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7 Tips to Prevent and Treat Cyclist's Palsy

When you think of cycling injuries, you probably think crashes, hip and knee pain or low back strain. Cyclist's palsy, also known as handlebar palsy, is a common but poorly understood condition that can affect cyclists’ hands.

What is cyclist's palsy?

Cyclist's palsy is a nerve injury resulting from the compression of the ulnar nerve at Guyon’s canal, an area of the wrist on the palm side below the small and ring fingers. The ulnar nerve origins at the neck and travels all the way down your arm to innervate some forearm and hand muscles as well as to provide sensation to your pinky and ring finger. At the wrist level, the ulnar nerve divides into sensory (provides sensation) and motor (creates movement) branches. Symptoms of cyclist's palsy will depend on which branch of the nerve is irritated.

Sensory symptoms of cyclist's palsy include:

  • Numbness and/or tingling of your pinky and ring fingers

  • Pinky and ring fingers “falling asleep”

  • Burning sensation to your palm, pinky and ring fingers

Motor symptoms of cyclist's palsy include:

  • Hand weakness

  • Hand cramps

  • Pain on the pinky side of the hand and wrist

  • Decreased movement of ring and pinky fingers

  • Clumsiness or regularly dropping objects

  • Inability to tuck your pinky close to your ring finger

What causes cyclist's palsy?

Cyclist's palsy can affect road, mountain and even stationary cyclists. It is most commonly seen with long distance cycling or during high volume training. It is a nerve compression injury caused by excessive stress applied to the nerve. The challenge is to determine what caused the stress. Cyclist's palsy is almost always due to a combination of training errors, biomechanics issues and a poor bike fit.

Common causes of nerve compression when cycling include:

  • Prolonged extreme wrist position

  • Poor posture

  • Weak core

  • Low bike handles

  • High bike saddle

  • High level of vibration (overinflated or skinny tires, small wheels or rough terrain)

How to treat cyclist's palsy?

In mild cases, symptoms will go away on their own within a few days. If symptoms are lingering, you should seek a certified hand therapist. Their expert eye and activity analysis skills allow them to break down your movement pattern and how your body interacts with your bike.

We gathered a few tips and tricks that can make a big difference with the prevention and treatment of cyclist's palsy:

  1. Nerve gliding exercises: nerve glides are exercises aimed at improving the mobility of your nerves from your neck all the way down to your fingers. When injured or compressed, a nerve can get “stuck” due to inflammation, swelling or scar tissue. Nerve glides keep your nerve mobile allowing it to send messages back and forth between your brain and your hands.

  2. Looking beyond your hands: Cyclists often put their bodies through significant stress in terms of sustained awkward postures and environmental stress (weather, vibration, falls, etc.). Neck hyperextension, shoulder hiking and bent elbows are all examples of other areas that can compress your nerves and trigger symptoms farther down your arms.

  3. Using padded gloves and handlebars: using padded cycling gloves or padded handlebars can help decrease the pressure on your wrists and distribute the pressure more evenly throughout your hands.

  4. General strengthening: various strengthening exercises can be added to your training to minimize the load on your wrists. A strong core, back and upper arms allow for proximal stability to better distribute weight between your saddle and your handlebars. A complete assessment of your specific areas of strength and weakness is needed to develop a strength program aimed at optimizing your cycling.

  5. Changing hand positions: there is no single perfect hand position when cycling. What’s important is to frequently change your hand position to avoid putting stress in only one area.

  6. Moving your saddle: if you’re looking for a quick change that can help decrease the pressure on your wrists, lower your saddle and move it back. This will result in a posterior shift of your weight distribution with more load supported through your saddle versus your handlebars.

  7. Get a professional bike fit: we won’t pretend to be experts in bike fit. There are so many options for equipment and so many nuances when fitting a bike to a cyclist’s needs. If you are doing any significant volume of cycling, a professional bike fit is definitely something we would recommend as part of injury prevention.

Finally, if you’ve read through this blog and feel like the symptoms are similar to what you are experiencing but instead are felt in your thumb, index and middle fingers, you might have carpal tunnel syndrome which can also occur from cycling, although it is less common. Similar strategies can be implemented for treatment but an assessment with a hand physiotherapist in Edmonton is always a good place to start!

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