Pins and Needles: Wrists, Tendons, and the Healthy Cyclist

Most cyclists will do everything they can to ensure comfort at the points where body meets bike, especially hand-handlebar contact points. But despite all efforts of padding, many cyclists still experience problems with hand or wrist pain and numbness. These symptoms can be caused by compression of any number of structures (tendons, nerves, arteries, etc.) that run through the wrists. These structures are easily irritated because they are near the surface of the skin and there is little natural padding between tendons, nerves, bones and ligaments.

Parts is Parts
The anatomy of the wrist is characterized by separate compartments (or tunnels) formed by bones and ligaments. Tendons, nerves, arteries and muscles must pass through their respective compartment friction free in order to provide good movement, sensation and circulation in the hands and fingers. One commonly known compartment in the wrist is the carpal tunnel. This tunnel is located toward the palm side of the hand and contains the median nerve and nine flexor tendons that allow you to perform the "grasping" motion with your hand. Though carpal tunnel syndrome is a well known culprit in wrist pain, not all wrist and hand discomfort can be attributed to it. In any case, a persistent painful wrist or hand should be evaluated by a physician in order to determine the source of pain.

Most family physicians can pinpoint the origin of a painful wrist by looking at the clinical signs such as location of pain, patterns of abnormal sensations (numbness for example) and what movements or positions increase symptoms.

Accessories, Riding Position
If you do suffer from intermittent wrist pain while on a ride, there are some things that you should try in order to alleviate the pain. Well padded cycling gloves are a necessity. Gloves will help absorb the relentless shocks that are transmitted from rough roads or trails to your hands during rides. Even for short rides, wearing gloves may be important if you are prone to wrist pain.

Repositioning your hands frequently during a ride is also important. Maintaining one position for any length of time can limit circulation to the hands and irritate nerves. Attempt to keep a loose grip on the handlebars with your wrists relatively straight (avoid keeping your wrists excessively bent). On a road bike, alternate between the drops, in close toward the stem and out on the brake hoods. When riding your mountain bike, alternate between placing your hands over the main part of the hand grips and out toward the handlebar ends with your thumbs pointing up (take note that this position is not recommended when riding in traffic as you do not have easy access to your brakes). Bar ends are great accessories for providing additional hand grip options. It's also helpful to occasionally shift weight from center of your palm to the outside edge of your palm. Whole body position must also be examined when persistent wrist pain exists. If you have recently switched to a more aerodynamic body position and noticed an increase in wrist pain, note that a more horizontal body position transmits more body weight to the wrists (unless you have added an aerobar, in which case, your body weight will rest on your elbows).

Stretching
Gentle stretching of the forearm musculature can be helpful since the muscles of your forearm are at least partially responsible for wrist and hand strength and movement. To stretch your wrist, place your arm out in front of you with your palm facing away from you (as if to motion "stop"). With your other hand pull back on the fingers of your outstretched hand until you feel a gentle pulling sensation. Hold this position for 20 seconds and repeat for the other hand. Repeat this stretch before performing any activity which requires a lot of wrist or hand movement (riding, typing, manipulating tools, etc...).

If pain persists despite every attempt to resolve it, don't just ignore it. Pain is your body's way of telling you there is something wrong. Pain will often progress in intensity or go from intermittent to constant. Get it checked out before this happens. When caught early, wrist pain can be just a temporary irritant but, if left untreated irreparable damage can take place.