Recovering from CFS- was ouch! cycle tourer suffering numb, painful hands, arms

[peliroja]

Woolly here from Peli's account!

I was sure that I had the perfect bike set-up: Mary Bars from On-One, racer stem, and Ergo grips.

This has worked perfectly for around a year before we took off on our world pootle. Yes, once in a while, on long rides, I got a slight numbness/tingle in the hands, which disappeared after a shake of the hands or little stop for a drink or a jelly bean.

I was fine on some of the roughest roads in the world and on very long and hard days in the saddle in South America. In the States I had the numbness/tingle more often and sometimes for more than once a day. This was on tarmac most of the time, sometime chip-seal but mostly smooth surfaces.

When we arrived in New Zealand almost as soon as we rolled out of the airport I had numb fingers. As we made our way up to Northland, I got numb fingers no matter how often I tried to move my grip or shake my hands. I always cover my brakes, three years as a cycling instructor will do that to you, I very rarely grip the bars.

As we cycled south of Auckland it started to become painful and the pain was moving from my fingers to my wrist and lower arms. It got so bad that I could feel it in my shoulder. I had a sharp pain in one, like a needle, and when I pressed the site of the pain it relieved the pain in my hands and wrists. The palm of my hands, especially the fleshy bit near the thumb, is very sore and at the end of the day the ulnar nerve is very tender, often with shooting pains up my lower arms.

I have played around with the Ergon grips and just got some new mitts but nothing has helped. I'm even trying out some Bontrager BuzzzKill dampers, the jury is still out on them. I did feel something change when going downhill at speed, more like the vibration you get when power drill is changing speed but very subtle.

It is now so bad that I wake up in the night with painful arms, elbows and shoulders. It feels like the painful part of pins and needles but without the pins and needles. The first hour in the morning I struggle to make a fist and my fingers feel very tender and stiff.  After one day of rest my hands have started to shake for the first hour or so after waking up, and a few hours later there is still a touch of the shakes.

Last time we were in a country where we had to wear helmets we both had pain from the base of our skulls down the spine past the shoulder blades, with pain from going out to each shoulder. This time around it is the same and it is a great pleasure to take the lid off when we are having breaks or at the end of the day. When we have been on quieter roads I have taken the helmet off. This makes a slight difference in delaying the pain appearing in the hands, wrists and arms.

The helmet is really the only thing that's changed between cycling here and in the Americas, where I had no problems. The set-up of the bike is the same as I'm always careful to use plenty of markers to make sure they're put back together in the same way.

So, I'm not sure what could be causing me this intense pain. Simple overuse, even though we're not doing mega mileage? Carrying too much on the bike (even though our load is much lighter here in NZ compared to Patagonia?) Front tyre being a bit worn out (it's a Marathon Plus Tour and is showing signs of wear - I'd planned to replace it after NZ)? The helmet, gloves or even the road surface?

One solution I've been considering is to get a suspension fork that can take front racks on a 700c wheel. I know it will push me a bit higher up but perhaps that's what I need, though I've been very happy with set-up on the 58cm Surly for over four years now. I've also considered getting a 60cm frame since a few people have said it does look a wee bit small for me.

I know that taking painkillers would be an temporary option but I'm not really keen on masking pain, since that is how the body tells you something is wrong.

We are going to have nearly four days off the bikes now and if we cycle it will be short distances. When we're back on the bikes it will be on quiet roads or trails, so I won't wear the helmet, and with more rest days in between.

I can't post photos easily at the moment (the wonders of New Zealand's internet service), but there are plenty of photos of me riding at www.woollypigs.com/galleries if you want to check my position on the bike.

In the meantime, what does the yacf panel think could be the problem here? Your thoughts, ideas, advice, and jokes at my expense are welcome!

[Erudin]

Sounds quite nasty, have you seen a good physio? I get ulnar nerve related numbness using flat bars on long rides, don't get the problem at all with compact drop bars.

I've got an old neck injury and find neck exercises/pilates stop it flaring up (like in this YouTube vid).

Have you tried butterfly bars or drops? I guess butterfly bars would be easiest to try, they do give a short and long reach position that might help.

