's exercise regimen may be all that is necessary to ameliorate their symptoms and accelerate the healing process.

Bicycle Anatomy

Bicycles consist of a frame,


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