Follow this cycling PT’s approach to preventing, treating, and eliminating Carpal Tunnel Syndrome When Cycling.
When a cyclist thinks about nagging injuries that potentially could keep them out of the saddle, thoughts don’t immediately turn to Carpal Tunnel Syndrome When Cycling. However, wrist pain is a common complaint throughout society, and whether cycling is the cause or not, it remains an issue many riders must address.
Cyclists experience two primary types of gradual onset wrist injuries—Carpal Tunnel Syndrome (CTS) and Handlebar Palsy. Both conditions are usually caused by compression of the nerves as they travel through the wrist.
Handlebar Palsy, or Ulnar Nerve Neuropathy, is when compression of the nerve running along the inside of the hand (the ulnar nerve) causes numbness, tingling, and weakness of the ring and little finger.
Carpal Tunnel Syndrome When Cycling is the other. To prevent it from keeping you out of the saddle, it’s essential to know more about it and what you can do to avoid the chronic condition.
What is Carpal Tunnel Syndrome?
Carpal Tunnel Syndrome is a condition of the wrist characterized by pain, numbness, and tingling of the hand and fingers. The median nerve’s job is to provide sensation and movement to portions of the forearm, wrist, and hand. It’s a long nerve that originates at the spinal cord and travels down the arm, through the elbow, wrist, and into the hand.
The carpal tunnel is a narrow opening in the wrist constructed of the wrist (carpal bones), ligaments, and connective tissue of the palm side of the hand. The median nerve travels through the carpal tunnel on its way to the fingers to help them move and feel.
When the median nerve is compressed or squeezed as it passes through the cyclist’s carpal tunnel, it causes carpal tunnel syndrome when cycling. The cause of injury in cyclists varies, but it’s rarely because of the median nerve itself. Instead, inflammation of the ligaments and tendons surrounding the carpal tunnel decreases the space the median nerve can pass through, and the nerve gets compressed and entrapped.
That’s when carpal tunnel syndrome when cycling begins to become a nagging nuisance.
Carpal Tunnel Syndrome in Cyclists
Health professionals consider Carpal Tunnel Syndrome to be the most common nerve injury involving an athlete’s extremities in sports medicine. It is also the most common nerve entrapment injury in the general population, accounting for 90 percent of all nerve-related wrist complaints.
According to the National Library of Medicine [September 2022], Carpal Tunnel Syndrome affects 5 percent of Americans, with a similar incidence and prevalence in most developed countries.
Researchers in an October 2022 study published in The Physician and Sports Medicine of over 62,000 recreational cyclists discovered that 20.1 percent of the riders complaining of gradual onset injury experienced upper limb symptoms.
Symptoms and Diagnosis of Carpal Tunnel Syndrome
The most common symptom of CTS is numbness, tingling, or burning in the thumb, index, middle, and half of the ring finger. That is the part of the hand the median nerve provides sensation.
The tingling and numbness often come on while sleeping and can get so bad that it wakes you up. Some people have a habit of sleeping with their wrists held down, increasing pressure on the nerve. Some doctors recommend wearing wrist (cock-up) splints at night to prevent bad sleep habits.
While some cyclists complain of forearm, wrist, and neck pain, it is not a classic sign of carpal tunnel syndrome when cycling. Although the numbness, tingling, and burning can become so intense that cyclists describe it as painful.
Weakness, loss of grip strength, and lack of manual dexterity happen, but they’re not characteristic signs of carpal tunnel syndrome when cycling.
Medical conditions like diabetes and obesity are risk factors for CTS.
Carpal Tunnel Syndrome when cycling comes on gradually and worsens with repetitive use. In severe and debilitating cases carpal tunnel release surgery, cortisone injections, and invasive medical intervention becomes the only option.
Ask yourself these questions?
- Do you get numbness and tingling in your thumb, index, middle, and half of your ring finger?
- Does numbness in your hand wake you up at night?
- Does your thumb, index, middle, and ring finger get numb when you ride your bike?
- Do you get numbness and tingling in your thumb and hand when you bend and hold your wrist down towards your forearm for a minute?
- Do you do a lot of typing or other repetitive activities and fine motor tasks with your hands at your real job?
- If you use a wrist splint (Cock-Up splint) at night, do you have less numbness and tingling when you’re trying to sleep?
If you answered “Yes” to two or more of these questions, Carpal Tunnel Syndrome could be the reason, and you need to do something about it before it worsens.
The diagnosis of Carpal Tunnel Syndrome can be challenging because there is no defined standard. Your healthcare professional will base the diagnosis of carpal tunnel syndrome when cycling on the rider’s complaints, their frequency, duration, and type of activity, and clinical findings.
If your physician suspects you suffer from carpal tunnel syndrome and you have the characteristic numbness and tingling pattern, he or she will send you for electrodiagnostic testing. Electromyography and Nerve Conduction Velocity tests (Nerve Conduction Studies) will assess median nerve damage and assist in the diagnosis.
There is another thing a cyclist can do.
