Pain guide · Neck pain
On a bike you lean forward and tip your head back to see the road, often for hours, so neck pain is among the commonest complaints of recreational riders. Riders' necks aren't weaker than anyone else's: the problem is holding the position, and lower bars make it harder.
Some neck pain needs help first, and after a crash the rules are different. This guide covers those warning signs, the National Health Service (NHS) advice not to ride while you can't turn your head, bar height and reach, aero bars, Shermer's neck on very long rides, how much pain is fine, and a three-stage plan from gentle movement to neck and shoulder strength, with a 3D demo of every move.
Exercise is for pain that has been checked or is clearly mild and settling.
Location narrows the likely causes; it does not diagnose.
Eases when you sit up or get off the bike, and may be stiff afterwards: ordinary neck pain from holding your head up.
Read: Neck pain →Across the top of the shoulders and up into the neckTight and sore over the upper trapezius muscle, worse with shrugged shoulders and locked elbows. Strength training for that muscle has trial support.
Read: Tech neck →Stiff, sore to turn, often on wakingYou can't turn to look behind you: a stiff or wry neck. Don't ride until you can turn your head.
Read: Stiff neck and wry neck →Down one arm, with tingling, numbness or weaknessA narrow band of pain that changes with neck movement suggests a pinched nerve. Both hands clumsy or numb, or trouble with balance, is different and urgent.
Read: Pinched nerve in the neck →A headache that starts at the back of the head on long ridesUsually one-sided and brought on by holding the neck position: a headache from the neck.
Read: Headaches from the neck →A stiff, achy neck from mid-life, worse looking upComes and goes, and looking up from a low position is often the hard part: neck arthritis (cervical spondylosis).
Read: Neck arthritis →After a crashNeck pain and stiffness, sometimes starting hours later, once the injury warning signs have been checked: whiplash.
Read: Whiplash →Arm or hand tingling or aching, worse with the arms raised or carryingOften into the ring and little fingers: thoracic outlet syndrome, which is uncommon.
Read: Thoracic outlet syndrome →Between the shoulder bladesA mid-back ache on long rides: our upper back and shoulder pain when cycling guide covers it.
Read: Upper back pain when cycling →Hours into an ultra-distance event: possibly Shermer's neck, which is rare. Stop riding: see the warning signs and the note below.
Neck complaints were the commonest overuse complaint in a 1995 survey of 518 recreational riders (48.8%), and women had 1.5 times the odds of neck complaints and twice the odds of shoulder complaints. Neck pain was 14% of the complaints of 1,505 riders at bike-fit services, and at one cycling medicine clinic it was more often a discomfort than the main reason to come. A 1991 review put neck and back pain together at up to 60% of riders.
To see the road while you lean forward, you tip your head back. In a lab study of 8 men, lower bars increased the backward bend at the top of the neck, and racing bars produced a bending load at the base of the neck three times that of sitting upright; the authors recommend higher bars for riders who are uncomfortable looking up. In 26 riders, the further they leaned forward, the more they tipped the head back.
It looks like an endurance problem: in 45 men, riders' neck strength was no different from non-riders', and riders with neck pain weren't weaker, so the authors put the pain down to fatigue from holding the position.
Aero bars put you lower still, but we found no study of neck pain on aero bars. A helmet that sits low over the eyes, or glasses whose frames block your view, can make you tip your head further back (our suggestion; heavy helmet lights and cameras were named as a risk in the Shermer's neck report).
What we know comes from one case report with a short review, which we read as an abstract. On ultra-distance rides, usually after about 800 kilometres non-stop, the neck muscles can give out so the head drops. The report named a past neck injury, long spells low on aero bars and helmet lights or cameras as risk factors. Rest and stopping riding were the treatment, and full neck control took 2 to 14 days to come back. It is rare, though the authors warn it can affect untrained riders in popular events of about 300 kilometres.
Source 8
NHS inform says to call 999 after a neck injury if the person is unresponsive, has severe neck pain or can't move their head, or fell from a height such as 5 or more stairs. It says to call 111 for new or worsening numbness or weakness in the arms or legs, bladder or bowel changes, or changed feeling around the bottom or genitals.
