Pain in back of hands on long descents

[Frank9755]

Has anyone else had this / know what I should do? 

Pain in the backs of both hands, when doing long Alpine or other descents.  I had this this summer, when doing the Transcontinental Race, so fairly extreme conditions well outside what I normally do.  Basically, on any of the long descents, which take 30 minutes to an hour, the backs of my hands would get really painful.  I would have to stop a few times on a descent for relief, and I started to dread the descents as I knew what was coming. 

It takes a while for it to come on so I've never had it with UK hills as none I have ridden have been long enough.  It's a new thing - I didn't used to get it, on the same bike with the same position, a couple of years ago when I previously did long descents.

I thought about disc brakes to lighten the braking, but I'm not convinced it is from braking, I think it is more from the weight on my hands in a descending position.  It was never a problem when riding long days on flat or rolling terrain, or climbing for that matter.

Googling just brings up loads of stuff about ulnar or medial nerve palsy, which I have had before so know it is not that.  I think I have my wrists reasonably straight in my descending position.  I wonder if there might be some sort of hand strengthening exercises that I could do to ward it off?

[T42]

I've done a few long descents (Alps, Pyrenees) and never had any hand problems. I'd try rubbing in an anti-inflammatory cream in advance and keeping gloves over it. Sounds to me like tendinitis but IANAD so what do I know?. 

[slowfen]

Not sure if relevant, but when tandeming in past, used to get hand/wrist pain, which seemed related to the extra effort for braking, but would go once had time to rebuild muscle strength/endurance.

[Karla]

How much are you changing your hands around on descents? 

You could try:
Descending on the hoods for the shallow parts and on the drops for the steep parts
Occasionally unweighting both your hands when you change and wiggling them about
On parts that aren't super steep, unweighting one hand and wiggling it about, or dropping to your side and shaking
'Milking' the brakes, one hand then the other, to keep a lid on your speed, rather than feathering both
Doing core exercises to help you put less weight on your hands in general

I'm guessing you already do all this and I'm teaching granny to suck eggs though.

[Frank9755]

How much are you changing your hands around on descents? 

You could try:
Descending on the hoods for the shallow parts and on the drops for the steep parts
Occasionally unweighting both your hands when you change and wiggling them about
On parts that aren't super steep, unweighting one hand and wiggling it about, or dropping to your side and shaking
'Milking' the brakes, one hand then the other, to keep a lid on your speed, rather than feathering both
Doing core exercises to help you put less weight on your hands in general

I'm guessing you already do all this and I'm teaching granny to suck eggs though.

Thanks, but I'm kind of doing the bits of that that I can, with the execption of changing my hands round - I'm talking descents like the Stelvio and Gavia, there are not many shallow bits where you can sit up and take a rest - its pretty full on for the best part of an hour, slamming on brakes for each hairpin.  The only way to rest is to stop and get off for a few minutes, which I did a couple of times on each - but it only prolongs the ordeal.
The core strength stuff (which I've done for Shermer's neck) helps in steady state riding but, when you brake, it's the force through hands and shoulders that stops your upper body taking flight, isn't it? So I don't see that as a way round it. 

[Frank9755]

Not sure if relevant, but when tandeming in past, used to get hand/wrist pain, which seemed related to the extra effort for braking, but would go once had time to rebuild muscle strength/endurance.

That's my hunch - I don't do any big descents for a year or two, then go binging on some big ones - where the braking forces are bigger - and my hands don't have the necessary muscular strength any more.

I am riding a tandem in the Chilterns fairly regularly and not had any issues there, but the descents are over within a minute.

[PaulF]

How confident are you on descending? Could you be tensing up which is causing the pain?

[Kim]

Wonder if you could reproduce it with a turbo trainer on a ramp or similar, so you could work out if it's the braking itself or the bracing position?