The orthopedic maneuver most health professionals do to test for the signs and symptoms of Carpal Tunnel Syndrome can be done by you in the comfort of your own home. It’s called the Phalen’s Maneuver, and here’s how you can do it.
Firmly hold the backs of your hands together with your fingers pointing down while keeping your arms parallel to the floor. You likely have median nerve involvement if you experience numbness, tingling, pain, or a combination within a minute.
Causes of Carpal Tunnel Syndrome When Cycling
Improper bike fit, postural and positioning abnormalities, and strength and flexibility limitations contribute to Carpal Tunnel Syndrome when cycling symptoms.
Carpal Tunnel Syndrome when cycling occurs during prolonged road and gravel cycling and mountain biking. When a cyclist isn’t holding the handlebars correctly with their wrists in a neutral position (not bent up or down) the excessive undue stretch puts stress on the median nerve.
If the rider’s bike fit is too stretched out or they’ve “slammed the stem,” excessive pressure on the wrists and the carpal tunnel compresses the nerves. The handlebar pressure combined with repetitive traumatic road and trail vibration is enough to cause inflammation of the carpal tunnel structures.
With the fatigue of the core, abdominal muscles, and trunk comes increased weight bearing on a cyclist’s hands. A steely-eyed focus on the road or trail can cause a rider not to change their hand position often enough. Some cyclists are too tough to wear gloves or use cushioned bar tape.
All of these can be prevented and eliminated by making a few changes and following a plan.
Carpal Tunnel Syndrome Treatment and Prevention Plan
Make the necessary Bike Fit, Equipment, and Postural Corrections
There are several Carpal Tunnel Syndrome When Cycling prevention tips you can follow.
- Position your hands shoulder-width apart.
- Hold your wrists in a neutral position.
- Don’t lock your elbows.
- Use padded cycling gloves and cushioned bar tape to absorb vibration and lessen the impact.
- Use a relaxed grip on the handlebars. Stop the death grip!
- Set your bike handlebar height for a slight bend in the elbows.
- Change your hand position every three to five minutes from the brake hoods to the drops to the bars.
Perform These Upper Body Stretches
Whether your posture is poor because you slump over your desk at work or the handlebars of your bike, the result is the same. The muscles in the chest and the front of the body become tight. The postural muscles of the spine and those stabilizing the shoulder blades get weak.
The lack of flexibility in the forearm muscles causes the carpal tunnel to get compressed, putting pressure on the median nerve. When a cyclist experiences Carpal Tunnel Syndrome when cycling symptoms, the tendency is to limit wrist motion to reduce discomfort.
Even more tightness and weakness in the muscles and structures surrounding the carpal tunnel of the wrist occurs. The unhappy cycling cycle will worsen unless you put on the brakes and do something about it.
Here are some stretching exercises you can do after your next bike ride.
Add These Strengthening Movements to Your Routine
The major muscle groups targeted in the case of Carpal Tunnel Syndrome When Cycling are the postural muscles, the scapular stabilizers, and the core. Here are a few to add to your routine.
Try Some Tendon Glides
Tendon glides are essential to the Carpal Tunnel Syndrome when cycling toolbox. Tendon glides of the carpal tunnel ensure that the tendons of the fingers and hand move freely and don’t contribute to median nerve compression.
Here are a few tendon glide exercises for the carpal tunnel you can try before or after riding. You can start by repeating each exercise twenty times.
Make a loose fist, squeeze for a few seconds, and then relax.
Make a claw hand by bending just your fingers so that the pads of the fingertips touch the lower third of your fingers, and then straighten them again.
Form an “L” with your hand by keeping your fingers completely straight and bending at the base of the fingers so that your fingers are at a 90-degree angle with your palm. Fold your fingers down one at a time to your palm and then open them back up.
Conclusion—Carpal Tunnel Syndrome When Cycling
Don’t let the wrist joint, hand, and finger pain of Carpal Tunnel Syndrome When Cycling interfere with your bike riding enjoyment. The sooner you identify and address the symptoms, the better. If your symptoms don’t improve or get worse, be sure to see a physical therapist, orthopedic, or sports medicine physician for further evaluation.
Has Carpal Tunnel Syndrome when cycling ever slowed you down?
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Semi-retired as owner and director of his private Orthopedic Physical Therapy practice after over 20 years, Chris is blessed with the freedom to pursue his passion for virtual cycling and writing. On a continual quest to give back to his bike for all the rewarding experiences and relationships it has provided him, he created a non-profit. Chris is committed to helping others with his bike through its work and the pages of his site.
In the summer of 2022, he rode 3,900 miles from San Francisco to New York to support the charity he founded, TheDIRTDadFund. His “Gain Cave” resides on the North Fork of Long Island, where he lives with his beautiful wife and is proud of his two independent children.
You will read him promoting his passion on the pages of Cycling Weekly, Cycling News, road.cc, Zwift Insider, Endurance.biz, and Bicycling. Chris is co-host of The Virtual Velo Podcast, too!