Physio advice for helping bike induced wrist and hand trouble?

[Matt Schiff]

After riding the CTR last year my smallest and ring finger had some numbness. I realized the aggressive/race position I used put too much weight on my hands over the course of 5 days. I'm about 95% better but obviously want this to be a memory. Does anyone who has had this type of hand trouble - ulnar neuropathy, handlebar palsy - have some good exercises or tips for healing they recommend? I haven't found much luck searching the net.

[riverfever]

I've tried different grips, wrapping them in cork tape, bar ends, etc. Traditionally, the stack height on my bike hasn't really been all that different from a typical XC bike. For 2012, I was having a lot of issues with my neck (slipped disc at C6). The pain was unbearable. I built up a new bike and ended up running a whopping 40mm of spacers under a 0 degree stem. This was after playing around with spacers above and below, doing several rides on a circus bike that got loads of looks before making the final decision. This made a huge difference on how my neck felt during longer rides but it also ended up helping my hands. I also had issues with numbness (particularly the left hand). It eventually goes away like you said but I think doing something like CTR causes damage. No matter what grips you use. For 2012 CTR I used Ergons with no barends and no additional tape because the extra stack height made such a difference for me. I don't know of any exercises to do to alleviate the numbness. My PT is actually a really good XC racer and we talked about this issue while he was trying to help with my neck and he knew of nothing to help either. Hope that helps.

[Matt Schiff]

It sounds like a more upright position helped your hands. It's pretty common bike fitting knowledge - to reduce pressure on your hands, raise and shorted the reach. At the time I didn't want to change my cockpit too much and raised the front just 1/2 inch. This year I'll be the guy with the short stem at +6 degrees mounted at the top of the steerer tube. Last year I was the slammed guy.

[phil_rad]

Two years ago I had some nerve damage done to my right hand after 6 days on the TDR, my little finger and ring finger were totally numb and I couldn't use my index finger and thumb. I went to a couple of doctors but nothing seemed to help. After about six weeks I tried acupuncture, cured it in 4 sessions, I couldn't believe it. At the time I was using ergon grips and a niner flat bar, I've since then went to a drop bar and it seems to have helped. Having the option of different hand positions is a big help too.

[Matt Schiff]

Was the acupuncture focused on the hand and wrist or did it go up the arm or throughout the body?

[phil_rad]

That's a good question, I think it was both. Some needles were in my hand Nd wrist and some on my arm. Sorry, can't remember all of the details

[Adam Alphabet]

Things that worked for me....
*Chiropractor: I go once a week every week. After the initial onset of the injury (6 hour race, thin grips) He would adjust my wrist in addition to my spine. Good nerve flow is the key to life.
*Bucket of Ice Water. Put my hand half way up to my elbow in a bucket of ice water for as long as I could bear it religiously after each ride for the first few months after the initial injury. Sucked a lot but helped a lot.
*Ergon grips, adjusted properly. Take the time to get the angle right, mark your bars, keep them right.
*Gloves with some padding. I don't like riding with gloves but they helped for the first while.
*Concentrating on my shoulders, neck, and grip tension while riding. Relaxing these things helped.

I haven't had any issues since, although I am very conscious of it as I am with all my past injuries. I thru rode the CT last summer, have done lots of long rides, bike tours, races, bike packing trips...etc. Seem to have things under wraps.
Good Luck!

[the tortoise]

I have found bars with more sweep and Ergon grips really help. My present bars have a lot of sweep (not sure of degree) but I am thinking of going with more sweep like the Jones Loop bars. Hands, wrists and arms survived the TD no problem.

[Matt Schiff]

I was using Ergon grips on the ride. I think they're good for reducing pressure on the outside of the palm but don't do a whole lot for wrists. I also like the ritchey foam which dampens vibrations a little better

http://www.ritcheylogic.com/dyn_prod.php?p=38-226-950&k=99205

I will ride with some of these in the spring to see how they work. I road with them on my road bike in the fall and they reminded me when my wrist was bent

http://sixsixone.com/bike/joint-support/pro-wrist-support

I do think padded gloves help a bit, taking away some of the vibrations.

