Back Pain & Neck Pain


Low back pain is a common problem for cyclists. If this is a new and severe problem, the first question to be asked is whether it could be a herniated disc. If there is any question, see a doctor as a slipped disk would be made worse by increased exercise. If the problem is muscle imbalance, read on.

First, a little background. The back, or more properly the abdomen, is definitely the weak link for many riders. Cyclists have huge leg muscles but donít have the torso strength to support and resist the tremendous forces which those big legs can generate. Any force directed into the pedals also goes up into the torso. If the torso is weak, that force DOESN'T go into the pedals but is dissipated in flexing of the torso. Look at tired riders - every stroke generates an "S" curve in the back, and it is the constant effect of the power of their legs that causes fatigue, and eventually, overwork and spasm of low back muscles. And as a corollary, a rider will never get stronger by pushing pedals alone as long as their torso continues to absorb the force generated by the legs.

Our evolution has given us musculature designed for quadripedal animals, and the muscles which could support a hanging, horizontal spine can't easily stabilize a vertical one subjected to all the impacts and forces our upright posture dictates. However, we have potentially quite strong abdominal musculature to provide stiffness to the entire torso to support and reflect the force of the legs, whether pushing away against the ground in quadripedal running, or pushing against the pedals in riding a bicycle. Riding with undeveloped abs is something like riding a bike with a cracked frame - all the energy gets dissipated in flexion, and doesn't get you down the road.

Here are a few tips from David LaPorte, U. of Minn. ( It's been estimated that about 80% of low back pain arises because of poor posture. Posture problems occur when we stand but are even more significant when we sit or ride a bike. We tend to round up our low backs, stressing the ligaments and tendons which lie along the spine. It is the irritation and inflammation of these ligaments and tendons which leads to most low back problems.

An excellent book on back pain is "Treat Your Own Back" by Robin McKenzie, Spinal Publications Ltd., P.O. Box 93, Waikanae, New Zealand ISBN 0-9597746-6-1. They use this book at the Low Back Center of the University of Minnesota Hospital.

Q. "I'm training for RAMROD, a one-day event in Washington state. It covers 155 miles with three major climbs totaling 10,000 feet of vertical gain. My weekend training ride includes a tough climb of 6,000 feet that I've done all-out for three weeks. Now the nerves in my lower back are inflamed and I'm in pain even on the flats. I've had an expert bike fit, so bad position isn't the cause. What's the solution?" -- JG

A. Bike fit is usually the cause when long climbs produce back pain. However, there are lots of "correct" fits. Some are more aggressive than others (lower handlebar, higher saddle) and are more likely to make your back hurt. So the first thing to check is that your "fitter" didn't go too far in that direction.

Even with a correct fit (for you and your style), long climbs can make anyone's back hurt. The muscles of the low back work harder during seated climbing as they provide support for the trunk (much as strong abdominals are needed for aggressive cycling). Usually, climbing during training will make them stronger. You have been doing too much climbing, for your level of training, and gotten ahead of the curve for your back muscles adaptation. The solution would be to cut back on your training expectations and stop hammering yourself before the event. Climb a bit less, and don't go all out.

You might also check your climbing technique. Alternating sitting and standing is key to relieving tension on back muscles.

And remember those abs I mentioned above? Low-back pain can result from a lack or imbalance of midsection strength. Hard climbs put a whole new level of stress on your midsection muscles and may require extra abdominal strengthening work. Crunches and other abdominal exercises may be very helpful.

To see illustrated back exercises and stretches for cyclists, click, a site developed by roadie Rick Schultz.

Q.This season was my 3rd season on the bike. I've never really had any back problems until about the end of June this year. I've developed some muscle pain/soreness in my lower back. Flat riding doesn't seem to really provoke it, but if I do any extended climbing, my back will be very sore the next morning, and will last for several days. I've tried to do back stretches, and this helps, but not enough to cure the soreness. I'm a bit puzzled because last season over the same long climbs, my back never bothered me afterwards, but it does now. The only thing I can think of is that about the same time I started to develop the back problems, I got a new set of pedals. I could feel they were "lower," or my foot was closer to the pedal axle, almost like I had raised my saddle. I never did lower my saddle as it never occurred to me until just now that maybe this contributes to the problem. I just recently lowered my saddle, but maybe there is some other training I can do to strengthen my back??? What do you think may cause my back soreness? Any suggestions? - LJ

A. I think you are in the same boat as JG above. You use your back muscles more when you climb (or if you go extremely hard on the flats)- so that is the most likely reason it is sore with climbing but not on the flats. Why now versus last year? Could be the pedals, one always needs to consider changes in gear or positioning when a new ache or pain develops, but I doubt it. Probably just a body that is 1 year older plus another year of hard riding on the muscles and joints of the back. I'd focus on core muscle (abs esp) strengthening exercises along with stretches. Pilates are one approach that might work well for you.

