 So welcome back or welcome to the 14th edition of the RCA Training Tip Show. We're gonna get into things straight away again today because I'm joined again by an expert bike fitter, Neil Stambry, who's been fitting road cyclists for around 10 years in conjunction with being a sports physiotherapist and today we're gonna be talking about a very common issue, why cyclists get sore or numb hands and what to do about it. Now I am conscious this topic has been done quite a few times in the past, notably by GCN. In fact, they did a video a couple of weeks ago on the topic, which was very good, but I'm confident if you watch this video as well today, if you watch that piece by GCN, you're gonna leave this video with an even greater insight of why this happens and what you can do about it. So let's get into it. Why does that happen and how can we stop it from happening? Yeah, you're right, man. It's super, super common. It'd have to be maybe 50% of people or more that rock up for a fit with me. It's one of their complaints, even if it's not their primary complaint, it's one of their complaints. And numbness and tingling in the hands is typically caused by a compression of a nerve pathway or a restriction of circulation or a restriction of circulation to the nerve rather than the hand itself. So they fall into two main categories. The classic one that you'll read about if you Google it is carpal tunnel compression, which is compression of the carpal nerve, just a little section of the median nerve where it passes through the wrist here. It passes through a little shallow space between a couple of bones. And that area, if you hold it long enough or put pressure on it for long enough, it can kind of scarify around the nerve and you can end up with a semi-permanent compression of the nerve, which needs to be surgically released or something like that. And cyclists are really prone to it because of the static nature holding onto the bar and absorbing road vibration and that type of stuff. And the second type of the... So that one will give you a numbness in the median nerve pathway, which is sort of the palm of the hand and into a couple of the middle fingers. The other ones fall into one other sort of main category, which is proximal to that area. So compression of the nerve pathway through the forearm, the elbow, the shoulder, where the nerve pathway passes out underneath the clavicle here, which is called thoracic outlet syndrome. And then there's some which can also come from your neck. So if you've got a nerve compression in your neck from a little bone spur, some arthritis or a disc herniation or something like that, that will often also manifest for the first, as a first symptom is pins and needles in your hand. So you get these kind of two areas, the ones which occur here and the ones which occur further up. And there's lots and lots of different types of those ones. The primary cause of most of the ones which affects cyclists is too much weight on their hands. It's not so much a local problem where, oh, you know, my bars are five millimeters too high or too low or too far away from me or too close. That is the position of the front end is one of the causative mechanisms, but it's definitely not the main one. The main causative mechanism of compression of the nerves anywhere through the arm on a bike is usually too much weight on your hands. And that opens up a huge can of worms who why have we got too much weight on our hands? Well, there's a lot of different reasons. There's a seat height, the seat, four and a half position, the seat setback. The cleat position bizarrely can play a role in it too. If you've got a dodgy cleat position which is not allowing your glutes and your hamstrings to function strongly and lift weight off your hands, the mass in your upper body, you know, all this sort of stuff. And then secondary to that, the position of the bars, height and reach. And then one of the least causative mechanisms is actually the position of the hoods and that type of stuff. It very rarely causes big trouble. What could there be a third? I'm thinking because there's a lot of people that are just getting into road cycling to support the channel. That being, they don't realize that they shouldn't be putting so much weight on the handlebars. Could that be a reason as well? It can be, yeah. Yeah, especially if they're new to it most, a lot of new riders really hold on really tight because the road bike is a twitchy apparatus when you first get on it compared to like a mountain bike or a Kmart bike they rode when they were a kid. The road bike is sharp and precise and so a lot of them, and you see a lot in ladies who are arguably much more risk averse than most men. They will hold the bars really tight and brace themselves almost as a safety mechanism as an unconscious thing that they do. But in most people it is just too much weight forward over the hands. And so what we seek to sort of strive to do with the position in a global sense is to create a balance where you're cruising along on your bike at a decent clip. We're not going too hard, not going too slow, just around your threshold or down below that and you've got very little weight on your hands. You can get the weight off the riders' hands, there won't be a compression issue. So they need just enough weight on their hands to steer the bike, but not so much that they're really loading their hands. And so that's kind of the ethereal concept of balance is really the best thing you can do. If you've nailed down the balance of the rider four and aft up down, their glutes are engaging well, their bars are in a nice comfortable position, they've got a gentle bend in their elbows and they're not loading their hands heavily, regardless of where the compression is occurring, it'll probably disappear. And so it's a function of a lot of things, the seat height and the setback and all that sort of stuff. And it's very rarely a massive problem in the wrist. Although every year