[uphillbothways]

It's unlikely to be anything that's changed, but rather an over-use injury. The most likely culprit is a postural issue, resulting in pressure being put where it shouldn't. Although the Mary bars have considerable sweep, they are still essentially a flat bar and so ergonomically less than ideal. Their shape generally precludes the use of bar-ends and they provide only one good hand position. Swept bars present a complex fitting challenge, as it is difficult to provide a truly neutral wrist position.

To rule out some obvious possibilities, a few questions:
How much do you, your bike and luggage weigh?
What size tyres do you have fitted, and what pressure do you run them at?
How tall are you and what is your inseam measurement?
What is the drop from your saddle to handlebars?
Have you had any prior issues with or injuries to your hands or arms?
When experiencing the symptoms you describe, are you able to make an "OK" sign with your forefinger and thumb?
Where does the numbness and tingling start? Is it particularly strong in certain fingers?

Were you not in the middle of a major trip, I would tell you to immediately stop riding and consult a specialist. Given that you're halfway around the world, I would advise you at least to change your handlebars - practically anything would be an improvement, simply by changing your position on the bike. The obvious suggestion would be butterfly bars, which provide at least four good hand positions. These will allow you to use your existing stem, levers and shifters. Ideally I would recommend fitting clip-on aero bars of the ski-bend type, positioned high, wide and tilted up. These would completely alleviate the stresses on your wrists and forearms and hopefully allow you to continue on your trip unimpeded - although unusual, such an arrangement is the choice of many ultradistance riders.

[Ham]

Without the slightest mefical background it sounds like something is either worn or inflamed and a nerve is trapped somewhere, I would think taking anti-inflamatories a la VIt-I will help, although then you need to be careful not to do more damage. ^^^ wot everyone else said, too, and hope you are feeling better soon <waves>

[mike]

has your saddle angle changed?  If the nose has slipped down even a little bit it might have put more weight forwards onto your hands.

I never got on with mary bars on my mtb, something about the swept-back angle meant i couldnt get comfy, have you tried a normal (straighter) riser bar?  Butterfly bars are a good idea too, even though they are ugly...

good luck sorting it.

[mrcharly-YHT]

Doesn't need to be a change in posture, but over-use, like uphill said.

Inflammation on tendon sheaths where they pass through the carpal tunnel area would cause this.

Rest, gentle wrist rotation (I said *gentle*!).  Gently 'spread' the base of one hand (as it turns to the wrist) with the other hand.

Neurofen to reduce inflammation.

[clarion]

Straight/riser/Mary bars (i.e. those with just handgrips at the end) don't offer many alternative hand positions, so the strain can simply be overuse in one way.  Adding the right bar ends can help, but I'm not really sure what (if anything) would work with a Mary.

[zigzag]

the only thing i can suggest is to change position on a bike so there's less pressure on your hands. normally, arms/hands should be gently touching the handlebars, not bearing considerable weight until they get numb. strong core muscles can do wonders to alleviate numb hand issue, but it's not a quick fix that you need now..

if possible, i'd see a doctor/physio as it sounds pretty serious now.

[clarion]

That sounds like good advice.  Anti-inflammatories will probably help in the meantime.  IANAD.

[Cudzoziemiec]

I googled Mary bars and found this photo which shows a possible way of getting a variety of hand positions.


I'm no kind of expert but I'd say you need to a) have regular rest days. Take every Sunday off or something like that.
b) see doctor.

[hellymedic]

I think there are both neck and hand problems here, compounding each other.
The effect of h*lm*ts on the neck is little covered on the cycling fora, especially the problem of nerve compression.
There will be some wear and tear in the neck in most who have passed age 40.
I don't think people were designed to arch the neck back whilst leaning forward, especially with any extra weight atop the head!
Empirically, I would suggest bars that allow the most upright back and neck posture.
The hands may have developed neuromas of the ulnar and/or median nerves at the wrist, follwing months on the road. Carpal tunnel release may be on the cards for the future but would be impractical right now.
I really can't suggest much of any use; a recumbent might address multiple postural issues but I can't magic one that fits, carries loadsa luggage and suits you out of the air...

