Top 3 Causes of Hand Tingling/Numbness + Pain with Cycling

Pssst.. I have to tell you a secret about cycling..

As much as we all love cycling, and all the benefits that cycling has to offer — The sad truth about cycling is that our bodies were never meant to be hunched over a bike frame, sitting on a small saddle, pedaling, while placing direct pressure through the extended wrists/hands for an extended period of time.

In general, a sensation of tingling and numbness anywhere on our body occurs from compression of nerves. And, although there are a multitude of reasons why and how a nerve can be compressed/stretched throughout the body, when we talk specifically about hand numbness/tingling while cycling, two specific nerves, the median and the ulnar nerves, are the most prone to getting compressed.

Here’s why.

1) The ‘median nerve’ is aptly named, because it runs from our neck and along the center of the arm, and passes through the carpal tunnel in our wrist, which is formed by the small, pebble-sized carpal bones and a thick travnsverse ligament completing the tunnel effect on this nerve. (see Fig 1). When the median nerve is compressed — generally by excessive wrist extension (bending of the hand backwards) and pressure through the palm of the hand- causes compression of this nerve within the carpal tunnel, and a rider experiences tingling and numbness into the thumb, index and ring finger of the hand- See Figure 2.

Fig 1. The thick transverse ligament covers the carpal tunnel and the enclosed Median nerve. In cycling, this nerve becomes compressed when our wrist is extended (back bent) on a handlebar for a prolonged period of time.

Figure 2. Note the distrubition of sensation from the Median, Radial and Ulnar nerves. Image on the Left represents the palm-side of the hand, and the Right image is of the back of the hand. Compression of Median and Ulnar is more common than Radial in cycling.

2) The Ulnar nerve runs from our neck down the inside of our elbow, and is the same nerve that gets that ‘zap’ feeling of ‘hitting your funny bone’ on our medial elbow. It then runs into our lateral hand, and innervates the lateral palm, ring and pinkie fingers (See Fig 1), and is compressed from direct pressure on the palm itself- in an area where the nerve is exposed in the hand called ‘Guyon’s tunnel’ where again we have a connective tissue ligament creating a tunnel over the nerve. See Fig 3

Fig 3. Note the Ulnar Nerve compression point at ‘Guyon’s Tunnel’ from direct presure through the lower outside part of the palm, such as when riding on a handlebar. This causes tingling/numbness into the ring and pinkie finger of the hand.

3) Another consideration . . Compression of spinal nerves at your neck.

As we mentioned, all the nerves that innervate your arms/hands comes from you neck, so there can be compression here as well with cycling. Hand numbness that is coming from the neck is generally a result of too much cervical extension (i.e. back bending). In this case, symptoms usually begin at the neck/shoulder region, and then radiate down, eventually into the hands, depending on what level at the neck is getting compressed. See figure 4. The most common compression occurs at levels C5–6, followed by C6–7 and C4–5 levels.

Fig 4 Each level of your neck has a nerve that passes between the vertebrae that delivers sensation into thew arm/hand

Fig 5 When the neck back-bends excessively, such as when positioned poorly on the bike, compression at the spinal nerves at the neck can radiate into the arms and hands.

OK, so what should I do if I’m experiencing symptoms?

Glad you asked.

Although we do still need to place some pressure through the hands/wrists with cycling, the goal is to have have an ideal balance of saddle vs hands to be ~70/30, wherein 30% of your weight would be through your hands on handlebars, and 70% throughout the saddle, give or take 5%. This raitio can often accomplished with a proper Bike Fititng, and underatanding the positions vs equiment on the bike that leads to cause more weight through the hands:

Bike Fit considerations that lead to increased pressure through wrist and hands, as well as place excessive strain on the neck include -but are not limited to:

• Saddle position nose down (dumps majority of weight onto hands)
• Saddle too high (often accompanied by saddle nose down)
• Poorly installed brake levers/shifters/hand grips
• Handlebars too wide vs narrow
• Elbows locked-out during riding (more stress through wrist/hands)
• Reaching too far to handlebars (shoulder angle >90degrees when hands on bars)
• ‘Slouching’ on the bike with excessive rounding of upper back (throacic spine)
• Excessive Saddle to Bar Drop (saddle vs bar height)
• Tire pressure high = less dampening of vibration through the hands

General guidelines:

• The faster the symptoms occur, the bigger changes needed in positioning (i.e. symptpms occur in 5 minutes. . . vs 5 hours)
• Keeping mobile, and change hand positions frequently helps
• Wearing gloves and Ergonomic (Ergon is a popular one) hand grips/bars can help alleviate direct pressure
• Goal is neutral wrist of about 20deg extension — not completely straight
• Try to keep your ‘chest up’ when hands are on bars to keep your ‘head over shoulders’ a bit better, and to avoid excessive back bending at the neck

Kevin Schmidt, PT, MSPT, BikePT is an everyday cyclist, entrepreneur, Physiotherapist and Bike Fitter with a passion for elevating the field of healthcare in managing cycling injury and Bike Fititng. In 2012 he founded Pedal PT: Bike Friendly Physcial Therapy. He has dedicated himself to the ‘bike life’ and hasn’t driven a car to a workday in over 12 years.

— — — — — — — — — — — -

Are you a Physcial Therapist passionate about cycling and working within the cycling population?

Be sure to check out my brand new online course offering: “The Pedal PT Online Academy — Earn CEUs, and learn Bike Fit skills and how to succeed as a Physiotherapist in the cycling niche!

Over 8hours of and 30+ lessons designed to streamline, demystify, and explain clinical Bike Fit and working with the cycling population to help ALL riders experience the joys of pain-free cycling → Click HERE