Cyclist palsy: what it is and how to treat it

Specialist hand and wrist physiotherapist Rachel Maccabee explains causes, symptoms, treatment and prevention of cyclist palsy

what is cyclist palsy

Cyclist palsy (sometimes called handlebar palsy) is a cycling hand injury that can cause numbness and pins and needles in the hand, and in some cases some paralysis.

  • What is Cyclist palsy?

Cyclist palsy means damage is done to the ulna nerve by cycling. It’s a handlebar contact point injury involving the irritation, compression and subsequent partial blockage of the ulna nerve at Guyons canal (little finger side of wrist). Palsy is used as your hand can develop some paralysis.

  • What causes cyclist palsy?

Cyclist palsy can be the result of excessive vibration from the ground through your bike, causing repeated blows to the base of the palm and/or the amount of body weight transferred through your hands onto the handlebars. This issue can be made worse when your wrist is held for prolonged periods in a static extended position, this places stretch (traction) on the nerve whilst it is being compressed. It’s most common in long-distance cyclists.

  • What are the symptoms of cyclist palsy?

The blockage of the ulna nerve can cause sensory changes in your little finger side of the hand, such as numbness and tingling. Riders may also experience pain, weakness, cramping and clumsiness. In more advanced cases a clawing deformity of the hand can be seen. Strength and movement changes are usually less noticeable than the sensory changes, it’s therefore often ignored and you continue to cycle (continuing to compress the nerve), until more debilitating symptoms develop.

  • What is the treatment of cyclist palsy?

Compression on the ulna nerve needs to be removed or minimised for healing to occur. When symptoms are mild, it’s worth initially looking at some of the posture and bike adjustments I’ve discussed in prevention below. If this doesn’t cause relief, then you should take a break from cycling until improvement occurs. At this stage ask your physio and/or doctor for guidance on your next steps.

With physio these may include some anti-inflammatory treatment, work may be done on your core and trunk strength, plus specific exercises to strengthen hand muscles and glide the nerve can aid recovery. Further assessment may be needed to look at your back and neck.

  • How can you prevent cyclist palsy?

There are lots of simple bike and posture adjustments that I recommend to prevent the occurrence or reoccurrence of cyclist palsy. There are at least three different positions for your hands to grip onto your handlebars, and regularly shifting between these increases the blood flow to the nerve and alters the pressure.

Consciously try to relax your grip (avoid “death grip”) and upper body, and making sure there’s a slight bend in your elbows whilst riding will help distribute absorption of any bumps and shocks from the road surface through your whole upper limb.

Padded gloves and handlebars can also help with this. Keep as much weight off the arms as possible, which can be done by increasing your core strength and getting a bike fit to make sure your handlebars are not too low or the seat is not too high and forwardly tilted.

A good core strength developing exercise is pedalling on a stationary bike with your hands off the bike, while keeping your trunk still in position.

Hopefully one or the combination of the above is able to prevent or resolve these hand and wrist symptoms.

If you have any medical concerns at all always seek medical attention from a registered physiotherapist or doctor.

Rachel Maccabee is a specialist hand & wrist physiotherapist at Six Physio
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