The National Institute for Health and Care Excellence (NICE) lists a bicycle collision among the dangerous injuries that put the neck at high risk, alongside being 65 or over and tingling in the arms or legs. A possible concussion means no riding: our concussion guide sets out the steps back.
Not without warning signs: in 1,211 adults without symptoms, 87.6% had disc bulges on magnetic resonance imaging (MRI), including most people in their 20s. After an injury, NICE's rules decide who needs imaging.
The NHS says most neck pain lasts a few weeks, and NHS inform expects most new neck problems to settle within 8 weeks, with the biggest change in the first couple of weeks. No study has followed riders' neck pain, and no one can promise a date.
For neck pain that lasts, a Cochrane review found moderate-quality evidence that strength training for the neck, shoulder blades and arms reduces pain by a moderate to large amount straight after treatment. In 180 women office workers, neck strength or endurance training with dumbbell shoulder work reduced pain and disability over 12 months, against advice to do aerobic exercise and stretching; the endurance group lifted the head from lying. No trial has been done in riders.
In 48 women with long-lasting pain in the upper trapezius, 10 weeks of strength training for that muscle cut their worst pain by about 79%, while leg cycling with relaxed shoulders gave only a small, short-lived drop. The plan's dumbbell exercises follow that programme as described in the neck hub's trial note.
In 198 workers with frequent neck and shoulder pain, 2 minutes a day of elastic-band training, 5 days a week, cut pain by 1.4 points out of 10 at 10 weeks against weekly health information. Both trials were in office workers, not riders.
Higher bars reduced the backward bend at the top of the neck and the load at its base in a lab study of 8 men, and leaning forward less went with less tipping of the head in 26 riders. Bars about as wide as your shoulders lowered arm muscle activity in a lab study of 10 women, and stock bars are often wider than women's shoulders. These are lab measures, not trials in riders with neck pain.
The NHS says to keep your neck moving, not to wear a neck collar unless a doctor tells you to, and not to drive or cycle while you can't move your neck. NHS inform's exercise advice starts with 2 to 3 repetitions at a time, little and often, building towards about 10. Riding itself isn't a treatment: leg cycling barely changed neck muscle pain in a trial.
After a fit, 160 mountain bikers reported less neck pain at 30 days, but there was no comparison group, so time alone could explain some of it. Across 18 studies, many measurements used in fitting weren't linked with pain, and no study shows a fit prevents neck pain.
In 70 riders, arms with ulnar nerve symptoms in the hand came with neck pain 3 times as often and shoulder pain 5 times as often as arms without, and more often had positive tests for thoracic outlet syndrome. Numb hands with neck pain are a reason to think about the neck as well as the wrist.
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This guide uses the neck hub's rule, from NHS inform's neck exercise advice: rate your pain from 0 to 10. During exercise, 0 to 3 is minimal and 4 to 5 is acceptable; 6 or more is too much. If it goes higher, do fewer repetitions, move more slowly or rest longer between movements.
Exercise should not make your neck worse overall. Soreness from a new exercise should ease quickly, and your neck should be no worse the next morning. Stop any exercise that makes your symptoms worse or causes new pain.
Arm symptoms are the exception. If an exercise or a ride sends pain, tingling or numbness further down your arm, or the extra symptoms last more than an hour afterwards, make the movement smaller or the ride shorter and more upright. A hospital leaflet on nerve glides allows a short-lived rise in symptoms but not one lasting over an hour; the rest of this rule is the neck hub's suggestion.
On the bike, our suggestion: when the neck starts to ache, sit up, move your hands and do a few slow chin tucks at a safe moment, and end the ride if it climbs past 5. Stop for dizziness, double vision, slurred speech or trouble swallowing, which are warning signs.
Start at the first stage. Each move opens a full guide with a 3D demo.
The first days to about 2 weeks. Keep the neck moving little and often, as NHS inform advises. Ride only once you can turn your head to check behind you, and keep rides short and upright. The doses are the neck hub's unless the move page is named.