I come across a few people who've got a proper carpal tunnel and it's become an issue where they're getting it off the bike just as much as on the bike. And the bike is worsening it, but it's actually a mechanical problem in their wrist which they need to get sorted out by a surgeon or something like that. But that's fairly rare. So we try and create balance on the bike and sort out the front end position so that it's very comfortable and the rider can ride along with just enough weight on their hands to steer the bike, but not so much that they're really loading their upper body and gripping. And upper body mass I guess I should mention comes into it as well. If you've got a really lightly built rider like myself who's really light in the upper body, that rider's gonna throw less weight forward for a given position than someone who's got large, whether it's muscle or not, someone who's large in the upper body. They've got more weight can to leave it out over the bars, the heavier they are in the upper body. So is that what you see with your fitting clients? That's when people complain about that, they're typically heavier? Yes, it's certainly more common in people with big shoulders or a big gut. Anyone who's heavy in the upper half, it's a much more of a problem because that rider is just gonna throw more weight forward almost no matter what you do than someone who's built like Chris Froim or like me, who is very light in the upper body. And playing into that comes the person's core strength, how well they can stabilize their torso in a flexed position and so forth. So if they've got rubbish core strength, they've got more weight on their hands, right? So it's kind of an interplay between all of these things and a good way of sort of examining it yourself, if you're wanting to know if too much weight is being applied to your hands, are you routinely riding with your elbows locked because when you bend them, your triceps fatigue too much. So if you bend them slightly and you're having to really push down with that tricep, that means your weight is still trying to tip forward, right? If that's happening, you're getting a lot of tricep fatigue unless you lock your arms out, you're probably throwing too much weight forward for one reason or another. And another great way of sort of quantifying it is to look at Steve Hogg's seat set back balance, I think he calls it the balance test, somewhere deep in the depths of Steve's huge website as a video and some photos of this. And if the rider is riding along at a moderate clip, say a 20 or 30 minute effort, something that they could, around their threshold sort of power, if they can swing their arms back next to their hips and maintain the same torso position or very, very, without sort of tipping forward or sitting upright, just with the act of pedaling, that means most of the time they'll be able to place their hands back on the bars and have very light, very little weight on their hands. And that balance test is a nifty way of kind of examining saddle set back and seat height and bar position for being sort of grossly wrong or grossly right. So if you've got your seat way too far forward and you go to swing your hands back while you're riding, you're just gonna go, yeah, whack on the bars, right? So it means the seat's too far forward. Assuming that all else about the position is good means your seat is too far forward. So would somebody try that type of thing and that test on the road or on the trainer? Try that on a trainer. Okay, yeah. Yeah, I can do it on the road, but I'm assuming there's no cars around. I've got amazing core strength and I'm very light in the upper body, so it's really easy for me. But you should definitely do that on a trainer. Safety first. Yeah, okay. So what about the seat? Because someone once told me, and I've kind of run with it, that if you don't have the right seat width or seat position, that can affect blood flow from down there and into your hands. Luckily, that's an urban myth. That's a myth, okay, all right. The sensory nerve pathways go one way. So they go from the limb towards your spinal cord and your brain. The descending motor control of your nerves and muscles goes the other way, but this is a feedback system. So the one in your pudendal nerve, the one in your crotch, won't play a role with your hands. Except for the possibility that if the saddle is grossly wrong, it might throw your weight forward. Or you might find yourself creeping forward constantly on the saddle, which loads your hands. Interesting. Or something external to that direct roll. So it can play a role. It certainly can, yeah, yeah. Saddle choice, yeah, can certainly play a role. It's one of the things that we change relatively regularly is the saddle to create a better balance for the rider. That four aft up, down the pelvis, the cantilevered position of the pelvis, which dictates where the shoulders are on the bike and that sort of stuff comes a lot of the time from the correct saddle choice in the first place. If you've got a saddle which is not allowing you to roll your pelvis forward to the degree that your central nervous system wants you to ride at, then just pressing up under your crotch as soon as you roll your pelvis forward, for example, that rider will posteriorly rotate their pelvis to get away from the seat, which messes up the front end. So shorten their torso and trouble with their hands and shoulders. So, yeah, it's all kind of an integrated system is the moral of the story. But I guess if you could put it into one kind of nifty sentence of what causes pins and needles in my hands a lot of the time for most riders is poor balance on the bike, you know? And most of that, I'd sort of argue probably 75% of that comes from the position of the pelvis relative to the cranks, not so much where the front end is. Now, the front end needs to be right, but it can be a bit off and you'll be fine as long as you're in good balance at the back. Okay, interesting.