[LEL17] numb fingers (cyclist's palsy) after LEL

[Zed43]

So far I had never experienced cyclist's palsy upto a 600km ride, and had a slight case after a 1000km brevet. But after LEL I have a bad case in my right hand (pinky and ring finger). Even now and I didn't ride since Saturday.

How common is this? If you have prior experience with this, how do you deal with it? Total rest? short rides only? Any active recovery techniques that work?

[mmmmartin]

it'll take a few weeks for the nerves to recover after being squashed, hence the tingling. If you wish to avoid this have a proper bike fit from a proper, reputable shop (which I haven't done).

[The French Tandem]

Other body parts can get numb after LEL. Does it count in your poll?

[Zed43]

I've added a 4th option for other numb parts.

[grams]

If I put my hands in prayer position my right ring finger just does not cooperate and stays arched forward at 45 degrees.

I don't wear cycling gloves (accept when it's cold). This may change for the next extended brevet.

[frillipippi]

Last summer I was operated at the carpal tunnel.
It all started with a 2200k audax (Repubbliche Marinare): at the arrival, all my ten fingers were tingling and numb. I was unable to use cutlery or to handwrite properly. I had difficulties also in many simple tasks (buttons, typewriting, etc.).
For a couple of weeks, I waited and hoped my hands would recover by themselves. It didn't work.
After that I asked for help to the Italian equivalent of a British GP.
Electromyography to arms (and legs for comparison), etc. etc., it all ended with my right hand operated at the carpal tunnel. All the doctors, surgeons, etc., who visited me were absolutely certain that the bicycle wasn't the root cause. Maybe the "precipitating factor", but not the root cause. I was and remain very perplexed. Same operation planned for my left hand, I was told it's common practice to operate one hand at a time and wait some months before passing to the other.
In the meanwhile, say three months, the tingling and numbness passed at both hands. No particular difference between one hand and the other, but we had chosen the right one because the exams said it was in worse conditions. Who can tell how things would have gone without the operation... Anyway, I decided to delay the operation at the left hand sine die.
I haven't had any more problems until LEL 2017 (I've done a 600 and a 700 in the meanwhile, but tarmac was much better than at LEL). Now all the fingers are a little "fizzy", gently tingling.

What I learnt:
- the three inner fingers are served by the median nerve that passes through the carpal tunnel that can easily be a weak point
- the two outer fingers are served by the ulnar nerve whose weak point is generally at the elbow
- the inner side of the ring finger can be linked either to one or the other nerve
- nerves are very slow to recover (months more likely than weeks)

In order to avoid further problems:
- use a low pressure for the front wheel
- double tape the handlebar, or any other solution that makes it soft and wide
- avoid bending wrists, try to keep them straight (doctor and surgeon told me that when you bend your wrist the median nerve gets squeezed in proximity of the carpal tunnel)
- on the contrary, avoid riding with straight elbows, try to find a position where your elbows are bent, even just a little: in this way the joint can absorb a part of the shocks coming from the front wheel rolling on rough surfaces
- gloves also can make a lot of difference, try different gloves and discover which suits you better. Bring more gloves with you, possibily with different geometry, change them after some hours and pay attention to what your hands are telling you.

Enjoy safe rides.

[vorsprung]

In order to avoid further problems:
- use a low pressure for the front wheel
- double tape the handlebar, or any other solution that makes it soft and wide
- avoid bending wrists, try to keep them straight (doctor and surgeon told me that when you bend your wrist the median nerve gets squeezed in proximity of the carpian tunnel)
- on the contrary, avoid riding with straight elbows, try to find a position where your elbows are bent, even just a little: in this way the joint can absorb a part of the shocks coming from the front wheel rolling on rough surfaces
- gloves also can make a lot of difference, try different gloves and discover which suits you better. Bring more gloves with you, possibily with different geometry, change them after some hours and pay attention to what your hands are telling you.

Enjoy safe rides.

this is all blah blah blah, bike fit is the real answer.  Seriously.  Padding helps a little bit but good handlebar positioning is the main thing

[Graeme]

Someone on fb recommended going for a swim. I followed that up and I'm beginning to get feeling back. It wasn't a miracle cure - but I think it is helping.

