The American Bureau of Transportation Statistics states that there are more than 40 million Americans who ride bikes at least monthly. Over 5 million people ride at least 20 days/month. With so many Americans bicycling injuries sustained have also risen especially neck and upper back pain.
Because of the position that a cyclist takes while biking, this can increase a cyclists symptoms of neck pain. [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.
Neck pain can be made worse by several factors to include riding position, technique, and comorbid conditions. In the cycling position, the neck is in the position of extension with the back flexed for long periods at a time. Riding in a position with 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, more extension of the neck occurs. 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 hyper-irritable areas occurring as small knots in the muscles throughout the body. They send pain signals to the brain and contribute to a cycle of pain, muscle spasm and pain. 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. Shoulder pain is also prevalent among cyclists. Cyclists frequently present with pain in their left levator scapula caused by looking over their left shoulder for oncoming traffic frequently.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.