Q. "Recently I was in a car accident. As I had back pain, my doctor ordered an MRI and found that I have an herniated disc at L5 and S1 . Should I continue to cycle ? My doctor says it is OK to ride for now , but he feels I will need surgery in the future. Does this injury heal by it self, if left alone ? i go for therapy just about 3 times a week." -- Gil.

A.Herniated discs don't "heal", but the pain will lessen as the swelling from the acute injury resolves with time. Many people get these herniations spontaneously as they age - and only 10% or so ultimately need surgery. You just got yours a little earlier in life. So go easy, start cycling again, and listen to your body. If there is a significant increase in pain, slow it down a bit. But I would avoid surgery unless:

Neck Pain

Scapulocostal syndrome is a general term for pain in the upper or posterior part of the shoulder radiating into the neck, head, arm, or chest, caused by an abnormal relationship between the scapula and the posterior wall of the thorax. Another term, which refers to a specific muscle in the upper back/shoulder blade area is the levator scapulae syndrome.

What is the Levator Scapula Muscle? It is the muscle that lifts the shoulder blade up toward the ears. For many of us, it works almost continuously (due to stress, posture etc.), and can become rather sore. Its tendon origin is on the transverse process of the first four cervical vertebrae. It passes downward and lateral to insert on the vertebral border of the scapula above the scapula spine. Its contraction elevates the scapula, tends to draw it medial, and rotates it to lower the lateral angle. Motions of the neck also affect the levator scapula muscle because of the mechanics of its attachments. Relaxing the levator scapula muscle will allow the shoulders to rest easily and may also reduce this muscle soreness. There are 2 levator scapula muscles, one on either side of the spine.

The dominant shoulder is the most commonly involved (82%). Pain can radiate to the neck and shoulder, but rarely to the arm. Movements that stretched the levator scapulae on the affected side aggravate symptoms. Radiographs and bone scans of the shoulders and cervical spine are negative in this condition. Increased heat emission from the upper medial angle of the affected shoulder can be documented with thermography in more than 60% of the patients. A bursa (fluid filled structure that decreases resistance to movement between a muscle and another muscle or bone) was found between the scapula, the serratus, and the levator in more than 50% of dissections of cadaver shoulders. This suggests that this syndrome is a form of bursitis and explains the constant trigger point and crepitation (a crackling sound or grating sensation, in a joint or a bursa, caused by swollen tissue or bone surface rubbing together) as well as the increased heat emission found on thermography. It is also the rationale to consider local steroid injections which can relieve symptoms partially in 75% of patients who undergo this treatment. An entity known as the "snapping scapula" has been described and may refer to the bursitis and crepitus that can be identified at the site of tenderness at the superomedial angle of the scapula.

Treatment of this condition includes:

  1. activity modification - cross training, limit activity during recovery. The fact that this condition has been described in posturally compromised, middle-aged individuals, usually woman, especially with desk jobs or those vocations which force them to extend their arms in front of them for a prolonged period of time supports the concept that it is the position on the bike that is the culprit. Shortening the handlebar stem in order to sit more upright and concentration on riding with elbows bent may be part of the approach to prevent recurrence. Another is getting off the bike regularly to allow these muscles to relax (they generally stay tensed to support the upper body while riding) can be of great help.
  2. massage therapy - I had personal success using a tennis ball, while lying on the floor, to apply pressure directly to the area where I could feel the knotted muscle and discomfort. Doing this twice a day supplemented massage therapy which theoretically breaks the pain/spasm/more pain cycle.
  3. physical therapy - ultrasound and treatment as a bursitis may be a helpful adjunct to the above
  4. anti-inflammatory medications
  5. and when all else fails - injection of steroids directly into the region of the medial superior scapular border.
A much more detailed discussion can be found at Scapulocostal Syndrome but might be a bit complex for the average reader.

Q.I've been having a lot of neck pain recently as I have ramped up my training. Any suggestions? - JB

A.Pros can routinely be seen stretching on their bikes during long road races. Avoiding stiffness is a key to comfort on any ride, and it is easy to neglect your neck. It will finally get your attention when you turn your head and notice how tight it's become.

A tight neck is more common when you are competing and your body is locked in the road-cycling posture with your head titled straight back. Here are 5 tips to help minimize the tension in your neck muscles (and reduce discomfort in your shoulders as well):

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