Why do my hands, neck and back hurt when I cycle?

Pain in the hands, neck, shoulders or lower back is nearly always weight distribution rather than fitness — and the adjustments that move that weight are free.

Difficulty: beginner
Time: 40 min
Read: 6 min

Short answer

You are carrying too much of your weight on your hands. Raise the handlebars, shorten the reach, or both, until you can ride with a relaxed bend in the elbow and no need to grip. Check saddle height and tilt first, because a saddle that is too high or nose-down tips you forward onto your arms and causes every one of these symptoms.

A bike touches you in three places: the saddle, the handlebars and the pedals. Your body weight has to be shared between them. Almost every ache that appears within the first hour of riding is that share being wrong — usually too much on the hands, which then sends the strain up into the shoulders and neck, and forces the lower back to hold a position it cannot hold. Very little of this is about fitness, and none of it is fixed by riding through it.

What you'll need

Allen keys
A tape measure
Someone to watch you ride
A spirit level or a straight edge

The three contact points on a bike and where pain comes from

Step by step

Fix the saddle first, because everything else hangs off it.Saddle height and fore-aft position set your hip angle, and a saddle that is too high or too far back rotates your pelvis forward and dumps weight onto your hands. Set height properly before you touch the handlebars.
Level the saddle.Put a straight edge along it and aim for level, or within a degree or two of it. A nose-down saddle slides you forward continuously and you brace against that with your arms for the whole ride, which is exactly what makes hands and shoulders ache.
Do the elbow test on the bars.Riding on the hoods or grips, your elbows should be slightly bent and soft, and you should be able to lift both hands off the bars for a second without your torso dropping. If you cannot, you are propped up on your arms rather than supported by your core and saddle.
Raise the bars before you shorten the reach.On a threadless stem, remove the top cap and stem bolts, move spacers from above the stem to below it, and refit. On a quill stem, slacken the top bolt, tap it down to free the wedge, raise the stem and never go past the minimum insertion line. Raising the bars is the single most effective change for most riders.
Flip the stem if you have run out of spacers.Most stems have an angle: turned over, a stem with a seven-degree rise gains a useful amount of height for nothing. It looks unconventional and it works.
Shorten the reach if the bars are high enough and it still feels stretched.A shorter stem brings the bars back. Changes of ten to twenty millimetres are noticeable; do not jump straight to something drastic, because a very short stem makes the steering twitchy.
Rotate the bars and levers so your wrists are straight.Looking down at your hands, the wrist should be a straight line with the forearm, not cranked up or bent outwards. On drop bars, the flat section of the drops usually wants to be roughly horizontal or angled very slightly down; brake hoods sit so the tops and hoods make a continuous line.
Move your hands and unweight them regularly.Numbness and pins and needles in the outer two fingers is the ulnar nerve being compressed at the base of the palm, and in the thumb and first fingers it is the median nerve. Change hand position every few minutes, ride with loose elbows so bumps are absorbed by your arms rather than your palms, and consider padded mitts and thicker bar tape.
Give each change a week of real riding.Change one thing, mark the old position with tape or a pen first, and ride normally for several outings. Changing three things at once means you learn nothing about which one helped.

Tips

Most people ride bikes that are set up too low and too long at the front, because that is how bikes are sold and photographed. Comfortable is faster over any distance you actually ride.
If you can only make one change, raise the bars.
Bar tape and grips are cheap. Thicker tape, gel pads under the tape, or ergonomic grips with a wing that supports the heel of the hand solve a lot of hand pain on their own.
A professional bike fit is worth the money if you ride a lot or have a persistent injury, but do the free adjustments first — a fitter will start there anyway.

Common mistakes

Buying a suspension seatpost or gel saddle to fix hand pain — Hand pain is a weight-distribution problem at the front of the bike. Nothing you fit to the saddle changes how much weight is on your hands.
Adjusting saddle and bars in the same session and riding once — You cannot tell which change did what, and one may be masking the other. Change one thing, ride it properly, then change the next.
Ignoring the minimum insertion mark on a stem or seatpost — It is there because the tube below it is unsupported. Going past it can snap the post or the steerer at speed.

If it doesn't work

Numb or tingling hands

Cause: Nerve compression from too much weight on the palms, or a bent wrist angle — Fix: Raise the bars, level the saddle, straighten the wrists, move hand position often and use padded gloves. Persistent numbness that continues off the bike needs a GP, not a spanner.

Sore neck and upper shoulders

Cause: Reaching too far, so you have to extend the neck to look up the road — Fix: Raise the bars and shorten the stem. Also check you are not riding with locked elbows — soft elbows drop the head position without straining the neck.

Lower back ache after half an hour

Cause: Too much reach, saddle too high, or too far back — Fix: Reduce reach and recheck saddle height. Weak hip and core strength genuinely contributes, so this one is partly off the bike.

Knee pain at the front of the knee

Cause: Saddle too low, or too far forward, or pushing too big a gear — Fix: Raise the saddle in small steps and use lower gears at a higher cadence.

Knee pain behind the knee

Cause: Saddle too high, so the leg over-extends at the bottom of the stroke — Fix: Lower the saddle a few millimetres at a time until it stops.

Everything hurts on a bike that used to be fine

Cause: Something moved — a slipped seatpost, a new saddle, different shoes — Fix: Look for a shifted component before assuming your body changed. Mark positions with tape so a slip is visible.

Questions people ask

Is the bike simply too big for me?

Possibly, but frame size is a coarse measure and stem length, spacers and saddle position cover a lot of ground. If you have the bars as high and as close as they will go and it is still a stretch, the frame is too long, and that is a real answer.

Should the bars be level with the saddle?

For general riding, bars level with the saddle or a little above it suits most people. Bars far below the saddle is a racing position that requires flexibility most riders do not have and do not need.

Do I need shorter cranks?

Very few people do. Crank length affects hip and knee angle at the top of the stroke, and it matters most for shorter riders and those with hip restriction. It is an expensive change and it comes after everything free has been tried.