Advice from a Certified Hand Therapist: Cyclist's Palsy
Do you feel tingling, numbness, or weakness in your ring and pinky fingers after cycling? Do you notice discomfort in your hand or wrist after long bicycle rides, especially when going downhill or leaning heavily on the handlebars? Have you been experiencing hand cramping, sensitivity at the base of your palm, or even difficulty with fine motor tasks after cycling?
If any of these sound familiar, you may be experiencing a condition known as Cyclist’s Palsy, also referred to as Handlebar Palsy.
Cyclist’s Palsy is a nerve compression injury that most commonly affects the ulnar nerve at the wrist. The ulnar nerve travels through a narrow space called Guyon’s canal, located at the base of the palm. When this area is subjected to prolonged pressure, especially during long-distance or intense cycling, the nerve can become irritated or compressed, leading to uncomfortable or even disabling symptoms. Poor bike fit, suboptimal hand positioning, and extended time with weight on the handlebars all increase the risk of developing this condition.
The symptoms of Cyclist’s Palsy can vary from mild to severe. Some individuals experience temporary numbness and tingling during or after a ride, while others may report persistent weakness, pain, or coordination issues in the affected hand. In more advanced cases, loss of grip strength or fine motor control may occur, making even simple tasks like buttoning a shirt or typing difficult. These symptoms can persist long after cycling has ended, interfering with daily activities.
I have these symptoms, now what?
If you are noticing these symptoms and suspect they may be linked to your cycling routine, it is important to consult with a qualified healthcare provider. A physician may recommend diagnostic imaging, prescribe anti-inflammatory medication, or provide a steroid injection to reduce nerve irritation. They may also suggest a professional bike fitting to improve your cycling posture and refer you to a certified hand therapist for conservative treatment. If symptoms are severe or fail to improve with conservative care, surgical intervention to relieve pressure on the nerve may be considered.
How can hand therapy help me?
A certified hand therapist (CHT) will perform a detailed evaluation of your symptoms, hand function, and cycling mechanics. Based on your unique presentation, the therapist can recommend adjustments to your riding posture, hand position, and training schedule to minimize stress on the ulnar nerve. Therapy may include a combination of nerve gliding exercises, stretching, strengthening, and possibly the use of a custom orthosis to offload pressure from the wrist during or after cycling. If surgery is required, a hand therapist will work closely with your surgeon to guide your rehabilitation, aiming to restore motion, reduce pain, and return you to full function—on and off the bike.
Written by Jessica Si, OTD, OTR/L, CHT, CLT, COEE, with contributions from Eli Yovits, OTR/L, CHT. This blog is a contribution from the American Society of Hand Therapists (ASHT).