Most cyclists pay little attention to the neck until a problem develops in the area. The neck contains the cervical vertebrae, spinal cord, blood vessels, nerves, muscles, ligaments, and other soft tissue. In addition, it must support the head, which weighs as much as a bowling ball.

Neck fatigue and strain are common to cyclists. This fatigue can, however, usually be minimized or eliminated with the proper riding position, conditioning, and equipment. Drop handlebars force a cyclist to ride with the neck extended in order to visualize the road ahead. This position may cause problems in the neck and upper back especially during longer rides. As with any other problem associated with cycling, always check bike fit carefully. Neck pain can also be related to stem length, height, seat position, or type of handlebar. Many times the problem can be helped by frequently changing hand position or by changing the position or length of the handlebar stem. The position and angle of the seat also need to be examined carefully. As a last resort, some riders switch to an upright handlebar. However, this position is inefficient for effective cycling.

While riding, the neck should be periodically stretched by slowly going through a complete range of motion. Self massage while riding can also give some relief from mild neck and upper back pain. Riding with the arms, elbows and upper body relaxed can reduce the shock transmitted to the upper body and neck. Riding more with hands on top of the bars can also reduce neck stress. The neck should be kept flexible and strong, not only to give better support to the area, but in case of a crash. The neck and upper back should be stretched thoroughly with your daily stretching routine. This can be accomplished by slowly going through a range of motion and holding the stretch for several seconds at the endpoint. Strengthening can also be done by contracting the neck muscles while pushing against the head in the various positions: forward, backward, rotating and sideways. Nautilus also has an excellent machine specifically designed for strengthening the neck muscles. The weight of approved helmets has decreased dramatically, with some weighing only 7 ounces.

One common cause of neck and upper back pain is myofascial pain or trigger points. Trigger points are small hard nodules that contain degenerated muscle tissue. They are caused by prolonged muscle tension, chronic pain, spasm or trauma. They commonly occur near the insertion of muscle into tendon or bone, and are common in the neck and upper back. Trigger points can produce a wide range of symptoms, ranging from mild pain to severe burning. Generally trigger points respond to neuromuscular therapy, ultrasound, or electrical modalities. In severe cases, they may require mechanical destruction by lidocaine injections.

If you encounter a severe neck injury accompanied by pain or tenderness, be prepared for the possibility of a fracture or fracture-dislocation. The head should be stabilized in a neutral position with the head and neck aligned with the spine. Only trained medical personnel should move the injured person on a backboard.

Cyclists commonly experience muscle strains in the neck due to fatigue, overuse, and from turning to observe traffic coming from behind. I experienced severe neck pain while cycling in England. Riding on the left side of the road forced me to turn my head to the right to observe traffic, and this caused considerable discomfort. To alleviate neck strain, use ice over the affected region for 10 to 15 minutes.