Elbow, Wrist & Hand

What It Is

Cyclist's palsy is a nerve problem that can affect mountain bikers and road cyclists. It happens when the ulnar nerve is compressed (squeezed) at the wrist, in a small tunnel called Guyon's canal (ASHT, 2025). It can cause pain, numbness or tingling in the ring and little fingers, and weakness, clumsiness or cramping in the hand, so people may have difficulty with finger movements and pinching (ASHT, 2025; Sparapani et al., 2020). Overall it is a rare cause of ulnar nerve problems, but cycling is the sport most linked to it (Sparapani et al., 2020). It can follow a single day of mountain biking or longer road cycling (Sparapani et al., 2020). It is also called handlebar palsy, and is a type of ulnar neuropathy (ASHT, 2025).

It happens when you hold the handlebars for a long time, especially with your wrist held in one position. The pressure increases when cycling downhill, because your hands support more of your body weight. The vibration from the road and the pressure on your wrist together can irritate the nerve (ASHT, 2025).

Cyclist's Palsy Anatomy

The muscles commonly affected are the hypothenar muscles (the fleshy part of the palm on the little-finger side) and the first dorsal interosseous, the muscle between the thumb and index finger (Sparapani et al., 2020). The ulnar nerve controls these muscles. The nerve also gives feeling to the little finger and half of the ring finger (AAOS, n.d.).

At the wrist, the nerve enters the hand through Guyon's canal. This tight tunnel is formed between two of the small bones of the wrist and the ligament joining them. Within or just beyond the canal, the ulnar nerve divides into branches that supply feeling and muscle power to parts of the hand (ASHT, 2025).

Not a diagnosis — for more information, contact me or another trusted healthcare provider.

Treatment

Self-Care & Treatment

How to Treat Cyclist's Palsy

1. Rest

Taking a break from cycling from when symptoms start is one of the first steps in treatment (Chiaramonte et al., 2022). This type of nerve problem usually recovers with simple (non-surgical) care, as long as the pressure on the nerve is avoided (Sparapani et al., 2020), but it can take weeks to months. Most people recover, but some need further treatment, so see your doctor if your symptoms are not improving or if you notice weakness or loss of movement in your hand (ASHT, 2025; Sparapani et al., 2020).

2. Check Bike Size and Position

As well as allowing the nerve time to recover, make sure you are riding the right size bicycle and that the handlebars are in the correct position, to avoid undue stress on the muscles and nerves. A poorly fitted bike can contribute to cyclist's palsy (ASHT, 2025).

3. Hand Therapy

A hand therapist can teach you ways to prevent cyclist's palsy by improving your posture, positioning and cycling habits, and may provide stretches and exercises to reduce stress on the nerve (ASHT, 2025). I can help with this too, with nerve glides, hands-on work for the forearm and hand, and advice on your hand position and riding habits. See the My Approach tab for how I work.

Tips

Wear padded gloves or use padded handlebars. Padded gloves have been shown to reduce pressure over the ulnar nerve (Slane et al., 2011).
Change your hand position often during a ride. One study found that riding in the "drops" of a drop handlebar put the most pressure on the ulnar nerve and bent the wrist back the most (Slane et al., 2011).
Try to avoid bumpy roads or cycle lanes where you can. Road vibration is one of the things that can irritate the nerve (ASHT, 2025), so ride the smoothest surface you safely can.
Don't ride for too long at any one time without a break – holding the handlebars for long periods is a cause (ASHT, 2025).
Don't grip the handlebars too hard; relax your grip a little.
Avoid placing direct pressure over the heel of your hand on the little-finger side (where Guyon's canal is), by making sure your weight is spread evenly across your hands.
Take your bike to a professional to have the seat position and height assessed, so it suits your body. This can help to reduce the amount of weight placed on your wrists.
Choose suitable handlebars – the type of handlebar affects the pressure placed on your wrists.
Good shock absorbers on a mountain bike can help to absorb vibration. If you have a road bike or race bike this may not be possible.

Treatments you may want to discuss with your family doctor or nurse practitioner

Options outside my scope

Night splint: a splint (orthosis) worn at night may be used in the early stages of treatment (Chiaramonte et al., 2022).
Steroid injection: doctors sometimes use a steroid injection as one of the non-surgical treatments (ASHT, 2025).
Surgery: if other treatments don't help, an operation may be needed to relieve the pressure on the nerve (ASHT, 2025; Chiaramonte et al., 2022).

