Follow this cycling PT’s approach to preventing, treating, and eliminating Handlebar "Cyclist’s" Palsy When Cycling.
Cycling is a challenging recreational sport in a multitude of ways. Despite being low-impact and more joint-friendly, riding’s repetitive and extended nature can cause overuse injuries. Yes, of course, that’s the niggle you feel in your knees or the yip in your hip.
Handlebar Palsy When Cycling
Did you know that the upper body, our shoulders, arms, and hands, are the second most common area to be affected by gradual onset injuries? In a 2022 study published in The Physician and Sports Medicine surveying almost 63,000 recreational cyclists, 20 percent of the affected riders complained of upper limb injuries.
A cyclist’s wrists are one of the three areas where a rider connects with a bicycle. The wrist joint is a region of significant weight-bearing and dynamic interaction between cyclists and their machines. It’s also an area that’s prone to overuse injury.
Cyclists experience two primary types of gradual onset wrist injuries—Carpal Tunnel Syndrome (CTS) and Handlebar “Cyclist’s” Palsy. Both conditions are usually caused by compression of the nerves as they travel through the wrist.
Carpal Tunnel Syndrome, or Median Nerve Neuropathy, is when compression of the nerve running through the wrist causes numbness, tingling, and pain in a cyclist’s thumb, pointer, and middle fingers.
Handlebar Palsy in cyclists is the other gradual onset injury of the wrist. To prevent Handlebar “Cyclist’s” Palsy from keeping you out of the saddle, knowing more about it and what you can do to avoid the chronic condition is essential.
What is Handlebar Palsy?
Handlebar Palsy, also known as Ulnar Neuropathy, is a wrist condition characterized by pain, numbness, and tingling of the hand and fingers. The ulnar 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 ulnar nerve originates from the medial cord of the brachial plexus (a network of nerves in the neck that sends signals from the spinal cord to the upper limb). The ulnar nerve has two sensory branches that supply feeling to the hand, ring, and pinkie fingers.
The ulnar nerve passes through a tight tunnel formed by bones and ligaments of the wrist, Guyon’s Canal, as it enters the hand.
When the ulnar nerve is compressed or squeezed as it passes through Guyon’s canal, it causes handlebar palsy in cyclists. The cause of injury in cyclists varies, but it’s rarely because of the ulnar nerve itself. Instead, inflammation of the ligaments and tendons surrounding the canal decreases the space the nerve can pass through and gets compressed and entrapped.
Symptoms and Diagnosis of Handlebar Palsy in Cyclists
The most common symptom of Handlebar Palsy in cyclists is numbness, tingling, or burning in the little finger side of the hand, ring, and pinkie.
A cyclist may also complain of pain and cramping that can cause a clawing deformity in severe cases. Riders also experience weakness and fine motor coordination issues and will notice that they drop things and have difficulty pinching. These are less common symptoms of Handlebar Palsy in cyclists.
Medical conditions like diabetes and obesity are risk factors for CTS.
Handlebar Palsy in cyclists comes on gradually and worsens with repetitive use. Guyon canal release surgery, cortisone steroid injections, and invasive medical intervention become the only option in severe and prolonged cases.
Ask yourself these questions?
- Do you get numbness and tingling in the little finger side of your hand, ring, and pinkie fingers?
- Does numbness in your hand wake you up at night?
- Do the little finger side of your hand, ring, and pinkie finger get numb when you ride your bike?
- Do you get numbness and tingling in your hand and fingers when you tap the little finger side of your wrist at your palm?
- Do you do a lot of typing or other repetitive activities and delicate motor tasks with your hands at your real job?
- Are you dropping things a lot?
- Does your hand form a claw when you try to grip things?
If you answered “Yes” to three or more questions, Handlebar Palsy could be the reason, and you need to do something about it before it worsens.
The diagnosis of Handlebar Palsy in cyclists can be challenging because it is often under-reported, and there needs to be a defined standard. Your healthcare professional will base the diagnosis of ulnar nerve entrapment when cycling on the rider’s complaints, their frequency, duration, and type of activity, and clinical findings.
If your physician suspects you suffer from Handlebar Palsy and you have the characteristic numbness and tingling pattern, they will send you for electrodiagnostic testing. Electromyography and Nerve Conduction Velocity tests (Nerve Conduction Studies) will assess ulnar nerve damage and assist in the diagnosis.
There is another thing a cyclist can do.
