Back and Neck Pain While Cycling: Symptoms, Causes and Solutions 

by | Nov 15, 2023

Many cyclists experience back and neck pain while cycling at some point in their riding career.  If the issue is detracting from the cyclist’s ability to participate in and enjoy the sport they either put up with it, limit their participation, or seek help.   Professional assistance may come from a doctor, sports medicine doctor, physio, chiropractor, or bike fitter.  This article takes a look at back pain from the perspective of a bike fitter. Although back or neck pain may be the motivation for a bike fit session, it is also common for a cyclist to come in for a fit and present with relevant medical/injury history related to their back that the fitter should be aware of so they can take that into consideration. Back issues, including injuries and surgical treatments, can be broadly classed as muscular or spinal. 

Muscular Back and Neck Pain

Off bike 

If you have hurt your back from an activity off the bike and experienced a muscle strain or pinched nerve, then the recommendation is an appropriate medical intervention for assessment and rehabilitation before returning to cycling.  This may involve seeing a sports medicine doctor, physical therapist, chiropractor, sports massage therapist, or related body work practitioner.   

Subsequently, you may be wondering, “Can I still ride my bike after an off-bike back injury?” Cycling is unlikely to exacerbate the injury, but if your body is protecting the injury then you will have compensatory patterns on the bike which could lead to aches or pains elsewhere. There is no point in compounding the problem.

On Bike 

Back pain, especially lower back pain, is a very common complaint among cyclists. Fatigued and complaining back muscles are typically a result of postural compensation. In this scenario, the lower back muscles bear a disproportionately high workload to maintain the pelvic stability required for supporting the pedaling action of the legs.

This will usually manifest as a broad ache across the lower back but can be localized to one side and area.  This may only make itself known after a certain duration or level of effort, like climbing.  As climbing demands more effort, the workload increase can be the tipping point from a happy back to an unhappy and overloaded back.

There are a multitude of possible reasons for lower back pain when cycling, and often several working in concert to overload the back muscles.  These reasons can originate with the saddle and saddle position, the hand position, or simply a lack of awareness of how to arrange and use the body on the bike.

Sharp, localized pain is rare and could indicate an underlying medical condition, or result from trauma from a fall.  Appropriate medical assessment is recommended.

Causes of Back and Neck Pain While Cycling 

  • Unsuitable saddle causing posterior pelvic tilt to relieve genital pressure, rounding the lumbar spine.  This is often overlooked, but is a biggie.
  • Saddle too narrow, with not enough real estate to support the pelvis, leading to either pelvic rocking or asymmetrical positioning on the saddle.
  • Saddle height too high, again causing pelvic instability.
  • Leg length difference causing pelvic instability. 
  • Saddle too far back, causing increased hip and lumbar flexion. 
  • Saddle too nose down, resulting in the rider having to brace to stay on the saddle.
  • Handlebars too far out or down, causing the spine to extend to the end of range, instead of remaining neutral. 
  • Handlebars too close, causing the spine to flex and buckle to fit the available space, especially under higher workload. 
  • Center of mass too far forward, which shifts significant pressure to the hands.  This will usually cause hand, wrist, or neck issues, but the lower back will do its bit to try and unweight the front loading. 
  • Under-geared for climbs, requiring more low gear mashing, which demands more back-supported pelvic stability to push the pedals. 
  • Poor postural and positioning awareness.  

Resolving Back and Neck Pain 

Generalized lower back pain can usually be relieved with a professional bike fit in which the potential underlying causes are addressed, and the need for increased back muscle activity is reduced.  The bike fitter may not know exactly what issue is causing the problem, as it is often multi-factorial.  However, addressing issues of saddle selection and position, handlebar position, and coaching on postural awareness will often eliminate back pain while cycling.

Common opinion argues that a sore back is due to a weak core.  While everyone could benefit from a stronger core, and a weak core may play some role in back fatigue, this is rarely if ever the primary causative factor, but is a popular scapegoat.

From my experience as a bike fitter, one of the more common causes of lower back aches and pains is subconscious postural compensation for an unsuitable saddle.  On the bike, the cyclist will exhibit a relatively upright pelvis, and forward lean is taking place in the lumbar spine rather than the hip joint.  This aggravates the back but is a way to prevent even more aggravation from the genitals, if the pelvis was rotated forward.  Given the amount of weight most recreational and enthusiast cyclists put on a saddle – on an area of the body not intrinsically designed for this purpose – both saddle selection and positioning (height, setback, angle) are critical aspects to address in order to resolve back issues. 

Upper back pain is less common, but what hotly follows lower back pain as a complaint is upper shoulder tension that runs up into the neck, usually attributed to tension in the trapezius muscles. This is usually caused by too much weight shifted forward into the handlebars (center of mass biased forward), or a handlebar position either too low and far, or high and short, or any other combination! Note that opposite causes can have a similar effect, which can make upper back pain a little more challenging to sort out. A bike fitter will likely use a size cycle or a sizing stem to test and evaluate bar reach and stack to determine where the least amount of loading takes place, to reduce muscular tension in the upper back.

SPINAL 

Spinal conditions can present a more complicated situation to deal with but are often simpler to address in a bike fit than expected.  Spinal conditions will usually be described by both the region of the spine (lumbar, thoracic, cervical) and possibly the specific vertebrae involved, and the type of issue which may be the medical diagnosis or treatment. 

In broad terms spinal issues tend to fall into one of four types: 

  • Nerve impingement: pinching of a nerve as it exits the spinal cord and passes out of the spinal column.  This can stem from spinal stenosis, muscular tension, traumatic injury, or degeneration. 
  • Disc compression/herniation: a common injury> 
  • Fractures: there are several types including compression fractures.  
  • Degenerative: e.g. osteoporosis and arthritis. 

