Neck and back pain in bicycling.

Back and neck problems in bicyclists should be managed by a combination of bicycle adjustment or modification, technique change, and medical treatment. The bicycle should be checked for proper fit. Often it is necessary to relieve the rider's extended position by using handlebars with less drop, using a stem with a shorter extension, raising the stem, or moving the seat forward. Changing hand positions on the handlebars frequently, riding with the elbows "unlocked," varying head position, using padded gloves and handlebars, and riding on wider tires all reduce the effects of road shock. Initial medical management includes ice, massage stretching, and nonsteroidal anti-inflammatory drugs or acetaminophen. Definitive treatment is neck and back rehabilitation based on dynamic muscular stabilization. It involves three progressive and overlapping parts: (1) establishing range of motion, (2) finding and stabilizing the neutral position, and (3) adapting the neutral position to exercise.