Help my hand is broken!

July 20, 2008 6:16 PM

I am having some weird hand symptoms after a 200 mile bike ride.

So I rode the STP last weekend. Standard road bike with drop handlebars. My previous longest ride was 75 miles. By the end of the ride I was having a lot of numbness in the 3rd-5th fingers, palm side, left greater than right (I am right handed) and I was unable to operate shifters or hold on to much. The next few days things got a tiny bit better but I still had a lot of trouble opening caps of bottles, flossing teeth, and even typing. Now, a week later I can pretty much do most normal activities but I still cannot play guitar *at all* which kind of freaks me out.

So I am obviously dealing with a median nerve compression neuropathy and I know all the stuff to do about it. But I have some questions for you cyclists out there. Number one, do people develop permanent or long term problems from this kind of activity? Number two, is there something I could do to prevent this from happening on future rides? Because seriously people, riding to Portland with 9500 other people was the most fun I have had in months.

posted by Slarty Bartfast to sports, hobbies, & recreation (17 comments total)

Congratulations on the major ride!

Assuming you were wearing new, properly padded gloves and were changing your hand position frequently, you may need to raise your handlebar to get some weight off your hands and/or get some aero bars. There's some discussion of aero bars and hand numbness here and further discussion of preventing and treating numbness here.
posted by maudlin at 6:38 PM on July 20

Common? Yeah. Avoidable? Pretty much if you think ahead. I assume you wore gloves. I switched from Pearl Izumi to Descente and was night-day difference. Also I keep in mind to frequently change hand positions while on the road: drops, hoods and bar. Also go one-handed and stretch/flex the other hand, shake it out and if you can put it behind your back to stretch. One other thing is let your core (like back and abs) support your weight more than using arms and hands.

Long-term wise, I've ridden almost 5,000 miles in about three years and can't tell if I have serious problems.

Looking at some bike books that cover health and injuries they also suggest bar changes in position and height. Also it says tube length and maybe moving saddle back a little. But I think good gloves and often changing hand locations is the easiest (and best) way to stop this.
posted by fijiwriter at 6:49 PM on July 20

You find this odd? 200 miles? Welcome to real life. You know, Lance and the boys have weird pains too, but they just ignore the ones that don't slow them down.

Anyway, that's a major ride for an amateur, congrats.
posted by caddis at 6:49 PM on July 20

Get your bike professionally fitted, if you haven't yet. People absolutely can suffer long-term if they ride under conditions that are hurting their body, and if you have hand, wrist or arm problems already, riding can exacerbate them.

When I get numbness in my hands, it's usually because my neck and shoulder muscles are tight. Learn some good upper-body stretches, and practice them each and every time you stop to rest. Making a habit of shaking out one arm, then the other, every once in a while will make you more comfortable, too.
posted by freshwater_pr0n at 6:55 PM on July 20

Congrats on doing STP. I did it a few years back and I'm still kicking myself for doing it in two days instead of one. On the other hand, instead of damaging my hands, I developed tendinitis during the second day and was off the bike for a few months, plus I was unable to walk up stairs without pain.

Your problems with your hands definitely sound serious, you should definitely do something about it. Raising your bars should help, although it's difficult with modern threadless stems. You may need to get a stem with a positive rise. Although everyone loves to claim more padding is good, it may be the padding that's giving the problem - the foam/gel in your gloves/handlebars may be putting pressure on things that weren't mean to take pressure. The soft, fleshy parts of your hands in between the tough bony parts may have the cushioning pressing into them, causing problems that your body already solved. It's the same reason why some riders (as myself) ride on the most rock-like saddles for hundreds of miles, and riders with soft cushy saddles experience problems after only an hour or so.

Aero bars aren't a one-size fits all solution. You have to adjust things around, otherwise you're just going to move the pain somewhere else.
posted by meowzilla at 7:03 PM on July 20

I did the STP too. Great weather, no?
Anyway, it sounds like you made a big leap in mileage, true? That can be a problem.
Surely you should lay off a while.

My wife had issues like yours last year. This year she did a bunch of centuries leading up to the STP and she was a lot better off afterward.

You need to shift hand positions a lot on a ride that long.
Second the fitting idea. Too long a stem or too low the bars can get you.
It can be worse if you are tired and get all stiff armed. Keeping flexed avoids that pounding that adds up on long rides.

