Physio advice for helping bike induced wrist and hand trouble?

[THE LONG RANGER]

Matt, thanks for posting that video, started doing it last night, and my fingers feel already a bit better. One thing it made me realize is that my hands are really, really tight - some of the movements, like the, "mask", I couldn't even get into position to do.

I was surprised I hurt myself so much just from 7 days on the CTR - my front shock went out on day #7 - I think that had a lot to do with it, but having a handlebar with very little sweep just feels so unnatural, now.

I went to a massage therapist, who also suggested some tai chi-like hand movements and the idea of, "lubricate with motion" When I brought up the idea that I had nerve damage, she actually had the opinion that it wasn't that, but rather pressure on the nerve from various other parts of my hand. Considering how tight my hands are, I think there's some merit to what she had said. The massage itself helped with things, as well.

Still can't play cymbals.

[sanjuanrider]

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?

Thanks for the replies guys. Great information.

Matt - my issue is definitely with a severe blockage in my ulnar nerve in my dominate hand and a moderate blockage in the same nerve in the left hand. The blockage then causes muscles to atrophy due to lack of blood.
I did stop biking completely in the last 2 weeks because the muscles got to a point that I can barely open a jar or operate a pencil. My Occupational Therapist told me to do the "lubricate with motion" just like Long Ranger mentioned. I'm told the fluid motion of the arm is the modern thought of healing over flossing since it is about getting the flow of blood in the nerve to come back prior to growth being able to occur.  Apparently - if scar tissue builds up in the ulnar nerve after damage then the muscles can't recover without the blockage being removed, hence surgery to get growth to start occurring.

All that info aside, I'm still in hopes of some alternative (acupuncture, cortisone, sweet drugs) to get my hands back.  These forums are helping a great deal in learning more about the problem which is extremely common in bikepacking as I am noticing.

[B_Bock]

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!

I too like the chunky grips. I've experienced numbness in my hands and finger tips. More from TDR than races where I'm on and off the the bike.
I like to switch between cycling gloves, full finger, and wearing no gloves during the race.

[Sean Allan]

Thanks for the replies guys. Great information.

Matt - my issue is definitely with a severe blockage in my ulnar nerve in my dominate hand and a moderate blockage in the same nerve in the left hand. The blockage then causes muscles to atrophy due to lack of blood.
I did stop biking completely in the last 2 weeks because the muscles got to a point that I can barely open a jar or operate a pencil. My Occupational Therapist told me to do the "lubricate with motion" just like Long Ranger mentioned. I'm told the fluid motion of the arm is the modern thought of healing over flossing since it is about getting the flow of blood in the nerve to come back prior to growth being able to occur.  Apparently - if scar tissue builds up in the ulnar nerve after damage then the muscles can't recover without the blockage being removed, hence surgery to get growth to start occurring.

All that info aside, I'm still in hopes of some alternative (acupuncture, cortisone, sweet drugs) to get my hands back.  These forums are helping a great deal in learning more about the problem which is extremely common in bikepacking as I am noticing.

If possible, try to see a CHT (Certified Hand Therapist). My wife is an OT and a CHT and there is a big difference in the amount of knowledge and resources. Good luck, I think we all suffer to some degree from hand pain and such, kinda goes with doing stupid stuff on your bike, especially as you get older or you use your hands for a living.

[Yogi the Barry]

Gloves - Out of desperation with finger numbness, at about day-3 in last year's CTR, I started riding half the day without my 3/4 length gloves, when weather and terrain allowed. Riding sans gloves seemed to help restore feeling quite a bit. Seems like the padding in the glove should help, even though I normally wear thinly padded gloved, but almost any padding seems to make my hand issues worse. Wish I knew exactly where my pressure point(s) was(were) located...
Grips - I'm a fan of the ultra-cheap and ultra-light Ritchey foam grips [Not just because of the matching surname either. However, I truly wish Tom was my cousin]. The Ritchey foams are easily sanded/shaped with a Dremel tool, or sandpaper, to make the shape more hand friendly. Also very inexpensive if the experiment fails. Also, at least for my hand issues, smaller diameter grips make it worse.

...I like to switch between cycling gloves, full finger, and wearing no gloves during the race.

[mtnbound]

There is a lot of useful info in this thread.  I have begun having hand and elbow problems recently.  When I ride on a bikepath/road on my mtb for more than a couple of hours, I start to get needle prick sensations in my hands, making it hard to grip the handlebars.  If I keep going, if I even just touch the handlebars, it feels like a bunch of needles are shoved into my hands.  However, I don't think I have ever had that same sensation on pure singletrack.  Not sure what this is a symptom of.

