Numb or Tingling Hands on the Bike
I posted this especially for Nancy, who just got a new bike and was complaining of this on Thursday.
Uncomfortably Numb – Tips for Healthy Hands
Unless you’re in a dentist’s chair with a suction hose hooked over your lower lip hearing the approaching whir of a high-speed electric drill, it’s probably safe to say that numbness is almost never a good sign.
A poor bike fit with too much forward pressure or riding on rough terrain under constant handlebar vibrations can send a sensation of pins-and-needles through the hands, disturbing nerves and ultimately decreasing grip strength and muscle tone.
It is a common affliction among cyclists, often called Cyclist’s Palsy or ulnar neuropathy, which is an injury to the ulnar nerve in the hands causing a rider pain, numbness or muscle weakness.
If we look at the anatomy of the hand, we see that the ulnar nerve runs along the anterior (front) ulnar (pinky) side of the hand. The ulnar nerve supplies motor and sensory information from the medial (inside) side of the hand to the pinky finger and part of the ring finger.
When the ulnar nerve enters the wrist it goes through Guyon’s tunnel, which is made up of two bones called the pisiform and the hamate that are connected by ligaments. This is a tight area. So once an injury and inflammation occurs in the area, it will be more difficult to heal due to the repetitive stress and pressure.
In addition, the nerve sends off sensory branches before it enters Guyon’s Tunnel, creating two areas of possible injury. One is the sensory branch that, if injured, results in numbness and tingling. The second is the motor branch that causes a loss of muscle strength when injured. However, an injury can affect one or both branches. Therefore, some people have only numbness, tingling and pain, while others have motor weakness, and a few unlucky patients have both.
When You Encounter Symptoms
If you experience any of these symptoms, it is important to correct the problem. First, make sure your fit is accurate; avoid holding all your weight on your hands and wrists, paying special attention to the fact that the nose of the saddle is not slanted forward. Should you feel upper-body fatigue in your shoulders and triceps muscles when riding, you are supporting too much weight with your upper body.
Also, use bar tape that absorbs vibrations and provides some cushion to the wrists and hands. Try properly fitted gloves with some gel protection—once again—to give cushion and decrease vibratory force. Finally, change your hand positions as often as possible and avoid extending your wrist.
However, if the symptoms persist, it’s likely time to see a doctor who has a background in sports or sports medicine and who will perform a thorough examination of the rider and bike. If ulnar neuropathy is suspected, the patient has various options for treatment, the most difficult being rest, as many people have key events that they have trained for all winter and spring.
Treatment Options
Most cases typically resolve themselves in three weeks with no residual issues afterward. In other cases, an Electromyograpy (EMG)/Nerve Conduction Velocity (NCV) test can be done in order to test the nerve and muscles of the hand to determine the extent of the injury.
Some of my colleagues usually prescribe NSAIDS (e.g. ibruprofen) to decrease the inflammation, which works very well. I recommend aggressive treatment to the areas of injury with the use of ice and heat for home care.
In the clinic we will use some manipulation and joint mobilization techniques of the wrist in order to maintain proper biomechanics and decrease the chance of other issues, like tendonitis and scar tissue formation. We will also use other modalities such as electric stimulation, ultrasound, low-level laser and soft tissue techniques.
There are other less conservative measures available, such as steroid injections in the area of inflammation. I do not recommend this because we have found that it causes more problems. Although, I have used a modality called Intophoresis, which is a way to get anti-inflammatory medications into the tissue through electrical impulses. This is done without puncturing the tissue, and I have had better results.
I always give home care instructions that include some basic stretching and rehabilitative exercises. In this case, self massage to prevent adhesions from forming in the area and proper use of ice and heat.
Some people have also used vitamin B6 to help; however, all of the research I have read was based on carpal tunnel, not ulnar neuropathy. B6 is an inexpensive vitamin, and an adequate daily dosage of 250mg will not cause any tissue damage and may be of some benefit.
Lastly, I find that most patients wait too long to receive a consultation. Do not wait! The earlier treatment begins the better. Never do a difficult or long workout with new equipment. Small changes or positional errors can create big problems for cyclists. Your body will eventually adapt and make small physiological changes so that over time it will conform to the bike.