I've had cramp-like pain in the middle of my hands (I think from working whatever infrequently used muscle to exhaustion and beyond in the interests of avoiding splatty DETH) from cautious descending in the Peaks/Dales on my Brompton, but I put that down to the combination of feeble brakes and severely compromised (because of the fold) lever ergonomics.  Very different from the usual nerve stuff, but it doesn't sound like this is quite the same thing.

[hellymedic]

I wonder whether this pain originates fairly high up in the nerves of the neck/upper back or axilla/shoulder.

I don't know where or if your posture is somehow compressing nerves somewhere.

As you have found out, ulnar nerve supplies the little finger side of the hand and the median nerve serves the palmar aspect., so it's not these.

[chrisbainbridge]

When you say back of the hands, where exactly? Over the wrist crease or the back of the palm?

Even if you are keeping the wrists straight you at just be putting a load on the bones they do not like.
Ulnar nerve from elbow might give pain on back of hand but more likely weakness/numbness.
Next time it happens, poke around and see if you can find a painful spot, mark it with a pen and upload a picture!!

How are you holding a plank? Does that bring on the pain?

[Frank9755]

When you say back of the hands, where exactly? Over the wrist crease or the back of the palm?

Even if you are keeping the wrists straight you at just be putting a load on the bones they do not like.
Ulnar nerve from elbow might give pain on back of hand but more likely weakness/numbness.
Next time it happens, poke around and see if you can find a painful spot, mark it with a pen and upload a picture!!

How are you holding a plank? Does that bring on the pain?

It's the back of my palm.  I recall it being all over the area rather than being localised, but possibly it was more on the medial / thumb side - although I'm not certain of that - it was quite widespread. 
It may well not happen again until I do some big descents next June. It doesn't happen when I do a two-minute plank, or on UK descents - it needs more time to build up.   
I could try to replicate it by doing multiple descents with lots of braking....

[Frank9755]

cramp-like pain in the middle of my hands (I think from working whatever infrequently used muscle to exhaustion and beyond in the interests of avoiding splatty DETH) from cautious descending in the Peaks/Dales on my Brompton

Thinking about it, it does feel a bit cramp-like...

[Frank9755]

How confident are you on descending? Could you be tensing up which is causing the pain?

Less so as I get older.  I'm sure I brake more than I used to.  That may well be a factor.

[Frank9755]

Wonder if you could reproduce it with a turbo trainer on a ramp or similar, so you could work out if it's the braking itself or the bracing position?

It wouldn't be a fun experiment but would be easy to set up.  I might try it...

I think it is more the position though as I get it in both hands to a fairly similar extent, but I am doing most of the braking with my right. 

[chrisbainbridge]

I have a number of possible diagnoses in mind but they are rather esoteric and need investigation.
It may be so niche in terms of causation however that it is incapable of diagnosis except at the bottom of such a descent and even then there may be no treatment possible (without an unacceptable level of risk)

[Frank9755]

Intriguing!

I'm hoping to prevent it happening next time. One easy change is disc brakes, which should make life easier for my hand muscles. I was also thinking of some kind of hand strengthening exercises - probably squeezing a ball would be the main one.  I guess I'll do that and see what happens next summer!

[morbihan]

Frank have you discounted scaphoid damage? Its located  little way away from where you are experiencing discomfort but in my experience you can get a lot of referred pain. Year of having my hands prized off a rugby ball have compromised mine and they used to hurt a lot particularly in cold damp weather or after doing weight baring stuff on the hands that aggravated it. That would have included gripping the bars/brakes on a long down hill.
Mine are a whole lot better since switching diets, so likely inflammatory/arthritic connotations too, which at your age could be a consideration.
Get yourself some hydrolic disc brakes!

[Frank9755]

I expect my rugby career was a good bit shorter than yours, and I generally either passed the ball, or hoofed it into touch, before the nasty forwards came charging through to rip it off me!  Also it is the same in both hands.  So I don't think it's that kind of injury, but I did wonder about arthritis.

Regardless, I've just ordered a new frame for disc brakes, which is the easiest potential fix!