The other problem that just started a few weeks ago is "tennis elbow" (I am over 40 years old, which may be a factor).  I have had it crop up a few times in the past 10 years (previously either playing tennis or lifting, but I don't do either now) but it has been a few years since it last popped up.  However, I rode mtb 3+ hours a couple of weeks ago and the next day, I got the same symptoms in my elbow - lots of soreness on outside of elbow.  It went away after 3-4 days.  I rode 4 hours this past weekend on the mtb and the elbow pain came up again (shortly after the ride this time) and it is lasting longer this time but slowly getting better.

My grips on the mtb are very old and I am looking to replace them, which I think will help both problems (I am also thinking of raising the bars 1/2 inch to ease pressure on my hands.  I also wear full finger padded gloves).  However, I don't know what grips to get.  I was thinking of Ergon GS1 or Serfa has two different types, all of which have a pad for the palm.  Ergon GS1 has the palm pad for the outside of the palm (i.e. under the pinkie) while Serfa has the palm pad for the inside of the palm (i.e. under the thumb) along with a small raised area on the outside edge of the grip to rest your pinkie (they claim it is a ulnar pad for your ulnar).  Anyone know why the palm pad is in different locations for these two brands and if the ulnar pad is useful?  Second, are any of these features useful for my specific problems?

Thanks!!!!!

[sanjuanrider]

There is a lot of useful info in this thread.  I have begun having hand and elbow problems recently.  When I ride on a bikepath/road on my mtb for more than a couple of hours, I start to get needle PRC sensations in my hands, making it hard to grip the handlebars.  If I keep going, if I even just touch the handlebars, it feels like a bunch of needles are shoved into my hands.  However, I don't think I have ever had that same sensation on pure singletrack.  Not sure what this is a symptom of.

The other problem that just started a few weeks ago is "tennis elbow" (I am over 40 years old, which may be a factor).  I have had it crop up a few times in the past 10 years (previously either playing tennis or lifting, but I don't do either now) but it has been a few years since it last popped up.  However, I rode mtb 3+ hours a couple of weeks ago and the next day, I got the same symptoms in my elbow - lots of soreness on outside of elbow.  It went away after 3-4 days.  I rode 4 hours this past weekend on the mtb and the elbow pain came up again (shortly after the ride this time) and it is lasting longer this time but slowly getting better.

My grips on the mtb are very old and I am looking to replace them, which I think will help both problems (I am also thinking of raising the bars 1/2 inch to ease pressure on my hands.  I also wear full finger padded gloves).  However, I don't know what grips to get.  I was thinking of Ergon GS1 or Serfa has two different types, all of which have a pad for the palm.  Ergon GS1 has the palm pad for the outside of the palm (i.e. under the pinkie) while Serfa has the palm pad for the inside of the palm (i.e. under the thumb) along with a small raised area on the outside edge of the grip to rest your pinkie (they claim it is a ulnar pad for your ulnar).  Anyone know why the palm pad is in different locations for these two brands and if the ulnar pad is useful?  Second, are any of these features useful for my specific problems?

Thanks!!!!!

I've been doing a lot of research on this the last 2 weeks do to the severity of my problem. A quick explanation of the causes is from a Google search http://orthoinfo.aaos.org/topic.cfm?topic=a00069 . Most of the times it seems that a change in positioning seems to solve the problem.
 I used Ergonomics grips for the CTR 2 years ago and had no problem.
 I used Ergonomics grips for the Highland Trail 400 and have tons of problems.
Difference -I was on a hard tail and leaned over at a more severe angle on Highland Trail than I was on CTR with a full suspension with a more upright angle.
Not conclusive yet but I'm sure positioning and cushioning coincide with the problems.  The elbow soreness (which I did NOT have) has been asked by each of the doctors I have consulted with since it often causes the same problems with the hands. I would do short rides and adjust angles to see if the soreness changes. If NOT stop riding (I know that should never be said) but I learned the hard way!

[Matt Schiff]

There are definitely a couple different injuries people get from cycling but really the only one that can be fixed with a product is one for your hands, which means means gloves or grips. I think it's important to remember that the pressure on the hands may not be the cause of tingling/pain/weakness in the hands. If you follow the nerves back to spine there are several places they can become irritated. My issue, for example, was too aggressive a position which put more weight on my upper body and forced the triceps to work really hard. The triceps, down into the elbow is where my problem was originating from.

[mtnbound]

Thanks for the responses!  I have been doing some reading (including sanjuanrider's link - thanks!) and decided to get the Ergon GS1 grips.  Took one ride with it over the weekend and they felt a bit weird a first.  It was only a short ride but it didn't make my elbow worse (only my left elbow hurts), so only time will tell if it works.  I have tried some self massages (on my elbow) and wrist exercises as well as IB.  I will not do a long (3+hr) ride until the pain goes away.  Matt, I think I will get some new gloves too since mine are about a year and half old, maybe that will help.  Plus, I will raise the stem by 1/2 inch to get more of an upright position and take pressure off the wrists.  I have been learning to play the guitar, which puts my left hand/wrist in an awkward position, and have put that on hold until the elbow gets better.