15 comments
I am 57 years old and experience this tingling and numbness only when biking,. I bike about an hour a day at least 4 days a week, not for competetion, just for exercise and pleasure.
What do you reccommend tha I do? Contact my doctor? If left untreated what are th complications?
Thank you
Eileen
Hi Eileen,
So sorry this is happening to you. It is hard to tell what the cause could be, but I would suggest that you look into someone looking at your bike position. You might be leaning too much on the handlebars, your handlebars could be too low, or your seat too high in comparison to the handlebars. Or, your seat could be too close to the handlebars. I would try this first. If it is not better, then go see your Dr.
Good luck!
Thank you so much for the info. I just got a bike and that has been happening to me. It is worse in the left than the right. I believe that is because I had surgery on my left hand 5 years ago.
I have just started cycling and find that I have numbness and tingling in my right hand which starts in the thumb, NOT in my pinky, so the ulnar compression/circulation issue is a non-starter for me. I have taken the bike in a few times for fitting and will continue, but I wonder if I somehow am pinching nerves high up in my arm and it gets exacerbated by the cycling? I have fallen onto my shoulder as a result of falls from horses about 3 times over the past 15 years. Could that have an “impact” on my hand issues? (sorry about the pun- I couldn’t resist!)
Hi Karen,
That stinks, sorry you are suffering from this. Bike fit is the number one thing to try first. But, have you tried going to a physiatrist or sports doc to have them check your neck to see if possibly it is a pinched or swollen nerve radiating? Also, because you are new at cycling, you might be shrugging your shoulders that could show this symptom if you have an neck alignment issue. Good Luck!
Thanks. I am looking into acupuncture in my area. I don’t trust allopaths anymore…big Pharma is too powerful and offers too many incentives to MDs these days. I don’t want to have steroids injected to take away inflammation or swelling. It’s probably a pinched nerve- I have many muscle knots in my neck and back, so yoga and acupuncture are my treatments of choice. Thanks for the good wishes. This will work out, one way or another.
I have been biking for some time, but have just recently started greatly increasing my distances. I have developed some strange loss of strength in my left hand, particularly in my middle, ring and pinky fingers. You said the first thing to try would be to fix the bike fit, so I’ll go try that. Any other suggestions?
Hi Bethany, sorry you are having discomfort. Bike fit would be my first suggestion. My second would be if you started wearing bike gloves, or if you changed your bike gloves. Sometimes they are too tight in certain areas that can cause discomfort. Good luck! Let me know if either of these suggestions help. –Diane
Getting a better bike fit helped! As it turns out my handle bars were way to wide for my shoulders. When they put on a more narrow pair, my pain went away! Thanks for the help.
Bethany, that’s great! Glad you are feeling better.
I was pulling staples from my hardwood floor preparing to refinish it and because my knees are so bad, I can’t kneel, I was sitting on my butt putting pressure on my left hand for about 2 hours. Later I noticed numbness, tingling and muscle weakness. It is now 3 days later and I still feel the tingling. It’s feeling a little stronger, but I can tell it is not 100%. It’s the pinky finger up through my hand on that side and my ring finger to some extent. Will rest basically take care of this or should I go to the dr.?
Hi Sandi,
I am not a Doctor, but it sounds like you should go to the Dr. Sounds like you might have damaged some nerves.
Good luck!
Diane
I remember reading in one of the cycling magazines that when riding your bicycle, it’s good policy to have your arms slightly bent, so that to absorb road fatigue, thus overcoming that problem of your full body weight on the handle bars. so you are quite right to say avoid this riding position.
Diane, bike fit is one of the big priorities, but hence we forget to that what we do outside of exercise also has a big impact on what happens to us when are exercising. Big trouble makers for us is sitting on unnsupportive surfaces, such as recliners, sofas that are to soft, unsupportive mattresses, sleeping on our stomach ( a problem creator for the neck which innervates the shoulders arms and wrists.)
So true Dr. Jim! Thanks for posting.
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