Handlebar palsy is also known as Guyon’s Canal and is a common over-use cycling injury. The term palsy means that a nerve is being compressed. In this case, the nerve(s) that is(are) affected is the ulnar and sometimes the median nerve. The ulnar nerve runs along the outside border of the hand, on the side of the little finger, and becomes compressed as it runs through what is know as the Guyon’s Canal, or just before the canal. The median nerve runs through what is known as the carpal tunnel at the base of the wrist. These nerves supply different parts of the hands motor and sensory function.

What are the symptoms and causes of Handlebar Palsy?

The symptoms will correlate to the nerve(s) affected and will be as follows:

  • pins and needles;
  • numbness;
  • muscle or hand cramp;
  • loss of or weakness of specific hand movements and clumsiness.

These symptoms are generally temporary, either felt while riding or if the nerve is severely compressed, can cause a neuropraxia where the symptoms may last until the nerve regenerates and heals, which can take up to several months.

This injury occurs can be as a result of a multitude of factors. These include:

  1. the wrist position on the handle bars;
  2. the physical position and padding of the handle bars;
  3. the terrain on which you ride;
  4. the time spent on the bike;
  5. the seat height;
  6. body weight of the rider;
  7. infrequent change of hand position while riding and
  8. poor core strength, to name a few.

How is this condition treated?

The treatment of these hand injuries include a decompression of the nerve. This is done conservatively using physiotherapy or, if unresolved, surgically to release the nerve. Physiotherapy treatment will involve a few options, including:

  • a release of the nerve along its pathway;
  • joint mobilisations to free up the nerve and obtain pain free movement;
  • grip and finger strengthening and
  • core training to ensure correct posture and endurance on the bike.

A bike set-up is often necessary to correct problems that might have contributed to the injury. Your physiotherapists will need to assess problems such as handle bar position, the position of the seat, the correct size of the bike, sufficiently padded gloves and adequate muscle strength to decrease the pressure on the above-mentioned nerves.

If you have struggled with symptoms of handlebar palsy then a visit to your Physio is necessary to minimise injury time and time spent off your bike!


  1. https://www.physio-pedia.com/Cyclist_palsy
  2. The effect of long-distance bicycling on ulnar and median nerves: an electrophysiologic evaluation of cyclist palsy.Akuthota V1, Plastaras C, Lindberg K, Tobey J, Press J, Garvan C. 2005 Aug;33(8):1224-30. Epub 2005 Jul 6.