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Ask the Experts: Hand and wrist pain on the bike

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Knowledge level: Beginner

Physiotherapy

Article posted: 03/09/2014

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Having dealt with the delicate issue of saddle soreness in this previous article, prompted by a Member’s query, we turn our attention to the second of the three contact areas on the bike, your hands and wrists.

Once again we call on the expertise of Lead physiotherapist with the Great Britain Cycling Team and consultant physiotherapist to the Sky Pro Cycling Team, Phil Burt, for information on the conditions that can affect a cyclist’s hands and wrists and the steps you can take to prevent them.

There are two main conditions that can lead to discomfort, pain, tingling or numbness in your hands and wrists.

Handlebar Palsy

A relatively common complaint among cyclists known medically as Ulnar neuropathy but also as handlebar palsy. It’s caused by compression of the ulnar nerve, which enervates your ring and little finger, and manifests in the fingers as tingling, numbness or pain or weakness in the hand. As well as compression, hyperextension of the nerve can also lead to similar symptoms and this can occur when spending long periods of time riding down on the drops. If you experience any symptoms of this nature you should act on them immediately as they can be extremely stubborn to resolve. Seek professional medical advice and apply the preventative steps described below.

Carpal Tunnel Syndrome

Caused by compression of the median nerve at the wrist, carpal tunnel syndrome is characterised by numbness or tingling in the thumb, index, middle and ring fingers or weakness in the hand. A common cause in cyclists is excessive pressure when riding on the bar tops or with flat bars. As with handlebar palsy, don’t ignore these symptoms, apply the preventative steps suggested here and seek professional medical advice.

Preventative Steps

Bike fit

A badly fitting bike is often the cause of many aches and pains that you might experience when riding, including hand and wrist pain. If you’re putting too much of your weight through the front of the bike, this can easily result in discomfort throughout your upper body. An excessively high saddle, low bars or a cramped or overly stretched cockpit can all result in poor weight distribution on the bike. Consider having a professional bike fit, look at this article or get a copy of my book, Bike Fit: Optimise Your Bike Position for High Performance and Injury Avoidance.

Keep relaxed

Assuming you’ve optimised your position on the bike, you should also try to keep your upper body as relaxed as possible. You obviously need to hold your bars securely but avoid a “death grip”. When climbing in the saddle, you can almost just rest them on the bar-tops.

Padded gloves

You should always ride in gloves or mitts to protect your hands in the event of a fall but, with many offering anatomically placed padding to reduce pressure on your ulnar nerve, they can also be invaluable if you tend to suffer from sore or numb hands.

Bar-tape

Consider a double wrap of bar-tape or gel pads under the tape to give increased protection from road buzz. Top riders will do this for the cobbles of the Spring Classics but it’s a good idea for less than perfect UK road surfaces.

Anatomic bars

Anatomically shaped bars can provide a less stressful position for your hands and wrists, especially when you’re down on the drops. Also, it’s important to ensure that your bars are the correct width.

Regularly shift hand position

On road bars you’ve got at least three different hand positions so, make sure you regularly shift between them, moving from tops, to hoods and drops, adapting to the road, gradient and pace of riding. Even if road conditions and pace remain the same for extended periods, get into the habit of switching you hand position.

Brake set-up

Ensure that your brake hoods and levers are correctly set-up. Exact positioning comes down largely to personal preference but, if you are experiencing problems with hand or wrist pain, is worth looking at. Also look at reach to the brake levers as this can also cause unnecessary strain to your hands. Many set-ups allow you to adjust the reach using spacers. Mountain bike brake lever set-up is especially important, due to the hard and prolonged braking involved, and you should be looking for your wrists to be straight when in your descending position.

Factors off the bike

Many factors off the bike, such as time spent on a keyboard or playing the piano, can also contribute to hand and wrist problems. If you are experiencing problems on the bike, it’s worthwhile exploring potential exacerbating factors off it and looking for ergonomic solutions to them.

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