The neck is the most commonly reported area of pain in cyclists outside of the lower back and legs. It is often tolerated in the early stages but can become progressively worse if left unaddressed.
What causes neck pain?
The neck, as part of the spine, has similar structures to those of the lumbar spine that can become irritated. These are; facet joints, intervertebral discs, nerve roots, spinal ligaments, and muscles.
The cycling position requires varying degrees of forward bend through the back to be able to reach the controls (handlebars) of the bike, in order to maintain safe vision on the road ahead the neck needs to be held into an extended position.
As such, the neck needs to be held for sustained periods in middle to end of range extension while the head is forward of the shoulders. Over time this places a repetitive strain on certain elements and parts of the spine and supporting structures.
Risk Factors
Previous neck pain or injury
Previous shoulder injury or surgery
Unsuitable bike fit - commonly too long a reach and too much drop to the handlebars. Both will increase weight bearing through the hands, arms, and neck which in turn increases the effort required in the neck extensor muscles.
New to cycling, partcularly on drop bar style bikes as it will be an unaccustomed position for the neck
Significant increase in riding duration - endurance riders particularly complain of neck pain
What are the symptoms?
Pain generally starts at a low level and builds gradually over the course of a ride or over a period of weeks on repetitive rides.
It can be a dull ache or become sharper and restrict movements in the neck - especially bending your head downwards or turning from side to side - this is most common with rotation to the right in countries where you cycle on the left side of the road (due to checking / sighting for traffic) and vice versa in countries where you cycle on the right side of the road.
The following locations are the most commonly reported sites for neck pain problems to arise:
Base of the skull
Across the tops of the trap muscles
On either side of the neck
Down the border of the shoulder blade (referred pain)
How can I manage it?
Activity Modification
The severity of symptoms will guide what riding reduction is necessary. For example, if it is only on rides of 3+ hours then it would be sensible to minimise these to get the pain settled more quickly.
Consider working on shorter duration rides or using intervals to generate effective training sessions without the need for long hours on the bike.
If the pain has become more severe then a complete brake from riding may be necessary.
Over the counter pain-relievers such as paracetamol or anti-inflammatories such as ibuprofen can be helpful in acute stages where there is pain off the bike and potentially also some movement limitation. You should always consult with your doctor before commencing any course of medication.
Heat, either from a hot water bottle or wheat bag can be extremely effective in easing muscle ache and tension associated with many kinds of neck pain.
Bike Fit
As mentioned above, an unsuitable bike fit is one of the most common culprits for causing neck pain in cyclists. The most common observations are:
Excessive reach (from saddle to handlebars)
Excessive drop (the height distance between the saddle and the handlebars)
Forward tilted (nose down) saddle position. (increases weight on hands/neck)
Handlebars that are too wide (increases elbow extension / lockout)
A thorough and comprehensive bike fit is the best way to address all of these elements to reduce strain on your neck. Having said that, there are some simple home solutions to the above problems that you can try:
Try a shorter stem
Try flipping the stem or placing more spacers under the stem if possible
Bringing the saddle level will help reduce pressure on hands/neck.
Handlebars that are similar to shoulder width will generally work best for most.
Physiotherapy
Neck strengthening and working on some of the under-trained muscles around the neck have good evidence and support for their longer term effects on neck pain. I particularly advocate training the muscles at the front of the neck for both deeper postural control and increasing overall strength.
Hands on treatment including soft tissue release (massage), joint mobilisation, and taping strategies can be helpful in the short term.
Flexibility and mobility exercises that cover both the neck and upper back can help to address deficits in certain movements and maintain healthy joints in the neck.
Advice on postural and work habits are also very important
Yoga & Pilates
Though quite different in their background and practice, yoga and pilates can have many positive effects for cyclists with neck pain. It is important to mention to your instructor that you have current neck pain so they can advise on modifying technique or avoiding certain movements that may aggravate your neck.
Injections
In cases of severe or recurrent neck pain injections of steroid to the facet joints are often considered when conservative measures have failed. Steroid injections may also be indicated to address acute nerve root compression leading to pain / weakness / tingling down the arm if it is progressively worsening despite treatment.
Surgery
This should again be considered as a last resort to address most neck pain. The exception to this is if there has been trauma that has caused an unstable fracture requiring fixation, or acute nerve / spinal cord compromise.
What else could it be?
Referred pain from upper back
Referred pain from shoulder
Related to migraines
Referred pain from temporomandibular joint (jaw)
If you are having issues and want to get in touch about booking a consultation or a bike fit then please email us: info@thebikethebody.com.