Fitness and Performance

Cycling injuries: Poor posture and related back pain

Jul 15 2019

In the second part of her cycling series, Claire Edwards discusses back pain in cyclists and the relationship between poor posture and the spinal column.

A sustained poor posture puts an enormous strain on muscles of the lower back. It places them on a prolonged stretch and loading one or two areas more than others. The human skeleton is designed with an ‘S’ shape spinal curve for a reason. Flexibility of the spine, hips and lower limbs are essential to safely maintain a relatively fixed position when cycling. And help to avoid back pain in cyclists.

Upper back (Cervical and thoracic spine)

Neck pain tends to arise from maintaining a largely static, unnatural position, sometimes for hours at a time. The body is designed to move to keep muscles supple and joints lubricated, therefore sustaining an often-excessive hyperextension causes excess strain on one or two joints, and muscles spasm to try to both protect and support the weight of the head. Similarly, if using a computer screen during the day this can force the chin forward as postural muscles fatigue and eyes tire adding to stiffness and overload.

Pain can also be caused by placing too much weight through the upper body (>40%), due to poor bike set-up and the neck suffers excessively if the handlebars are too low. A Time Trial bike position often forces the neck into even more hyperextension due to the aggressive position set trying to achieve better aerodynamics. This, however, does not always translate to faster as the rider may not be conditioned enough, having poor adaptation to sustained posture, and unable to produce the muscle activity for the power output required.

Pain can be an ache and stiffness in the neck but can also radiate down into the thoracic spine


  • Core stability and conditioning: commonly recognised for the lower back with talk of deep abdominals – also refers to deep muscle so the upper back and shoulder girdle
  • Gentle neck movements through range and regular stretches
  • Book an appointment with a physiotherapist to address workstation set up or many companies offer an ergonomic assessment for their employees.
  • Check your equipment – bike set up, handlebar position to prevent forcing the neck into an unnatural excessive hyperextension, seat position fore/aft to prevent hunching and excessively loading the upper body – we wouldn’t place other joints into such extremes of position and hold them there for hours.

Lower back (Lumbar spine)

Once again, most complaints can be traced back to sustained poor posture causing stiffness, weakness and poor activation. Anterior muscles such as at the hips, and shoulders can be tight from prolonged sitting. Others are overstretched,  thus reducing their functional movement. As such, this affects power output and power transfer.  For example, if the hamstrings or gluteal are working ineffectively or fatiguing quickly, the load transfers to the lower back. This causes the body to overcompensate and, as such, it attempts to use other muscles for jobs they are not designed for. Impaired neurological motor control patterns lead to poor and compensatory movement patterns.

As with the upper back, pain experienced can be sharp or achy with or without radiation into the buttocks. As with neck pain, there are many causes of low back pain and an accurate physiotherapy assessment is always advised to determine which structure may be involved – Disc compression, traction of joints, muscle strain, ligament strain are all possible.


  • A Bike fit is crucial really for injury avoidance for the whole body– best to get this properly measured and assessed. Listed below are the areas checked and are relevant for pain prevention anywhere in the body – check the saddle not too low or tipped at an extreme angle. If position is too aggressive think about raising the handlebars to relieve.

Below is a breakdown of the components, explaining how/why you should have them adjusted during a BikeFit assessment:

Seat height

  • The seat height should be adapted for the rider.
  • If too high, it diminishes power due to muscles of the lower limbs needing to work beyond their optimal length-tension range. Produces excessive stress on the posterior anatomical chain: hamstrings, gastrocnemius and the posterior knee joint capsule, excessive hip extension reduces the stability of pelvic core
  • Too low and it increases knee flexion, force and load on the knee joint reducing the muscular functional range for power generation.

Seat fore/aft

  • Important for knee loading- too far forward increases load at front knee
  • Too far back overlengthens hamstrings and gluteal muscles, inhibiting force production and translating to the lower back
  • Seat inclination affects back pain


  • Dependent on rider flexibility vs aerodynamics. The rider must also be comfortable when riding. Cycling experience and bike handling skills


  • Proportionate to limb length.

Cleats/pedal interface

  • Effective force transfer needs low stack height on cleats and foot closer to pedal
  • Float: a small amount of motion allows the cyclist to move the foot if required. This limits the amount of power applied to the pedals.


  • Comfort is key. As previously mentioned, pain in any one area will alter positions and movement patterns higher in the chain.

Other specific joint problems are discussed in associated blogs.

Final thoughts

In addition to the above, I’d also recommend purchasing a foam roller. They are a great tool to help keep the body mobile and connective tissue healthy.

Working on your core strength is excellent for postural support and helps stabilise the ‘foundations’ from which to generate force. Remember to be aware of your posture both on and off the bike. Conditioning your body is equally important. Ensure that it’s specific to the task. Finally, Cross-training is a great way to work on your balance by developing the complimentary muscle groups.