[perpetual dan]

Straight/riser/Mary bars (i.e. those with just handgrips at the end) don't offer many alternative hand positions, so the strain can simply be overuse in one way.  Adding the right bar ends can help, but I'm not really sure what (if anything) would work with a Mary.

Yes.
I have Mary bars on my MTB. Much more comfy than stright or riser bars, to me. But if there's a lot of road there isn't much movement of body position much less hand position. I'm not sure they are as good for that kind of riding - I'm saving up for some Jones bars, which have a second position.

[andrew_s]

I'd be inclined to suggest On-One Mungo handlebars, set to rise (or other North Road bars), with a shorter & higher stem, to give a position that's considerably more upright and with the knuckles turned outwards, Dutch bike fashion. It sounds like things have reached the stage where minor tweaks won't help.
It's even possible to reverse a short stem to get more upright. It will handle oddly at first but you'll get used to it in a few days.

You may like to consider a sprung saddle such as a Brooks Flyer at the same time.

[Kim]

I always get this after a few hours on a DF bike, knitting, using power drills, etc.  I blame too much mousing.

I find an upright riding position with as little weight on my hands as possible helps, though that's a straight trade-off against saddle area pain.  Butterfly bars with the traditional foam grips give comfortable positions and are good at absorbing vibration, in the absence of chunky tyres or a suspension fork.  Tri-bars are another common suggestion, though I suspect not a particularly useful one for the type of riding you're doing.

But obviously a recumbent solves everything arm and saddle related.  With one of those available for long rides and touring, comfort on the DFs became less important, so I stopped tweaking at that point.  Best bike for the job and all that.

[vorsprung]

Maybe raise the bars a bit

Your idea of fitting suspension forks to cause a bit of raise is interesting.  I'd probably fit an "adjustable" stem like this



Raising the stem on this also has the (good in your case) effect of slightly shortening the reach

Also might be worth lowering the saddle a tiny bit

[peliroja]

Peli here. Thanks so much everyone. Very helpful. We're resting at the moment and will consider all these suggestions in detail. Poor Woolly, hopefully we can sort him out.

[woollypigs]

Coming from butterfly bars, never felt comfy where the shifters and brakes are sitting, even moved them around to a better place and ended up with my hands there, out on the side. Though to solve this might have to learn and live with them.

I got a 110mm adjustable riser at the max and have not cut the fork.

No previous injury, even as a single handed teenager, it's the little finger first then the ring finger then the whole hand. That starts to get cold then numb.

I was told to take the 58cm frame over the 60cm, because I would be carry a heavy load while touring. Which I do, I think with the trailer I carry around 45-55kg, it was much more in South America.

I tend to run my tyres below the max in tarmac, might have to go softer, but that will make it much harder to ride.

Lowering the saddle we going into knee problems. Saddle angle hasn't changed either, though the Brooks has gone a little hammocky, for which I had to move the saddle up around 5mm around six months back, because my knees were hurting.

We had two days of the bike and last night sleep was the best though still stiff when I woke up. But the five km into town I could feel it in my hands and lower arms and a bit in the shoulders.

To rule out some obvious possibilities, a few questions:
How much do you, your bike and luggage weigh?
Me at 95kg'ish and bike 15-16kg and the luggage around 50kg

What size tyres do you have fitted, and what pressure do you run them at?
38mm and never at the max psi

How tall are you and what is your inseam measurement?
6'4" and 34"

What is the drop from your saddle to handlebars?
The handlebars are above the saddle, by an inch or two.

Have you had any prior issues with or injuries to your hands or arms?
Nope

When experiencing the symptoms you describe, are you able to make an "OK" sign with your forefinger and thumb?
Yes

Where does the numbness and tingling start? Is it particularly strong in certain fingers?
it's the little finger first then the ring finger then the whole hand. That starts to get cold then numb.

Any way thanks for help, gave us something to think about.

[Ham]

How much do you, your bike and luggage weigh?
Me at 95kg'ish and bike ......

Wooly, I have the answer for you. It is obvious from that small piece of information.