3D demoNeck CARs (controlled articular rotations)Beginner · No equipment2 to 3 slow reps each direction, every hour or two, building towards about 10 · NHS inform's dose. Separate turns, tilts and nods before full circles
Harder: Rabbit pose (Sasangasana)
3D demoChin tuckBeginner · No equipment5 to 10 slow reps with a 5 s hold, 2 to 3 times a day
Easier: Lying chin tuck · Harder: Isometric neck holds (four-way)
3D demoLying chin tuckBeginner · No equipment5 to 10 gentle holds of up to 10 s, once or twice a day · The low-load nod used in deep neck flexor trials
Harder: Chin tuck
3D demoThoracic rotationBeginner · No equipment6 rotations per side, moving with the breath · The move page's dose
Easier: Side-lying open book · Harder: World's greatest stretch
3D demoShoulder rollsBeginner · No equipment5 to 10 each way, a few times a day
3D demoTreadmill walkingBeginner · Cardio machine10 to 30 min a day · Editorial: NHS inform advises keeping generally active
Harder: Treadmill jogging
Move on when: You can turn your head comfortably both ways, and these moves stay within the pain rule.
About weeks 2 to 6. Riders' necks aren't weak but tire, so this stage builds endurance in the neck and shoulder-blade muscles. The doses are the neck hub's unless a trial or the move page is named.
3D demoIsometric neck holds (four-way)Beginner · No equipment3 to 5 holds of 5 to 10 s each direction, light effort · Build towards 5 holds of 10 s at about half effort. Include pressing the back of your head into your hand, the direction you hold on the bike
Easier: Chin tuck · Harder: Chin tuck with head lift
3D demoChin tuck with head liftIntermediate · No equipment3 to 5 holds of 5 s, building to 10 holds of 10 s · Head lifts were the endurance exercise in a 12-month neck pain trial
Easier: Chin tuck
3D demoBand rowBeginner · A band + An anchor point2 to 3 sets of 10 to 15
3D demoBand lateral raiseBeginner · A band2 minutes a day, 5 days a week, progressing the band · The trial dose; the exercise choice is the neck hub's
Harder: Dumbbell lateral raise
3D demoProne Y-T-W raisesBeginner · No equipment5 to 8 of each shape, 2 rounds
Easier: Wall angel · Harder: Bent-over reverse fly
3D demoFoam roller thoracic extensionBeginner · A foam roller5 to 8 slow breaths at each of 3 or 4 spots · The move page's dose. Keep your head supported
Harder: Fish pose (Matsyasana)
Move on when: An easy ride of 30 to 45 minutes on the hoods or tops leaves the neck no worse the next morning.
From about week 6, two or three days a week, then ongoing. The dumbbell exercises follow the trapezius pain trial's programme as described in the neck hub's trial note; the sets and reps are the neck hub's. Riding comes back by our suggested steps.
3D demoSupported single-arm dumbbell rowIntermediate · A dumbbell + A bench or box3 sets of 8 to 12 each side
Easier: Incline ring row · Harder: Bent-over barbell row
3D demoBent-over reverse flyIntermediate · A dumbbell3 sets of 10 to 12
Easier: Prone Y-T-W raises · Harder: Barbell rear-delt row
3D demoDumbbell lateral raiseBeginner · A dumbbell3 sets of 10 to 12 · Start light
Easier: Band lateral raise · Harder: Smith machine upright row
3D demoIsometric neck holds (four-way)Beginner · No equipment3 holds of 10 s each direction at moderate effort
Easier: Chin tuck · Harder: Chin tuck with head lift
3D demoStationary cyclingBeginner · Cardio machineEvery other day: 20 to 30 min at an easy effort on the hoods or tops, bars raised if you can · Our suggestion. Change hand position every 10 to 15 minutes. Ride a similar route 3 or 4 times within the pain rule before adding anything, then add time, about 10% a week, before hills or harder efforts
Easier: Recumbent exercise bike · Harder: Air bike intervals
Move on when: Our suggestion: keep adding time, about 10% a week, while the pain rule holds. Bring back the drops, aero bars and fast group rides last, in short spells, and on very long events stop if your neck muscles start to give out.
Our 3D figure can't show these changes. Most come from small lab studies or are our suggestions, so keep what helps.
The NHS says don't wear a neck collar unless a doctor tells you to; it's better to keep your neck moving. Injections and surgery belong to the pinched nerve and neck arthritis guides; nothing in the cycling evidence calls for them.
