Cyclist's Palsy is a hand pain. Our hands are one of our three main contact points to the bike (the others being the foot-pedal, and pelvis-saddle) and as such they undergo continuous pressure to support our upper body while also managing steering, gear changes, and braking.
What causes Cyclist's Palsy?
Due to the sustained pressure through the hands we can develop pain through some of the more sensitive structures that pass through the palm of the hand.
Any of the riding positions (tops, hoods, or drops) will require varying amounts of wrist extension (upward bend) and radial deviation (bending to the side towards the thumb) which can increase compression and stretch of the ulnar nerve (cyclist's palsy) and the median nerve (carpal tunnel syndrome).
Both nerves pass through small channels at the wrist which can make them more prone to compression forces in this area.
Median Nerve - Carpal Tunnel and Flexor Retinaculum
Ulnar Nerve - Guyon’s Canal
What are the symptoms?
When a nerve is compressed it can produce a variety of symptoms but the hallmark signs of this problem are that of tingling in the fingers, burning type pain, and even numbness.
The first sign is that you start to develop pain or discomfort in the palm or base of your hand
For most, these symptoms are transient, i.e they resolve once you have stopped riding. However with prolonged and repeated bouts of riding this can then lead to symptoms existing when off the bike also.
There are some simple clinical tests whereby gently tapping over the site of the nerve at either the Guyon canal (ulnar - No. 1 in image) or flexor retinaculum (median nerve - No. 2 in image) can re-produce your symptoms.
How can I manage Cyclist's Palsy?
Reducing ride duration to the point where symptoms are no longer being provoked is a key step.
Reducing use of the ‘drops’ which have been shown in the research to generate the highest loads on the wrist due to position and increased weight transfer.
Changing hand position regularly when riding.
Padded bar tape and padded gloves can help but as a standalone intervention will.
Mobilisation of the wrist and hand joints to free up and stiffness can reduce pressure around passage of the nerve.
Neural gliding or mobility exercises can be very effective as restoring natural movement through the course of the nerve.
Soft tissue work can free up excessive tension in the forearm muscles that may have developed from unnecessary gripping of the bars.
Taping strategies can also provide some temporary relief.
Stretching and mobility exercises targeting the wrist, hand, neck and shoulder should also be included.rarely solve the problem which likely has underlying bike fit origins (see below)
Top of the list in terms of management for this problems in almost all cases has to be bike fit. In nearly all cases of this presentation there is simply too much of the riders weight being placed through the hands. As such, achieving a better balance and weight distribution of the rider across the contact points is vital.
If the rider is position too far forward on their saddle it will increase weight bearing through the hands.
Long reach/drop will increase the likelihood of locked out elbows which in turn increases compressive forces at the wrist and hand. It will also transfer the weight of the rider forward
Handlebars that are too wide will force the wrist into further extension thereby increasing the stretch on the nerves and exposing them to further compression.
Excessively upward or downward angulated gear/brake hoods can place the wrist in a more stressful position of extension.
In recurrent cases steroid injections can form part of management but are not best offered as a stand along without physiotherapy and bike fit input.
Surgical decompression of both the median nerve and ulnar nerve both have successful outcome in cases where all other management has failed.
What else could it be?
Compression to one of the aforementioned nerves higher up the arm or indeed at the neck (cervical spine)
Synovitis or inflammation of the wrist joint
Sprain of ligaments in the carpal (hand) bones
Stress fracture of pisiform, hook of hamate, lunate, scaphoid
If you are having issues with your shoulder and want to get in touch about booking a consultation or a bike fit then please email us: firstname.lastname@example.org.