Whilst not as prevalent as injuries to the knee and lower back, injuries to the wrist and hand are a common occurrence amongst both professional and amateur cyclists and has the capacity to severely impair an individuals health, performance and enjoyment on the bike.
When traumatic injuries to the hand and wrist (such as fractures due to crashing) are taken out of the equation, and we only look at overuse injuries to this region, the incidence and prevalence of hand and wrist issues are significantly greater in amateur cyclists.
The most common overuse injury to the hand and wrist region in amateur cyclist is compression of the ulnar nerve in the Guyon canal over the region of the hypothenar eminence.
Image: Guyon’s Canal
Symptoms are often transient tingling and numbness locally over the region as well as radiating into the hands and fingers during or after cycling. Studies of amateur cyclist indicate that between 19% to 36% of participants experienced symptoms in their hands or wrists during long-distance multiday riding events.
The interesting aspect of this injury is that has a very low occurrence rate amongst professional cyclists. Analysing and understanding the reasons for this difference can help us identify causes and develop management strategies.
It should be stated however, that there can be a number of different causes of neural symptoms in the wrist, hand and/or fingers so it always best to seek the opinion of a qualified health clinician.
One of the major roles of the wrist and hands during cycling is to support the load of the upper body on the handlebars. The hand pressure magnitudes and loading patterns seen in steady-state cycling are of sufficient magnitude to induce ulnar nerve damage if maintained for long periods
The posture of the wrist and hand during cycling it also thought to be a contributing factor. The wrist is usually in a position of extension and ulnar deviation, which not only exposes the hypothenar eminence (lateral part of the plam of the hand) as the major weight-bearing surface but also increases tension on the ulnar nerve and surrounding tissues, increasing the risk of nerve injury. (Slane et. al. 2011).
Image: Hand Position during Cycling
The highest pressures at the hypothenar eminence were found to be when cycling in the drops. This may be due to the posture of the wrist but also due to a more forward and flexed riding position, which requires individuals to support more of their upper body weight with their hands and less on the saddle (Slane et. al. 2011).
So, how do you avoid, manage and prevent neural injuries at the wrist and hand?
Good Bike Fit Moving the front end up and/or away, or moving the saddle back can have the effect of distributing weight more effectively on the bike, reducing the amount of weight placed through your wrists and hands. Tilting handlebars forward/ backwards can also help reduce wrist extension and ulnar deviation and achieve a more comfortable and less compressive and tensile position for the nerves. These changes may also have the effect of obtaining a more relaxed position on the bike, avoiding the need to excessively grip the handlebars.
Gradually Increase Time on Bike If you only ride a total of 4 hours a week over 4 days, then chances are you will develop an overload injury if you suddenly decide to ride a 400km sportive over 3 days. Allow your body to gradually adjust and tolerate the loading through the wrists and hands.
Image: Gradually build your time on the bike
Padding Good quality bar tape, wearing padded gloves and changing hand position can reduce the magnitude and duration of loading patterns, which are both important to mitigate risk for nerve injury during extended rides.
Studies have found that wearing a glove with 3mm of foam padding was more effective in reducing pressures at the wrist than gloves containing gel. The difference in performance seems to be attributable to the greater compliance of the foam that was used. Another interesting finding was that increasing the foam padding from 3 to 5 mm provided no significant additional pressure reduction.
Change your Position Regularly Regularly altering and switching hand positions will help avoid the wrists and hands being in a compressed and vulnerable position for an extended period of time.
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