How I can help (see the My Approach tab)

Nerve glides and hands-on work for the forearm and hand
Help with your hand position, grip and riding habits
Help working out whether a splint might help and how to get one
Rehabilitation after surgery, once your surgeon agrees

Treatment

My Approach

Cyclist's palsy is pressure on the ulnar nerve where it passes through Guyon's canal, on the little-finger side of the heel of your hand. My aim is to take the pressure off the nerve, ease the tissue around it, and get you back on the bike without bringing it back.

How I help depends on how severe it is. If you have numbness or tingling in your ring and little fingers but no weakness, I can treat it directly. If you have weakness, clumsiness or wasting of the small hand muscles, or numbness that's getting worse, please see your family doctor or nurse practitioner first; once you've been checked, I provide supportive care alongside their plan.

I start by assessing your hand, wrist and forearm and screening the nerve (sensation, reflexes and strength). The ulnar nerve can be squeezed in more than one place on its way from the neck, so I check your neck, shoulder and elbow too.

If It's Mild

Finding where the heel of your hand is pressed, on the bike and through your day, and adjusting hand position, grip and set-up
Gentle myofascial and trigger point work through the forearm and hand, staying off direct pressure on the nerve
Treating the neck, shoulder and elbow where they're involved
An ulnar nerve glide, taken only to mild tingling that settles quickly
Help working out whether a splint would help for a while, and how to get one

If It's Severe or You've Had Surgery

I work alongside your medical team, and after surgery I need your surgeon's okay before hands-on treatment
Scar work once the wound has healed, then gentle nerve glides
A gradual return to grip strength, then to riding

Work near the armpit is only with your informed consent; work on the chest wall muscles also needs a written consent form.

What to Expect

Typical Course

Typical course: If it's mild, most people come once or twice a week at first, then weekly, then less often, with a reassessment at about 4 to 6 weeks; it usually settles with simple care, though this can take weeks to months. If you needed medical care first, expect recovery to sit at the longer end of that range, with visits following your medical team's or surgeon's plan.

What I Focus On

Severity Check

Pressure Relief

Hand & Riding Set-Up

Nerve Glides

Forearm Release

Sources

References

American Society of Hand Therapists (ASHT) (2025) Cyclist's palsy [patient education resource]. Available at: https://asht.org/sites/asht/files/docs/2025/Cyclist's%20Palsy%202025.pdf (Accessed: 7 October 2026).
Sparapani, F.V.C. et al. (2020) 'Acute handlebar syndrome: two extremes of a challenging diagnosis', Surgical Neurology International, 11, p. 366. doi: 10.25259/SNI_606_2020
American Academy of Orthopaedic Surgeons (AAOS) (n.d.) Ulnar nerve entrapment at the elbow (cubital tunnel syndrome). Available at: https://www.orthoinfo.org/diseases--conditions/ulnar-nerve-entrapment-at-the-elbow (Accessed: 7 October 2026).
Slane, J. et al. (2011) 'The influence of glove and hand position on pressure over the ulnar nerve during cycling', Clinical Biomechanics, 26(6), pp. 642–648. doi: 10.1016/j.clinbiomech.2011.03.003
Chiaramonte, R. et al. (2022) 'Preventive strategies, exercises and rehabilitation of hand neuropathy in cyclists: a systematic review', Journal of Hand Therapy, 35(2), pp. 164–173. doi: 10.1016/j.jht.2021.11.003

Massage therapy · Kitchener–WaterlooCyclist's Palsy

What It Is

Cyclist's Palsy Anatomy

Self-Care & Treatment

How to Treat Cyclist's Palsy

1. Rest

2. Check Bike Size and Position

3. Hand Therapy

Tips

Treatments you may want to discuss with your family doctor or nurse practitioner

My Approach

If It's Mild

If It's Severe or You've Had Surgery

Typical Course

References

Related Conditions

Book a session

Massage therapy · Kitchener–WaterlooCyclist's Palsy

What It Is

Cyclist's Palsy Anatomy

Self-Care & Treatment

How to Treat Cyclist's Palsy

1. Rest

2. Check Bike Size and Position

3. Hand Therapy

Tips

Treatments you may want to discuss with your family doctor or nurse practitioner

My Approach

If It's Mild

If It's Severe or You've Had Surgery

Typical Course

References

Related Conditions

Bowler's Thumb

Carpal Tunnel Syndrome

Cubital Tunnel Syndrome

Elbow (Olecranon) Bursitis

Book a session