Neck and Back Pain in Bicycling

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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.

handlebars, brakes, wheels, pedals, gears, and other components (figure 2). The key part is the frame, made of metal or metal alloys such as titanium, aluminum, steel, or carbon. Frames can be thought of as two triangles: the front triangle consists of the top tube, the seat tube, and the down tube; the chain stay, seat stay, and seat tube compose the rear triangle. Handling and maneuverability are affected by the angles within each of these triangles. Racing bicycles have a more upright geometry, with larger angles for increased maneuverability. Touring bicycles have a flatter geometry, which much less pronounced angles for easier handling and comfort.  In contrast, mountain bikes, designed for maneuverability and stability, have a geometry that provides for a lower center of gravity, resulting in much smaller angles in the frame.

Frame size is determined by the seat tube length in centimeters (mountain bicycles in inches), measured from the center of the bottom bracket to the center of the top tube or from the top of the bottom bracket to the top of the top tube. The top tube length affects the reach of the rider and is an important measurement for proper frame fit. The "virtual top tube" measurement is the top tube plus stem length, which equals the total reach.  While different bicycles are designed to position the rider differently (touring bikes allow for an upright ride, with less extension placed on the back, while racing and mountain bikes focus on the need for a more stream-lined ride, thus the rider is more "laid out" and has to extend his or neck more.  These differences impact what type of pain the rider experiences.

Neck and Upper Back Pain

Neck pain can be exacerbated by several factors to include riding position, technique, and comorbid conditions.  In the cycling position, the neck is extended and the back flexed for prolonged periods.  Riding in drop handlebars for long periods increases the load on the arms and shoulders as well as hyperextension of the neck, leading to muscle fatigue and 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 increased.  Prolonged 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 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 microtrauma, as is seen in overuse athletic injuries.  Certain techniques common to cyclists may also cause trigger point pain.  Cyclists frequently present with pain in their left levator scapula caused by frequently looking over their left shoulder for oncoming traffic.  Additionally, comorbidities must be assessed; in older riders, for example, it is prudent to question about radicular symptoms because a certain degree of neck pain may be secondary to arthritis in the cervical spine.

Thoracic outlet syndrome

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