I'm confident for the next year I'll have much less stress in that area. It's really about how to completely heal what has already been done. Thanks for the suggestions

[sfuller]

I had issues with both of my hands after an attempt at the TransWisconsin in 2010. Mine were shot after 4 days of riding on a bike that I had not done a proper fit on. I had the numbness you're experiencing due to irritation of the ulnar nerve, along with numbness in my other fingers, and a severe loss of feeling and grip strength. I spent the first month after the race having to look at anything I wanted to hold to make sure I was actually gripping it. We won't get into the other issues that crop up when this happens to your dominant hand

The only thing that really heals nerve damage is time, and depending on the level of damage, the healing is slow. I ended up having thoracic outlet syndrome, and used a combination of massage, accupuncture and time off the bike to heal up. I've since had a proper fit done on my Fargo and mounted a set of aero bars for an additional hand position and I have not had any issues since.

[BigPoppa]

Core strength is another big help, besides fit, ergo grips, and aero bars.

Do lots of planks, reverse bridges and balance drills. This is the type of strength that is totally sapped after a few days on the bike. Without it you end up putting way more pressure on your hands than you are used to and the nerve pain cometh.

[Matt Schiff]

Ended up finding the right combination of exercises to 100% alleviate numbness in my pinky and ring finger. While I'd tried some that were in the video, I spent no more than a week doing doing all of these exercises, especially the "owl eyes" one and the plate, minus smashing it at the end. After that, 100% better. There must have been some adhesions to the nerve (I think in the elbow and not the hand) that were bothering it with normal use, but broke free after the exercises. While there can be a ton of BS on the internet, I've also had great luck when I was 100% certain I had a hamstring tear but in the end it was sciatica. Hope this helps some people after they destroy their bodies in these crazy races.

Ulnar Nerve Flossing Exercise - Amazing Results

[krefs]

Here's my two cents:

-- Make sure your position is not too aggressive, as you mention. For really long rides, I raise my bars 1.5-2 cm higher than I often have them for regular riding

-- Use grips that dampen vibration. For the Tour Divide, I've used ESI Chunky grips with cork tape over top. For all other riding/racing, I use the Chunky grips alone. Now ESI also has some "extra" Chunky grips that have even more padding. I'm excited to try these.

-- Make sure Ergon grips aren't the problem. I gave them some serious testing a few years ago, and they caused some ulnar nerve problems that no other grips ever have, so the fancy grips just don't work for me.

-- Make sure your gloves do not have padding that increases the pressure on your ulnar nerve. I've had a few pairs in recent years that have gel padding on either side of that nerve, and as the gloves wear, they shifted so that one of the pads was directly over the nerve. Man, that sure was a stupid design for a glove.

Hopefully some combination of those might help!

[Joliver]

Ended up finding the right combination of exercises to 100% alleviate numbness in my pinky and ring finger. While I'd tried some that were in the video, I spent no more than a week doing doing all of these exercises, especially the "owl eyes" one and the plate, minus smashing it at the end. After that, 100% better. There must have been some adhesions to the nerve (I think in the elbow and not the hand) that were bothering it with normal use, but broke free after the exercises. While there can be a ton of BS on the internet, I've also had great luck when I was 100% certain I had a hamstring tear but in the end it was sciatica. Hope this helps some people after they destroy their bodies in these crazy races.

Ulnar Nerve Flossing Exercise - Amazing Results

Hey Matt,

I've been struggling with the same problem over the past 1 1/2 years.  Since you posted this video a few days ago, I have done the exercises every day.  They actually really seem to help.  Thanks for the info!

-Jerry

[mikepro]

I concur.  Thanks Matt for posting the video info, or being determined and relentless in your pursuit of good info.  I'm flossing, too, and finding good results (except the plate spinning).  Maybe I'll start with paper plates first.

[dbbcpa]

I had the same issue on a simple 100 mile overnight trip last year. I was really concerned because I was doing a trip with the ACA Group for a week between Whitefish and Lincoln on the trail. I got ergon grips and short nub endbars. Also my local bike shop guy said to use my back more my leaning forward and keeping my arms bent intstead of straight out. The combination of all of these worked and I have not had an issue since. The nub bar end grips are reaaly great becuase you can use more hand positions. It ends up I usually ride gripping the nub bar end grips instead of the regular grips.