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| Habit or position | Why it matters | Instead |
|---|---|---|
| Riding while you can't turn your head to check behind you | The NHS says not to cycle while you can't move your neck. | Walk, or ride indoors, until you can. |
| Long spells in the drops or on aero bars | Lower positions mean more looking up, and long spells on aero bars were named as a risk for Shermer's neck. | The hoods and tops, with low positions in short spells. |
| One fixed hand and head position for hours | Neck pain on the bike looks like fatigue from holding the position. | Change position every 10 to 15 minutes, look with your eyes as well as your head, and keep your elbows soft (our suggestion). |
| A soft collar | The NHS says don't wear a neck collar unless a doctor tells you to: it's better to keep your neck moving. | Gentle movement little and often. |
| Pulling your head into a stretch | Hand-loaded stretching at the end of the range is a lot for a sore neck or an irritated nerve, as the neck hub explains. | Let the head's weight do the work, as in the upper trap release.Try: Upper trap release |
| Heavy helmet lights or cameras on long rides | The Shermer's neck report named them as a risk factor. | Mount lights and cameras on the bars (our suggestion). |
| A helmet pushed low over your eyes, or glasses frames in your line of sight | You tip your head back further to see the road (our suggestion). | Adjust the helmet and glasses so you can see the road with your head level. |
Eight gentle neck and shoulder stretches for desk stiffness, done standing or seated in ten minutes.
10 minBeginner8 movesA wallA 12-minute routine for a stiff upper back and rounded shoulders: chin tucks, wall angels, Y-T-W raises and open books.
12 minBeginner8 movesA foam roller, A wallA 15-minute routine for cyclists: hips, upper back, chest, neck and wrists through the ranges riding doesn't use, plus back and neck endurance.
15 minBeginner12 movesA foam roller, A wallA steady bike ride for a first triathlon or fitness: 5 to 10 minutes easy, a ride you can talk through, optional short faster bursts and an easy cool-down.
45 minBeginner4 movesCardio machine, A wallLeaning forward means tipping your head back to see the road and holding it there for hours. Lower bars increased the bend at the top of the neck and tripled the load at its base in a small lab study. Riders' necks aren't weaker than other people's, so it's endurance and time in position rather than weakness.
Raise the bars or shorten the reach, ride on the hoods or tops, change hand position often, look ahead with your eyes as well as your head, and keep the drops and aero bars for short spells. Build neck and shoulder strength off the bike.
Often partly: bar height and reach set how far you look up. After a fit, neck pain fell in 160 mountain bikers, though without a comparison group, so pair any change with strength work.
Strengthening the neck, shoulder-blade and shoulder muscles has the best support for neck pain that lasts, and even 2 minutes a day of band exercises, 5 days a week, eased neck and shoulder pain in office workers. The plan on this page builds from gentle movement to holds and dumbbell work.
Not if you can't turn your head to check behind you: the NHS says not to drive or cycle while you can't move your neck. Keep it moving gently, and come back to riding when you can look over your shoulder.
Call 999 if the person is unresponsive, has severe neck pain or can't move their head. A bicycle collision is one of the dangerous injuries guidelines use to decide who needs a neck scan, and tingling or weakness in the arms or legs after a crash needs checking the same day. A possible concussion means no riding: see our concussion guide.
It's a rare problem on very long rides: the neck muscles give out and the head drops, usually after about 800 kilometres non-stop. What we know comes from one case report with a short review, read as an abstract; rest and stopping riding were the treatment. Double vision, trouble swallowing or weakness anywhere else needs a 999 call.
The upper trapezius muscle works to hold your head and shoulders while you lean on the bars. In a trial, strength training for that muscle cut long-lasting trapezius pain by about 79%, while cycling itself barely changed it.
A lower position means more looking up, and long spells on aero bars were named as a risk factor in the Shermer's neck report. We found no study of neck pain on aero bars, so our suggestion is to build up time in the position gradually.
Not without warning signs. Most adults' neck scans show disc bulges, even in their 20s, and most neck problems settle within weeks.
Exercise education, not a diagnosis or treatment plan. It is written from the guidelines and studies listed above; review by a clinician is pending. If your pain follows an injury, is severe, is getting worse, or comes with any warning sign listed on this page, get it assessed. Health disclaimer.
