Thursday, July 28, 2016

Hand numbness while bikepacking 101

Some thoughts on hand numbness from bikepacking long distances.
 
Its taken me a while, but I think I am getting a better understanding of the causes of the numbness/palsy/neuropathy that I picked up during my Tour Aotearoa in February. I'm not over it fully yet, but at least I can turn the key to start the car, pick up a handful of nuts from a bag, operate a zip, and finally, tie my own shoe laces. Its been 5 months so far. In the beginning my right (front braking) hand felt like it was in a pitchers mitt. It felt numb, and sensitive at the same time. My fingers felt like fried sausages trying to burst out of their skins. It was the top two fingers closest to the thumb, and the thumb itself. Classic carpal tunnel syndrome symptoms, from median nerve compression.  The other really common version of this that many riders will have experienced is the ulnar nerve compression which affects the other two fingers, well actually the lower one and a half fingers. One of the professionals I spoke to said the nerves travel a long way along your body and like a garden hose, they can be constricted at many places on their paths, necks, elbows, palms, but the hands tends to be where you feel it.

 Some people get muscle wastage as well. I was lucky not to get this and I still had a good range of movement and only about a 30-40% loss of strength, so there wasn't really any therapy advised to help in this area. My GP said up front the options were rest, drugs or an operation to relieve pressure. I opted for rest, which wasn't that hard, given I was tired, and it was very uncomfortable to ride. After a while, a month or two, I got very frustrated, and wondered if it would ever come right. The waiting was worse than the affliction itself, but it was helpful to evaluate the importance of cycling with respect to the "big picture".

This is a personal critique of my own set-up, but it might be relevant to you. It's not what to do AFTER you have "achieved numbness", its what you might do to STOP it occurring in the first instance.

Just remember, there are people who might say that riding a bike for 18 hours a day for 11 days, is not a particularly intelligent thing to do. They might be right, but it is possible to do it with minimal trauma to the hands, as my riding buddies and many others did, to a large extent.

Hand numbness is not uncommon in long distance bike riding, the problem is, with so many variables involved, you cant really effectively test your set-up, because it can take 4 days of riding 18 hours a day, before you even know if your set-up is going to work for you. Even 4 days may not be enough in an event that takes 10, or 16.  I had done 4 bikepacking events of distances over 1000kms and never experienced any hand numbness issues, but my set-up for the 3000kms of the Tour Aotearoa Dirt Brevet was not so forgiving. My issues surfaced on day 5 after a rough 20 minute white knuckled descent.

After 4 months of retrospection I have have come up with the following factors which could have lead to the hand issues some of us experienced.

1. Get a proper bike fit from a professional. If you know of a legitimate fitter with bikepacking experience then feel free to share them in the comments at the bottom of this post. Word of mouth would be the best criteria in choosing someone I would think. But someone whose experience is mostly in fitting roadies or triathletes for their bread and butter is unlikely to have the best background.

2. Multiple hand positions. I used to think this was the only thing that needed addressing, but I was proven wrong in the Tour Aotearoa. It's no use having lots of different positions if your overall position is not optimal, but it could help delay the inevitable and get you through a shorter event without issues.

3. Gloves. Wear padded gloves if you like, but if your position is rubbish, its probably not going to make that much difference in the end. I lost my gloves on day 1 of a 5 day event once and never missed them, I was on a fully though. A riding partner wore no gloves at all and he was on a rigid drop-barred CXer. Our riding positions must have been good enough for 5 days riding with no ill effects. Edit. Some gloves can make your hands more numb, beware!

4. Suspension. Bikepackers can get a bit obsessed about saving 800 grams by riding a rigid front fork. Ask yourself if it's worth it. Plenty of people move very quickly even on a full suspension bike. Maybe as we age its a good option to consider a hard-tail or a fully instead of a rigid? 51 year old Brian Alder just came 5th in the Tour Divide and admitted that front suspension of some kind could be a big help.

5. Weight bearing balance. This is the seat-to-hands weight-bearing aspect. In the Tour Aotearoa, my butt was completely mint. I didn't think this level of comfort was achievable when riding 18 hours a day for over 11 days. This was the first time I had ever experienced ZERO butt-trauma, but also the first time I had hand numbness. I suspect my fore/aft balance was way wrong. Is there a way of measuring this? I don't honestly know. Scales under the wheels? If your bars are set up too low, or too forward, the weight will transfer from your butt, to your hands/arms and over-load them over time.

