Handlebar Palsy – A Common Strain in Cyclists

There’s nothing like it. The sun on your back, the wind in your face as you pedal the miles away – your own mini-vacation from the chaos around you. You pride yourself on your accomplishments – healthy living, regular exercise – and nothing can bring you down, until you begin to notice some discomfort in your arm – or wrist – even your fingers.

You try to ignore it, but the numbness and tingling get worse, and before long you notice difficulty with things as simple as spreading your fingers apart. After a while, even something some trivial as moving the mouse on your computer becomes difficult.

You think back – did you hurt your hand? Whack your elbow?
Ulnar neuropathy, commonly known as “Handlebar Palsy” to avid cyclists, doesn’t necessarily come from any type of injury. Simple activities causing stress to your hands and wrists can be the culprit – something as simple as the grip of your handlebars, or repetitive strain, can cause debilitating numbness, tingling, even pain in your arms, wrist, even you fingers.

Repetitive strain injuries (RSI) affect millions of Americans. In fact, roughly 27 million Americans visit their physician with some type of RSI every year, with an estimated 40 million more suffering in silence. It comes from a combination of poor posture and improper technique.

WHAT IS ULNAR NEUROPATHY?

Neuropathy essentially is an injury to a nerve. Your ulnar nerve runs from your neck, down the inside of your arm into your hand. It is commonly known as your “funny bone”, and supplies movement and sensation to your arm and hand, especially the little finger and half of your ring finger. And while ulnar neuropathy is not life threatening, it definitely can cause chronic pain, pins and needles, and even loss of function of your hands.

Cyclists are especially prone to ulnar neuropathy due to repeated shock and bouncing while holding your handlebars and improper technique, thus coined “Handlebar Palsy”. And while, something as simple as discomfort may not stop you from your daily ride, chronic aggravation can lead to debilitating pain and loss of function.

HOW CAN I TELL?

There are some simple things you can do to tell if your ulnar nerve is being aggravated. Obviously, if symptoms occur when cycling, there is a good chance you are straining your ulnar nerve.

Try tapping on your funny bone, on the inside of your elbow. If you experience a mild twinge or some type of electrical sensation, chances are the ulnar nerve is becoming compressed, or squeezed – this is an early warning sign.

Grip a piece of paper between your thumb and index finger. If this is difficult, or even impossible, there is some type of aggravation to the ulnar nerve. Also, take a good look at your hands. Is there obvious “deformity”? By that, I mean, do your ring and little finger sink down right past the knuckle, then bend upward, similar to a “claw”? Do the muscles of your hand in this area look diminished?

And finally, do your experience an alteration in sensation to the ring and little finger – pins and needles? Numbness?

WHAT CAN I DO?

Obviously, the first course of action with any injury is to seek medical advice to rule out any serious medical problems. Your physician may prescribe rest and some form of anti-inflammatory medications. But, there are also some things you can do at home.
Since the ulnar nerve runs from your neck to your hand, it is important to exercise all these areas.

1. Neck exercises

Rotation – slowly move your neck from right to left using a rolling motion. Repeat in opposite direction.
Side Bends – slowly bring your right ear to your right shoulder and hold for several seconds. Repeat on opposite side.
Neck Flexion/Extension – slowly bring your chin to your chest and hold for several seconds. Then point your chin to the ceiling.

2. Shoulder Exercises

Shoulder Shrugs – bring your shoulder up around your ears, then drop them down.
Scapular Stretch – pull your shoulders back, squeezing your shoulder blades together and hold for several seconds. Then pull your shoulder blades apart by rolling your shoulders forward towards your chest.

3. Elbow and Wrist Exercises

Elbow – hold arm out straight, palms up. Bend elbow towards shoulder, then extend straight.
Wrist – stretch your wrist by pulling your hand upward, then downward, holding for several seconds in each direction.

4. Hand Exercises

Straight Finger Flexion – hold palm up, make a right angle with your knuckles, keeping your fingers straight, and hold.

Grip Strength – squeeze a rubber ball with your whole hand several times

Finger Squeeze – using a small object, such as a pen, place it in between two fingers, squeezing it tightly in between. Perform for each finger.

GETTING BACK TO CYCLING

Once you are ready to tackle the open roads once again, here are some suggestions:

1. Make sure your bicycle is the right fit. Poor posture can lead to handlebar palsy as well as back and neck strains.

2. Check your posture. Try sitting in a more upright position to decrease the pressure on your hands and wrists. Change your hand position from the bottom of the handlebars to the top.

3. Padding. Using well-padded gloves and handlebars may decrease the pressure on your hands and wrists. Wrist splints may also be helpful – consult your physician for proper splints.

4. Rest and position changes. When cycling long distances, take frequent brakes and change the position of your handlebars. And when symptoms are aggravated, a hiatus from cycling may prevent further damage.

Remember, while ulnar neuropathy may be viewed as simply a discomfort in your hands and wrists, it can lead to more serious problems if left untreated, such as poor grip, chronic pain and dysfunction. Any RSI is hard to cure. Best bet? Prevention! Taking a few minutes each day to stretch your neck, shoulders, wrists and hands may decrease the compression of the ulnar nerve, leaving you free to pedal the miles away!

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