The orthopedic maneuver health professionals do for testing the signs and symptoms of ulnar nerve entrapment when can be done by you in the comfort of your own home. It’s called the Tinel’s sign test, and here’s how you can do it.
Tinel’s sign is a fundamental way to check for signs of nerve irritation or damage. It’s the tingling or “pins and needles” you get when you tap the area where nerve compression occurs.
In Handlebar Palsy, it’s the little finger side of the wrist at the base of the palm. A positive test is when tapping on that spot with the pointer finger of your opposite hand causes tingling to shoot into your pinkie and ring finger.
Causes of Handlebar Palsy in Cyclists
Improper bike fit and postural and positioning abnormalities are common causes of Handlebar Palsy in cyclists. You will have too much pressure on your wrist and hands if your saddle is too high, your bars too low, or you have a cramped or overly stretched cockpit.
In addition, if your saddle is angled downward, it causes you to slide forward as you ride. The pressure on your hands and wrists increases as you try to hold yourself up. The poor weight distribution will cause compression of the ulnar nerve, and the symptoms will worsen as you ride.
Handlebar Palsy in cyclists occurs during long road and gravel cycling and mountain biking rides. When a cyclist isn’t holding the handlebars correctly with their wrists in a neutral position (not bent up or down), the excessive undue weight puts pressure on the ulnar nerve. The handlebar pressure combined with repetitive traumatic road and trail vibration is enough to cause inflammation.
Strength and flexibility limitations also contribute to Handlebar Palsy in cyclists’ symptoms. The more we ride, core, abdominal muscle, and trunk fatigue increase weight bearing on a cyclist’s hands. A deep focus on the road or trail can cause a rider to forget to change their hand position often enough. Some cyclists neglect to wear gloves or use cushioned bar tape.
These can be prevented and eliminated by making a few changes and following a plan.
Handlebar Palsy in Cyclists Treatment and Prevention Plan
Making the necessary Bike Fit, Equipment, and Postural Corrections Are Essential
There are several Handlebar Palsy prevention tips you can follow.
- Position your hands shoulder-width apart, and be sure that your handlebars are the correct width.
- Hold your wrists in a neutral position.
- Don’t lock your elbows.
- Use cycling gloves with anatomically positioned padding and cushioned bar tape to absorb vibration and lessen the impact.
- For off-road and mountain biking, adjust the shock absorption of the front shocks for a more comfortable ride with less vibration.
- Rotate the brake levers down on the handlebars to reduce the extension of your wrist.
- 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.
- Install anatomically-designed handlebars to decrease the pressure on your wrists.
Upper Body Stretches Are an Integral Addition to Your Program
Poor posture is not only a cycling problem. It’s an everyday problem. We live in a predominantly sedentary society and spend long hours seated at a desk or computer.
The time we spend slumped over the handlebars while riding compounds the problem. The muscles in our chest and the front of our bodies become tight. The postural muscles of the spine and those stabilizing the shoulder blades get weak.
A lack of flexibility in the forearm and wrist muscles puts pressure on the ulnar nerve. When a cyclist experiences Handlebar Palsy symptoms, the tendency is to limit wrist motion to reduce discomfort, making matters worse.
Even more tightness and weakness in the muscles and structures surrounding the wrist occur. The nagging nuisance 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.
You can find several Cycling Core Strengthening programs here. The Flutter Kick Progression is a great core workout for cyclists.
Try Some Tendon Glides To Your Program
Ulnar Nerve Glide #1
Start with your arm up and out to the side with a bent elbow as shown. Your palm should be facing toward the side.
Next, bend your wrist away and towards you as shown.
Your other hand is held on your shoulder, checking to ensure that your shoulder stays down and is drawn back the entire time.
Ulnar Nerve Glide #2
Start with your arm up and out to the side with a bent elbow, as shown. Your palm should be facing toward the side.
Next, bend your wrist towards you as you side bend your head towards the target arm.
Then, bend your wrist away from you as you side bend your head away from the target arm.
Your other hand should check to ensure that your shoulder stays down and is drawn back the entire time.
Conclusion—Handlebar Palsy in Cyclists
Don’t let the wrist joint, hand, and finger pain of Handlebar Palsy in cyclists keep you out of your properly positioned saddle. The sooner you identify and address the symptoms, the faster you’re back on the bike doing what you like. See a physical therapist, orthopedic, or sports medicine physician for further evaluation if your symptoms don’t improve or get worse.
Has Handlebar "Cyclist's" Palsy 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!