Head angle looks too extreme while riding on the drops. My back is too flat to enable a more upright head angle without cricking my neck. Photo Matt Dewes.
6. Bar height. I had been riding on Salsa Woodchipper drop-bars for several years, and never had any problems. I also had aero-bars, so I thought I had plenty of different hand positions. Even more hand positions than my previous flats/bar-ends/aero-bars combo. I am never more comfortable than when I am on my Karate Monkey, on the Woodchippers, or on the aero bars, I could fall asleep in this position I feel so relaxed. Where did I go wrong?

All the cool kids say, when riding off-road on dirt specific drop bars, you should "ride on the drops/hooks" not the hoods. It makes good sense, you have more control, more braking leverage in your hands in this position, more pedalling power for short pitches, and the curve of the bars keeps your hands locked in when the terrain gets squirrely. This was how I rode mostly, when on the trails.

BUT, what if your bars are too low or too forward? When I was braking on the drops I believe my bars were possibly a bit too low, and had to angle my head up in order to see ahead. I spent at least 20 minutes like this on day 5 of the Tour Aotearoa on a particularly rough descent and I suspect this is where I came undone. 20 minutes with your hands clamped tight and your head at a crazy angle is a pretty bad nerve stretch in hindsight. Some people DO have a tendency to set up their drop bars too low, more like they would on a road bike.

There is also a thing called lumbrical incursion where during flexion of the hand the muscles are forced into the carpal tunnel causing nerve damage. My theory is that median nerve damage, caused by the above, is just as likely (maybe more likely) to happen while resting or hard-braking on the hoods, or drops, as it is from resting your hands on the tops of yours bars. The lower your bar is, the more pressure on the hands, and the less on your butt.

While my bars could have been a bit higher I think I would have benefited a lot more from a much shorter stem with more rise.
 7. Cock-pit length. I suspect this was the biggest error I made with my set-up. Make sure the length of your cockpit (top-tube/stem combo) is suitable for you. You don't want to be too stretched out. If you are stretched out you will be canting your head up on a funny angle again which can cause nerve compression in your neck. About a week before the Tour Aotearoa I rode my buddies bike. Both of us on 29er steel MTBs with Woodchippers. His stem had to be at least 3-4 cm shorter than mine, and we both have similar length torsos. His bike felt completely different, his more typically MTB, mine more like a Cyclo Cross rig. A bunch of nerves called the brachial plexus come out of your spinal cord, down your neck and into your arms. These nerves can be affected detrimentally by over-stretching and wearing heavy packs. I wore a very light back-pack every day, so that is another thing to think about. It's feasible that with my upper buddy extended beyond a natural range that the back-pack could have had an effect, over time, despite the fact that it had very little in it. I was aware of muscle soreness on the undersides of my upper arms at one stage so this may also point to being over-extended with my cock-pit length as well.

The other side to this argument is, that if your cock-pit is too short, you may not be able brake or ride on the drops anyway as it will be too cramped, unless your bar is set up a lot higher. I guess you have to make up your mind at the start. Are you going to ride and brake on the drops, or are you going to do what many people do, on AND off road, and just ride on the tops of the bars or hoods. It would be wise to base this decision at least in part on the level of technical riding you are expecting in the event.

Check out these links on dirt-drop-bar set-up if that's what you use: Guitar Ted's link , Matt ChesterJason Boucher and Shiggy.

8. Head position. As above. If your bars are so low that you have to angle your head up, then you are asking for trouble. There is some good stuff on "Points of contact" here from John Hughs, and a link to Steve Hoggs stuff where he says that if your neck is angled at more than 85-90% of its range then you are in dangerous territory, and he is not even fitting people generally for all day riding.

It looks like the angle of my arms is too flat, and I have my head angled down, probably for comfort. (front rider). Geoff (in the red) is also on the aeros but his head is in a more natural position. Photo Matt Dewes.
9. Peaks? I wear a peak, as I have prescription glasses, it protects me from the sun, rain and dirt. I couldn't understand why more people didn't wear peaks, but  if your peak is too  low, you will once again have to cant your head up on angle to see ahead. Having your head at an awkward angle will compress the nerves in your neck. Adjust your peak to make sure it doesn't interrupt your vision when you are getting in to your most aero mode. My peak is adjustable on the fly, but I don't think I even thought it was an issue. I did not feel any discomfort in my neck.