[THE LONG RANGER]

I've been *slowly* getting back into riding MTB's, to give my tingling fingers a chance to heal. One of things I have purchased, from Greg @ Bolder Bikepacking's suggestion is a pair of Jone's H-Bars,

http://www.jonesbikes.com/h-bar.html

We took a 60 mile ride last weekend, along the CT, and GDMBR and they worked really well. Need to get a shorter stem, and it took a few minutes to re-wire the brain, as downhills were terrifying in this new position, but the extra hand placement options really does make things nice.

I've been trying to train for the Vapor Trail in a few weeks, so the more time I can get on the MTB, the better, but it's been a delicate balance between wanting to hit the trails, and being nice to my hands.

This bar should be on everyone's radar, if their attempting the Tour Divide - it almost makes aero-bars unneeded. Or just doing dirt-mostly tours - Surly got it right with their new ECR, picking this type of bar. 

[GrizzlyAdam]

The numbness in my hands and feet is almost gone. But my left hand is still goofy. I don't have the same level of dexterity I used to. It's improving, but so, so slowly. I've started using one of those hand squeezee things to add strength. Maybe it'll help. Up until about a week ago I had to have my wife clip my fingernails. I couldn't squeeze the clippers!

[sanjuanrider]

The numbness in my hands and feet is almost gone. But my left hand is still goofy. I don't have the same level of dexterity I used to. It's improving, but so, so slowly. I've started using one of those hand squeezee things to add strength. Maybe it'll help. Up until about a week ago I had to have my wife clip my fingernails. I couldn't squeeze the clippers!

Glad your coming back around.  I was in the same position as you since the end of May (end of the Highland Trail race) with not being able to even use nail clippers.  I could barely even use a pencil, pick up a plate, and the fingers started curling back under all the time.  I started seeing specialists and every one of them said surgery was needed right away to fix the problem.  All of them said it was a process of cutting the ligament, opening up the nerve, then stitching the hand back together.  I was a day away from doing the dreaded surgery until I decided, after reading a lot of posts and talking to many other bikers, to wait it out and let it heal on its own. I still have tingling and numbness in a few spots of the fingers but the strength came back and I'm sure the rest of the numbness will be gone soon as well.  Long story short - I'm so glad I listened to the advice of the biking community instead of the surgeons that make a lot of money cutting on people every day to make a living.

[Matt Schiff]

Glad your coming back around.  I was in the same position as you since the end of May (end of the Highland Trail race) with not being able to even use nail clippers.  I could barely even use a pencil, pick up a plate, and the fingers started curling back under all the time.  I started seeing specialists and every one of them said surgery was needed right away to fix the problem.  All of them said it was a process of cutting the ligament, opening up the nerve, then stitching the hand back together.  I was a day away from doing the dreaded surgery until I decided, after reading a lot of posts and talking to many other bikers, to wait it out and let it heal on its own. I still have tingling and numbness in a few spots of the fingers but the strength came back and I'm sure the rest of the numbness will be gone soon as well.  Long story short - I'm so glad I listened to the advice of the biking community instead of the surgeons that make a lot of money cutting on people every day to make a living.

I'm glad you didn't have the surgery AND it was the right decision

[Gimmearaise]

I had a pretty rough stretch of numbness after the CTR this year. Only a week ago or so did I realized that my my big toes and fingers were not numb! Hurray, It always goes away! I need to stop worrying

[phil_rad]

After almost four months since the GST my ring finger and pinky on both hands is still numb. More importantly the atrophy and loss of motor control in my right hand is going away, very slowly but its going away. I can at least button up my pants and shirts by myself. and use the fingernail/toenail clippers. I had some acupuncture done but it didn't seem to help this time. I think time is what does it, and not putting pressure on the spot again. Although I did ride a little bit for the first two months afterward. Glad to hear that everybody else is healing up.

 

[Flinch]

Besides not being able to get a comfy saddle, hand numbness is my second plague - no matter if training or touring.

On a Fernie to Pinedale (TD route) to Evanston WY ride this summer, 100km/day pace, I ended up with long term (>month) numbness on pinky and fourth finger of one hand, arms would fall asleep at night (did so also during ride), and hands were sensitive to normal working around house, Ie: anything to do with gripping - They would fall asleep or tingle. Pinky, etc recovered, ditto tendency for arms to fall asleep.  Hate to say I reduced riding for a couple months - shame...

I had replaced my leather palmed gloves with gel gloves, and am convinced = bad move. Pressure pads ended up on nerves. Got some riding relief without gloves, and changing positions frequently. Am going to ditch the Egron pads. Looking at Jones style swept bars. Raising bars.

It's important to note the difference in hand nerves that can cause issues, that is, Ulnar versus Median nerves. Former causes outside two fingers numbness, other thumb and first through fourth fingers. That may help diagnose what pressure/position is causing problems.

See: http://www.innerbody.com/anatomy/nervous/arm-hand

Ya ain't alone, good luck!

Glen