(click to show/hide)

Insufficient Cake

[uphillbothways]

Your symptoms are consistent with ulnar nerve entrapment, probably Guyon's canal syndrome - this is sufficiently common in cyclists to be often called "handlebar palsy". Get someone to help you check for Froment's sign - the presence of this would strongly confirm the diagnosis (though the absence of it would not rule it out). Given what you've described to me, it's most likely that your position on the bike is causing compression of the superficial branch of the ulnar nerve (diagram), although pressure on any part of the ulnar nerve would cause these sort of symptoms.

You need to relieve this pressure, or your symptoms are likely to continue to worsen. Ultimately this could become a debilitating injury that could impede your ability to perform even basic household tasks, so you need to take it seriously. I suspect that the sweep of your handlebars may be the key issue. Fitting Ergons may have actually made matters worse, because they're designed to work with relatively straight bars. If you're sure you want to continue with flat bars, I'd suggest something straight and relatively wide, with a thick padded grip - possibly even pipe lagging taped to the bar. The goal is to distribute weight away from the injured area, onto other parts of the palm. Ideally you would add aerobars or Spinaci, to give yourself a position that puts little or no pressure on your palm. Raise your bars as much as possible and make sure you're not slipping forward on your saddle and having to push yourself back. Check to see that you're not gripping the bars too firmly and that your wrists are in a relaxed and neutral posture. Anti-inflammatories like ibuprofen will help, but you really need to remove the cause of the injury.

[peliroja]

Thank you very much, uphillbothways (you certainly sound like you know what you're talking about!). Woolly (Henrik)'s been resting for a few days now and we've just ordered some butterfly bars so he can give those a go again. There is only one supplier in NZ so they're coming up from ChCh to Picton.

We're also considering other bail-out options, such as Woolly driving a car while I cycle, or even aborting the trip entirely and coming home while he gets sorted out. We certainly don't want him doing himself a serious damage.

Thanks again, everyone, for the advice and help. 

[CrinklyLion]

I hope it doesn't come to that Peli, and that you find a solution.

[woollypigs]

Trekking bars ordered from http://www.cycletrading.co.nz, arrived with a speedy delivery and a note from a forumite who works there, world is small

We just had three hard days cycling on the Queen Charlotte Track from Ship Cove back back to Piction. Let's just say it was fecking hard, off roading with lots of pushing and dragging our bikes up and over rocks and tree roots and steep hills. We had great weather, stunning views and great fun cycling the single track, glad we did it.

My hands are probably not better for it, since we now have very sore muscles in parts of our bodies that we didn't know we had muscles.

I had more pain in my hands/arms when we joined the tarmac for a wee bit, on the single track I was fine, go figure.

Will fit the trekking bars tomorrow with Lizard Bar tape, have a well earned rest day, then set out to see the Golden Bay nice and easy while hoping that this would solve the problem.

[L CC]

I had more pain in my hands/arms when we joined the tarmac for a wee bit, on the single track I was fine, go figure.

I think that's because you take more weight on your feet when off roading, I never used to have much trouble when I mtb-d even quite long distances (comparatively).

I've been watching this thread with interest, as a frequent sufferer of numb hands. It's quite bad at the moment, and certainly worse with bits of metal in my wrist than before that happened. It takes less than 50 miles on the Longstaff for it to kick off. They start to tingle before I get the 12km to work on flat bars. However I'd rather have no feeling in my left hand than ride with butterfly bars. </snob>

Let us know if /how you get relief.

[Cudzoziemiec]

Boab, if you've got metal in your wrists, maybe they're extra-tingly now due to the cold weather? I suppose this will depend how deep under the skin the metal is, but in wrists they're bound to be pretty close to the surface, and maybe how close the metal is to blood vessels and nerves? I know that when I had metal in my shoulder it seemed to react to cold, although the doctor said it shouldn't.

[L CC]

Nah, Cudzo, I don't feel it in the wrists, it's the old favourite ulna nerve damage/compression- numb fingers, starting with the little fingers and extending to ring & middle. Textbook. It's just that (I think) the tunnel the nerve goes through is narrower because of the scar tissue.