[chrisbainbridge]

Vorsprung is mainly right.

How you ride is also partly the answer  and sorry Graeme, but swimming is a placebo

You have two nerves in the wrist, median nerve and ulnar nerve.  The median nerve is well protected in the carpal tunnel and it is difficult to alter the pressure on the median nerve with resting on a handlebar.

The ulnar nerve is much less well protected and resting your weight on your ulnar nerve will certainly cause problems.

It is not completely clear whether this is a neuropraxia, or a segmental demyelination but the end result is that the nerve stops working for a period of several months.  You have altered sensation in the little and ring fingers with weakness of the small muscles in the whole hand.

So, how do you prevent it?

You take the pressure off the ulnar nerve.  I believe there are three main ways to do this.

• First, is a bike fit.  Most people without a bike fit will take a lot of weight through their arms onto the handlebar.  You should be able to cycle no hands, or with the hands resting an inch above the handlebars without significant strain.  Getting this right is probably the most important factor.
• Second, look at how you hold the bars, especially on the hoods.  Your elbows should be bent at about 20-30 degrees and the wrist should be straight.  The shoulder blades should be down the back, not up by your ears.  This will have the effect of moving the point of contact with the bars to the centre of the wrist and take all pressure off the ulnar nerve.
• Double wrapping the bar, padded gloves, etc are all a waste of time if you have not done the first two but can make the grip more comfortable after you have done the first two.

The original posters carpal tunnel was probably initiated by a maintained wrist extension position for the duration of the ride. This would be known as the reverse Phalens test and I have certainly seen a number of cases where maintained positioning of this nature for prolonged periods of time has initiated Carpal tunnel syndrome in a previously asymptomatic patient.

[hellymedic]

Ulnar nerve compression at the 'heel' of the hand, NOT the elbow, is the MAJOR cause of cyclists' troubles. Compression at the elbow is common with OTHER conditions.

[StantheMan]

I got permanent numbness after PBP2015. Couldn't tie my shoelaces. Fingers got little better after one year. Now after 2/3 LEL2017 (dnf) my fingers are both numb and on fire at the same time. Better now than after PBP because I have used to this

[ijsbrand]

There are exercises one could do to floss the ulnar nerve. Those help. Even during a long ride. But preventing such problems ever would occur is indeed even better.

[chrisbainbridge]

Those exercises are as useful for cyclists palsy as homeopathy.

[Jacques]

3 PBPs and a HBKH and each time I had numb fingers for several months after. This LEL I did finger stretches (pressing tips against the bars for a few minutes) every half hour or so on the bike. Not having any problems this time so seems to work for me.

[mr ben]

Pins and needles in both hands but left is much worse, so on the off-chance that this is because my right gets more use (right-handed) I've been giving my left some exercise with putty I had after some physio following an op on it last year. I'm struggling to lift a pint with my left hand (surely this is a standard measure of function?) but I can't tell if this is real strength/grip reduction or just because I can't feel it.

I didn't notice any issues until about Edinburgh, and then it was more that my fingers didn't quite do as I asked when using cutlery, rather than numbness; that didn't set in until I'd stopped.

[Redlight]

Well, 9 days on and my right hand is OK but the left is still in a bad way.  Until today, the fingers were too swollen to be able to put on my wedding ring (a bit of a relief as today is our anniversary) and still don't have the usual levels of flexibility.  I can't play my guitar - which may be a relief to the family- and typing is easier on one side of the keyboard.  None of this is too much of a surprise as I know that I lean slightly to the left when I'm on the bike but I'm happy that the hand is the only part that seems to be affected.

[hellymedic]

Ulnar nerve compression at the 'heel' of the hand, NOT the elbow, is the MAJOR cause of cyclists' troubles. Compression at the elbow is common with OTHER conditions.

I was very unimpressed when my physician boss suggested I needed decompression at the elbow. I had just returned from three weeks of solo cycle-camping, tanned and happy, with a complete left ulnar nerve palsy...