DBB

[sanjuanrider]

After reading all these posts and talking to many riders I decided too wait it out, do some exercises,  then consult with the doctors and Occupational therapists. Every rider is telling me to give the hands time and they will heal. I'm 2 months past the end of my last big tour (Highland Trail 400) and my hands are becoming more useless by the day. Decided to have an EMG (Electomyogram) done too see what was happening with the nerves in the hands. Tests show significant nerve damage damage and now severe muscle atrophy. Doctors are telling me that a minor surgery should be done quickly but that scares me almost more than lightning on the CTR.

1. Has anyone else had this advice and diagnosis?  If so, did you do surgery and did it help? If no surgery, did you regain the muscle strength in the hand and how long did it take?

2. Those of you that did acupuncture, how many sessions and time before you noticed improvement?


Post ride corrections:

I got rid of my Ergonomic grips since I'm convinced they did more harm than good.

I have stopped riding (which is mentally painfully) too let the hands try to heal.

Bought some Pearl Izumi gloves that are supposed to protect the nerve for future rides.

Any and all comments are very welcome since I'm about a week away from making the decision too be sliced on!

[RideLikeAlf]

I rode the TD 2012 with my bike set up to closely mirror my road bike position. That was a recipe for disaster, and sure enough by the end of the race my hands were virtually useless - I had to buy some pliers to use in place of my fingers. When I got home I tried physio on my hands, arms and neck with little improvement. After two months I had nerve conduction tests that suggested severe lesions to both major nerves at the wrist and elbow. After a further 6 months with very little improvement, I finally decided to have surgery on my left elbow and wrist (carpal/cubital tunnel release ops). I am now finally back on my bike and have little trouble with my hands. In fact working all day on a keyboard gives me more discomfort than riding my bike. Over the last year, my right hand (originally less affected) has gradually recovered without surgery to the point where both hands are equally recovered now. If the surgery hadn't been effective then I was planning on trying acupuncture next.

So to recap, the surgery has helped me, but I wouldn't describe it as an overnight miracle cure. I guess the nerve still has to recover/repair itself after the compression is released, and that just takes time.

Hope you get sorted out soon - I was miserably depressed whilst I couldn't ride.


     

[Matt Schiff]

After reading all these posts and talking to many riders I decided too wait it out, do some exercises,  then consult with the doctors and Occupational therapists. Every rider is telling me to give the hands time and they will heal. I'm 2 months past the end of my last big tour (Highland Trail 400) and my hands are becoming more useless by the day. Decided to have an EMG (Electomyogram) done too see what was happening with the nerves in the hands. Tests show significant nerve damage damage and now severe muscle atrophy. Doctors are telling me that a minor surgery should be done quickly but that scares me almost more than lightning on the CTR.

I would use surgery as a last resort. I've heard somewhere it takes 1 month for 1mm of nerve to regenerate, or something along those lines. You mention your hands are becoming more useless by the day. Are you saying they're getting worse even though you aren't cycling? My condition got worse for 3 months afterwards because the first month I continued to ride, the second month I was painting boards and lifting lumber every day, and the 3rd month I still rode once a week. Make sure you aren't doing any activities that are aggravating it, which can be hard depending on your profession. It took 7 months before I found out what exercises would help me. My issue was with the ulnar nerve. What are your symptoms? Is it numbness or loss of strength? Which parts of your hand, palm, wrists are effected? Don't be worried that a test shows nerve impedance. I've heard that most serious cyclists have reduced nerve conduction whether they experience symptoms or not. Have any exercises or the ones in the canadian video been helpful?

[timroz]

I agree with Kurt on gloves.  I can't stand the tips of my fingers pushing on the end of the gloves, and I find a lot of gloves have pressure points on the back of my hands near my knuckles also.  That can't help.  I've gone to only wearing gloves when it's cold.  My setup is Ergons with 3mm thick neoprene pads that I tape to the grips with athletic tape.  I put several layers of neoprene on for long stuff like the CT or the ITI.