Cyclists on the Tour de France are susceptible to Hand Pain

This is an article by the physiotherapist in Islington from the Angel Sports Injury and Physiotherapy Clinic.

This article covers:

• Numbness and tingling (paresthesia) in the hand from cycling
• Ulnar nerve palsy
• Anatomy of the wrist
• Incidence of ulnar nerve palsy in long distance cyclists
• Symptoms of cycling palsy
• How to avoid cycling palsy

The Tour de France is 3,430.5 kilometres of cycling between the 2nd and 24th July with just two days rest. This works out as 171.53 km per day or 106 mile per day as an average. When you consider this average distance includes ‘mountain stages’ it brings it home as to the length of time spent in the saddle.

 

 

Long distance cyclists are prone to injury and over-use syndromes are a problem. In a previous article by the Angel Sports Injury and Physiotherapy Clinic’s physiotherapist the knee was discussed, but due to the position of cycling other areas of the body suffer. The neck, back, feet and hands can all be problem areas. It is worth remembering that the training to get to a level of competitiveness for ‘Le Tour’ means that the total time spent in the saddle from training may be months and months.

Case reports have identified the presence of distal ulnar nerve sensory and motor dysfunction in long-distance cyclists; the actual incidence of this condition, referred to as "cyclist's palsy," is unknown. And a prospective study was carried out in 2003 looking at the incidence of this problem.

Symptoms of Ulnar nerve Palsy

The ulnar nerve supplies the top and bottom of the medial aspect of the hand and sensory loss will cover the little finger and the little finger side of the ring finger, front and back up to where the hand meets the wrist.

The muscles can also be involved and lead to a ‘ulnar claw’ appearance of the hand and they may complain of numbness or tingling in the hand that goes away within a day or two of cycling but then they may have persistent weakness in pinching and fine finger movements.

The Study in the American Journal of Sports Med. 2003 Jul-Aug; 31(4): 585-9.Ulnar and median nerve palsy in long-distance cyclists. A prospective study by Patterson JN, Jaggars MM, Boyer MI. Department of Orthopaedic Surgery, Barnes-Jewish Hospital at Washington University School of Medicine, St. Louis, Missouri, USA found that “Twenty-three of the 25 cyclists experienced either motor or sensory symptoms, or both. Motor symptoms alone occurred in 36% of the hands (11 cyclists) tested; no significant difference in the incidence of motor symptoms was found among cyclists of various experience levels or based on handlebar types (mountain bike versus road bike). Sensory symptoms alone occurred in 10% of hands (four cyclists) tested, with the majority of these being in the ulnar distribution. A significantly higher proportion of mountain bike riders had sensory deficits compared with road bike riders; however, there was no significant difference in the occurrence of sensory deficits based on level of experience. A total of 24% of the hands (eight cyclists) tested experienced a combination of motor and sensory symptoms. These motor and sensory symptoms were equally distributed between road bike riders and mountain bike riders and riders of various experience levels.”


How to avoid Ulnar nerve palsy

· Wear padded gloves to minimize the vibration forces on your wrist and hands

· Avoid direct pressure over the area of Guyon’s canal by avoiding resting the medial aspect of your wrist on the handlebars.

· Avoid letting your wrists rest in excessive extension

· Make sure you have a proper seat height and sitting position. This will help minimize the amount of weight you place on your wrists

· Select a proper choice of handlebar. The type of handlebar can also affect the amount of pressure you place through your wrists.

Other relevent articles

Cycling and knee pain

Video of Top 10 tips to make cycling more comfortable

If you are having wrist and arm pain and you wish to see a physiotherapist in Islington contact the Angel Sports Injury and Physiotherapy Clinic. Our physiotherapist will happily provide a FREE ASSESSMENT for any cyclist that is having wrist pain. We are happy to treat anyone that commutes to work on a bike as well as anyone in the Tour de France!


 



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