[vorsprung]

I got permanent numbness after PBP2015. Couldn't tie my shoelaces. Fingers got little better after one year. Now after 2/3 LEL2017 (dnf) my fingers are both numb and on fire at the same time. Better now than after PBP because I have used to this

Don't get used to it.  There is no need for it.  Follow  chrisbainbridge advice above.  See my blog articles https://audaxing.wordpress.com/2012/06/24/hand-numbness-and-long-distance-riding/
and https://audaxing.wordpress.com/2011/03/07/long-distance-ride-bike-fit-tips/

[Tomsk]

I see a lot of riders with arms locked straight: fit, long-distance ones as well as newbies on the club-run. Bike fit will cure of course, but isn't it simply that the bars are too low? I use the drops with elbows bent, [useful into headwinds as well as for a regular change of position] - some seem to hold the tops all the time and still be straining.

If fingers start going numb - get them moving, as for cold in winter. The good news is that nerves do re-grow...slowly.

[sizbut]

Having paid some attention to this on the ride home tonight I have to agree. A good bend at the elbow helps ease some of the pressures on the hand/wrist. Yes, the hand/wrist position is predominately the thing that has to be focused on if possible but elbow flex helps more than just the elbow itself.

[Zed43]

My current bike fit is (mostly) ok, I normally ride with elbows bent and a light touch on the hoods. But I know from prior rides that when fatigue sets in it takes (mental) effort to keep my elbows and shoulders relaxed instead of leaning on the bars. I have been doing pilates twice a week for a year now to improve core stability, but I think I still have much to gain in this area.

Didn't use gloves (other than very thin merino lines for warmth), but do have thick Cinelli bar tape with additional gel pads underneath. And very supple 35mm tyres, front at 2.5 bar / 36 psi. While I do have tri bars fitted I didn't use them as much as expected due to the road conditions.

The numbness is now noticeably less than 5 days ago, but still there. There's a 600km brevet in two weeks that I'd love to ride, am I nuts to even consider riding this?

[Graeme]

... sorry Graeme, but swimming is a placebo

Thank goodness for that - I thought it was all in my mind.

Today's 200 has returned some feeling - no longer numb... now tingling. Yay!

[hellymedic]

Not everyone affected has significant sensory symptoms (numbness/tingling/pins & needles). I believe the motor and sensory nerves are on different branches.

I only noticed I had a problem when I had pretty well no ulnar motor function at all. Little of this is needed in the non-dominant hand whilst on the move.

One's ability to swim is somewhat reduced as the ulnar nerve supplies the muscles that bring the straightened fingers together (palmar interossei).

I still think it's important to get ALL weight off the hands regularly. There's no way I can tell if the problem is due to the little blood vessels that supply the being compressed or compression of the nerve itself. Little blood vessels don't need much pressure to get blocked though.

[jochta]

I've never suffered hand numbness riding before and I've done several long tours. I was using a custom frame with a bike fit which I haven't had problems with before, Lizard skin bar tape and gel inserts underneath. Using padded gloves.

I think the lack of time off the bike, the daily distance (far more than I ever do on tours), the significant road buzz and extra weight on the arms to relieve pressure elsewhere (not that I suffered much from saddle soreness) contributed to the issue. Also using a handlebar bag and extra gubbins on the handlebars limited my hand positions to what I would normally have. Both my arms feel weak and I have a significant loss of grip in both hands, I only have ulnar nerve numbness on my right hand though.

[IJL]

Numb tingling fingers affect me fairly frequently but I have the problems on short hard rides rather than distance.  Only once has it being an issue on an Audax when it became so bad that I could only use the left STI by reaching around and pulling it from the inside. 

Chrisbainbridge wrote of straight wrists and the reason for the issues on short blast became clear I am riding low on the hoods with  the wrist flexed, change position and no more problem.  Cue an evening of fiddling (which is much cheaper than a bike fit) .  What I found most surprising in the difference a small change in bar position makes to the degree of flexion of the wrist, move a 1cm spacer from below the stem and my wrist are much more straight and riding on tops also feels better. 

I have always been a bit dubious of bike fits in the sense that how can they tell in 30 minutes what will work for many hours I'm now tempted to book one