If you can find a moment to ride no hands, or one handed and then that a stretch, that can help.

It was a blast, wasn't it?
posted by cccorlew at 7:49 PM on July 20

I would also recommend massage and/or chiropractic adjustments in the neck area. Loss of muscle use, more than just paresthesia (aka pins and needles), indicates that there is some considerable pressure on the nerves.

Can you sit up and ride no-hands? That can be a good way to relieve stress on the arms and shoulders.

When I ride a lot in the drops and my hands start to tingle, I'll shake the hand out, get on the hoods or the tops, whatever it takes to get the pins and needles sensation to go away.
posted by computech_apolloniajames at 8:26 PM on July 20

Yes, it was a blast.

Before they take away my medical degree I had to come back to correct myself. It's an ulnar neuropathy, not median. I'm an idiot. Please don't tell ikkyu2.
posted by Slarty Bartfast at 8:28 PM on July 20 [1 favorite]

The ultimate in no-upper-body-strain bicycling is with an under-seat-steering recumbent (with an above-seat-steering recumbent in second.) I went recumbent when a severe RSI made even a short ride cause enduring pain. Years later, I've never seen any sense in trying to go back.
posted by Zed_Lopez at 11:04 PM on July 20

Neurapraxias like this tend to get better; it can take longer than a week. The oft-quoted figure is 1-2 mm per day for the nerve distal to the injury to regenerate, but this isn't always reliable for mild pressure mononeuropathies or short nerves.

I have never ridden 200 miles. I do wear Specialized brand bike gloves with the ulnar gel pads and they seem to work pretty well. On the one 120 mile ride I did, my pinkies were getting a touch tingly at the tips, though. I can't even ride 40 miles without these gloves without the whole side of my hands going numb, and I shift hand position frequently like you're supposed to.
posted by ikkyu2 at 12:35 AM on July 21

Get some carpal tunnel wrist braces and wear them as much as possible until you feel all the way better, but certainly during the painful examples you gave above and while you sleep. Hands can get in weird positions during sleep and the warmth helps too.
posted by Skwirl at 2:29 AM on July 21

I had the same thing happen to me when I was in high school after a ~70-mile day. I think it was a combination of poor positioning, no gloves, and not changing my grip on the bars often enough. It took a few months before the last vestiges disappeared.

I've done much longer rides since, and it hasn't happened again.
posted by adamrice at 6:46 AM on July 21

Nthing the need for good gloves. I switched from using Pearl Izumi gloves to some Trek gloves and that made a large difference, but didn't completely fix the problem for me. Another trick I've found is to wrap your handle bars with this (or double-wrap them) -- tends to kill a little more of the road vibration and give you a little extra cushion.
posted by rand at 9:46 AM on July 21

Anticipating this problem before the ride, I have great gloves and I did do the "shake out" frequently. It is a newish bike and I never went back to get it properly fitted because the fit seemed so perfect on shorter rides. I'm going back to the shop to get things adjusted, I think I need a shorter stem, and probably I'll try some aero bars. I was mostly concerned about being this disabled a week afterwards. And just when my guitar playing career was about to take off...
posted by Slarty Bartfast at 10:00 AM on July 21

Get some carpal tunnel wrist braces and wear them as much as possible

Actually no, because the ulnar nerves don't pass through the carpal tunnel. The lesion is not due to ulnarflexion at the wrist so these braces won't help.
posted by ikkyu2 at 8:38 AM on July 22

So I can add the resolved tag now, I suppose. I got my bike professionally fitted. (Actually, the place I got the bike does free fitting and I can't recommend them enough -- Montlake Cyclery in Seattle.) The guy spent almost two hours with me and made significant changes, most notably raising the seat, raising the handlebars and shortening the stem. The problem with my hands has improved somewhat but I am able to ride *much* faster than before. I think I am also, just out of habit, leaning too far forward on the bars and I have been doing a lot more back and abdominal exercises at the gym which seems to help take some pressure off my hands.

It's been a month since the ride and my hands are finally just about back to normal and I am playing guitar again.

Thank you all for your help.
posted by Slarty Bartfast at 3:47 PM on August 17

Glad to hear it. If you plan another 200 miler, I would strongly suggest aero bars.
posted by ikkyu2 at 9:47 PM on August 17