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Cyclist’s Palsy

February 5, 2017


It’s a month into the New Year and people are well and truly on track for their long term cycling/triathlon goal. Many of us had a few weeks off from intensive training over the Christmas period and have returned to the saddle refreshed (hopefully) and ready to tackle some big rides. Cyclist’s Palsy is almost a seasonal injury if you ask me, although it can happen any time!

What is Cyclist‘s Palsy?

It is a type of nerve entrapment caused by the pressure and position of the hand on the handle bars, often called Handlebar Palsy for that reason.

What happens? Cyclist’s Palsy is in the majority of cases triggered by a combination of factors. The sustained vibration and intermittent shocks that get passed from the wheel to the fork and handle bar are absorbed by the hands. The hand is the first point of body contact in the front part of the bike.

Cyclist Palsy copy

When the pressure and vibration are sustained over long periods the ulnar nerve may become entrapped and inflamed. This will usually occur at Guyon’s Canal (see picture) in the hand or sometimes at the elbow. In some cases there is very little vibration and it is simply the static position of the hand causing the nerve entrapment

One would think mountain-bikers and off-road cyclists would be the group at greatest risk of developing cyclist’s palsy, having to deal with bumpy tracks and heavy constant vibration. But road riders and triathletes (in aero positions!) suffer just as much. When the athletes’ anatomical size and movement characteristics are not correctly applied to the bike Cyclist’s Palsy may result. Cyclist’s Palsy is more likely to occur when spending time in the “drops” or often when the handle bar is (far) lower than the seat position. There certainly seem to be more Cyclist’s Palsy problems when riders suddenly increase kilometres (from 200 to 300km/week) or after a period off the bike. Athletes would often not consider these factors as a major contributor.

The common symptoms in the early stage are usually a sensation of tingling (pins and needles) in the little finger. This often goes unnoticed or is ignored and once the symptoms start to run into the wrist and forearm the rider recognises there is a problem.

In certain cases there is no numbness at all and the rider complains of an inability to spread or close all fingers except the thumb (the interossei muscles of the fingers) due to entrapment  of the deep branch of the ulnar nerve.

As soon as you experience any such symptoms it is important to find a good physiotherapist to diagnose and treat the injury, don’t push on thinking you just need to harden up!

What to do about it?

Initially, and you will not like the sound of this, it is best to have a break from cycling. The least you should make sure of is that the symptoms are not present or not made worse by riding the bike. Perhaps clip Aero-bars could be a (temporary) solution. Beyond that it is important to get your bike set up checked by a qualified bike fitter. Here at Focus Physiotherapy we can check your bike set up and make most changes. A different stem is occasionally needed – we can recommend the size and pitch.

With adequate rest the symptoms usually settle down in two to four weeks.

Here are a few other simple measures you may take:

  • Non steroid anti-inflammatories
  • Physiotherapy treatment for effected muscles physio – massage/tape/needling
  • Padded gloves
  • New/more padded handlebar wrapping

Here at Focus Physiotherapy we are able to help you with the treatment for Cyclist’s Palsy and ensure you have an optimal bike set-up.

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