Addressing Cycling Lumbar Spine Issues 

Lumbar spine issues are by far the most common of the spinal problems, but surprisingly the easiest to deal with and the least troublesome for cyclists.  Medical treatment for the above may include rest, physical therapy, temporary back bracing, or surgery.   In some cases surgery may include spinal fusion, resulting in a reduced range of motion in the area. Many active people with lumbar spine issues turn to cycling due to the general low impact nature of the sport, and function well and pain-free on a bike. 

From a bike fit perspective, the key factors to attend to are creating a position with pelvic stability and a neutral spine. This applies to the whole spine, not just the lumbar spine. Pelvic stability will be driven primarily by saddle selection and positioning.  The goal is to minimize side-to-side rocking, twisting, or a twisted seated position, and to allow for the pelvis to tilt forward without noticeable genital pressure. 

A neutral spine is not an upright spine on a bicycle unless a high-wheeler is the mode of transport!  It is a spine neither compressed or extended in length, nor at the end of range for flexion (bending forward) or extension (arching backwards).  The key to a neutral spine is having enough anterior pelvic tilt such the rider can extend forward to the handlebars by pivoting in the hip joint and not bending in the lumbar spine.  Too much flexion in the lumbar spine or at the thoraco-lumbar junction is not neutral and will promote back pain. The handlebar position (bar reach and stack) needs to be appropriate as well, and the rider’s center of mass needs to be balanced over the bike (image would be great here).

A neutral spine allows the spinal vertebrae to stay largely parallel to each other, reducing pressure on the discs between each vertebrae, as well as relieving pressure on the nerve pathways exiting the spinal column. 

Addressing Thoracic Spine Issues 

Thoracic spine issues are the least common, and it is rare to have a rider present with an issue in the thoracic spine itself.  Injuries that could be associated with the thoracic spine include fractured ribs and collarbone.   

Fractured ribs need about 6 weeks to heal, and during that time the cyclist can still ride but should avoid any rough terrain (singletrack, gravel, and potholes), and keep their effort easy to reduce chest movement from labored breathing. 

A broken collarbone is one of the more common injuries from cycling accidents involving falls, and vary in the degree of trauma, need for surgery, and time to heal.  Medical advice is recommended.  Most cyclists can return to activity on a stationary indoor bike relatively quickly but should refrain from riding outside until strength and mobility have returned sufficient to safely hold the handlebars and control the bike. 

Addressing Cervical Spine Issues 

As the cervical spine is the most mobile part of the spine with the smallest vertebrae and least protection, it is the area most susceptible to traumatic injury. Cyclists with cervical spine issues usually present with either nerve impingement, or trauma-induced fractures that have led to surgery and spinal fusion.  

Nerve impingement may originate internally in the spine, or be externally provoked by poor cervical posture or having to sustain a poor position for a long period. A common cause is an aggressively low upper body position leading to excessive neck extension to maintain the ability to look ahead. A kinked neck = tight muscles and pinched nerves

The most challenging condition to cater to is a cervical spinal fusion, as this typically results in a significant reduction in range of motion in all directions.  A reduction in the ability to look ahead while bent forward is a literal pain in the neck and a safety issue. From a bike fitting perspective, cyclists with cervical fusion will need to be positioned with less bar reach and more bar stack to create a more upright position. Yes, this is both less stylish and less aerodynamic, as well as a less powerful position to ride in. However, the alternatives may have been much worse.  Comfortably being in a more upright position on a bike may be achieved by one or more of the following: 

  • More spacers under the stem (typically limited to 40mm on carbon steerer tubes). 
  • Shorter and steeper stem e.g. positive rise stem with + 17 to 35-degree angle; adjustable angle stem. 
  • Stem riser (only recommended on forks with a metal steerer tube, not carbon). 
  • Drop bar with rise, e.g Specialized Hover bar. 
  • Shorter bar reach (drop  bars) e.g. 70mm instead of 80–100mm 
  • Mountain bike bar with more rise e.g. 35–55 mm instead of a flat or low rise bar 
  • Change of bike type to allow for a more upright riding position, e.g. road race to road endurance; road endurance to flat bar road bike or fitness/hybrid bike. In some cases, a bike built with specific custom geometry may be the most viable solution.

Ride your Bike without Back or Neck Pain

Nothing detracts more from enjoying a sport than unnecessary discomfort, and back pain is an unnecessary discomfort. If a normal, healthy, and active human experiences back pain while cycling, but not at other times in their daily lives, then a poor bike fit is the likely cause. A person who has a history of back issues, either through strain, trauma or degeneration, can usually ride a bicycle very capably provided the bike is set up to take into account any loss in range of motion. In addition, the cyclist needs to be mindful of their spinal posture and positioning on the bike, which should be adjusted to promote a neutral spine and a well-balanced body, supported on a suitable saddle. 

 

John Higgins

John Higgins

John is an elite level bike fitter who works with non-elite cyclists - although a few have won races! Many don't race at all, but ride for fun, fitness, or to compete against themselves. John has worked with 18-80 year olds (and younger and older), novices, age groupers, masters racers and all levels of weekend warrior. These include road riders, mountain bikers, triathletes, tandem riders, tourers, commuters, bike packers and gravel riders and racers. All share a love of cycling and just wanted to ride more comfortably, and in many cases faster. John is the owner of Fit Kit Systems, and provides bike fitting services through BikeFitr (bikefitr.com)

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