It looks to me like my peak is obscuring my view and probably causing me to angle my head back more. Photo Matt Dewes.
10. Be conservative. What works for you in a 4 day event may not work in a 16 day event. Aero is good, but not at the expensive of nerve damage. Aero does not equal low, aero equals smaller frontal area (mostly).

11. There is no one best handlebar. To my way of thinking these things are very personal, a lot like saddles. The best handlebar is the one that allows small hand movements that can change the fore/aft pressure on your hands and butt. You should have a set-up which allows these micro adjustments as you ride. This is why I like drop bars. But if I am going to continue to ride on drop-bars, and brake and ride on the drops, I will look at a higher position for the bar compared to what I currently have. Google "LD" stems, that is the style of stem you are getting close to for really comfortable drops-based braking for extending periods.

See Shiggys weight distribution change with
each differing position on his drop bars.

If I change my style to just braking from the hoods, stem/bar height is not an issue. Many of my buddies brake this way, but they are better riders than I and they have more confidence bombing descents with their hands resting on the hoods. Mini-cross levers were Josh Katos solution for confident braking on the top of the bar.

After the the 2015 Kiwi brevet, Joe Jagusch suffered from debilitating Carpal tunnel Syndrome for a year. This is the set-up he used in the Tour Aotearoa to combat his earlier problems. Scores high on the "LD scale" but it worked for him.

12. Aero bars. I think aero bars are great, but as mentioned above, don't get sucked into an uber-low position. They are there to relax onto, and increase your aero-ness a bit, but don't set them so far forward that you over extend your arms and end up tilting your head back in order to see ahead.

A lot of people are using the fred-bar styled arrangements that give the aeros extra height and clean up the "handle-bar-real-estate" area.

People who throw on a set of aero bars at the last minute are asking for trouble because generally.
1. They wont have had time to adapt to them.
2. They will probably use them a lot more than they thought they would, making any problems worse than they thought possible.
3. My gut feeling is, the longer the event, the more likely it is that you are going to use your aero bars.

13. (A late addition). Bar tape. If you have big enough hands, think about double wrapping your tape or using appropriately placed gel inserts.  Some people swear by double wrapping.

14. (A later addition). Core strength! A strong core will help you in many areas, but it will help support your upper body weight and keep some of it off your arms.

15. (A later later addition). Finger exercises to relieve numbness on the bike as practiced by Cliffy in this years Kiwi Brevet.


These are just the things that I have observed that I believe effected me. There are quite a few factors in there to be considered. In isolation you might get away with a couple of problems, but the longer you are out there, the more chance they have to come into play. This ramble is very "drop-bar-centric" given that that was my experience, but I believe most of the things I have looked at are universal. I used Salsa Woodchippers, but there are many other drop bars out there. Read the comments on Guitar Teds link to see what other drop-bar users use.

Maybe a check-list could be something like this:

1. Choose your bar/s.
2. Decide how you will use it
3. Determine the optimal cock-pit length
4. Determine the optimal stem/bar height
5. Make sure there are varied positions available possibly with bar extensions and or aero bar add-on options.
6. Try to get the fore-aft butt-to-hands balance right.
7. Check that with the above all done, your head angle is comfortable over time.
8. If in doubt, err on the side of comfort over speed.
9. Maybe look for a proper bike fit first, if there is someone close. It might give you a better starting point?

It might feel nerdy, but get someone to take some side on shots of you in varying positions with you bike on a stationary trainer with the front wheel level to the back. I don't know the exact angle your upper arms should be at. Its likely to differ a bit, depending on how low the bars are, and whether or not you are using a fred bar mount or risers of some kind on your aero-bars, if you are using aeros.

Its now 6 months since I started the 2016 Tour Aotearoa. My hands are at 97.5% I reckon. Time heals. It was the best event I've ever done. I look around at some other events that have been and gone in that time, and others that are just about to start, and I realise how lucky we are in NZ to do such a diverse ride. Would I change anything?
Sure, I'd put on a shorter stem !  

The 2nd Tour Aotearoa starts Feb 2018.

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You can read about my other ailments and prevention here : ) http://jeffsbike.blogspot.co.nz/2015/09/what-is-your-achilles-heel.html