HandLab Clinical Pearls

May 2020 No. 62

Cycling with Thumb CMC Joint Arthritis: Keep Moving Forward!

Karol Young, OTD, OTR/L, CHT

 

When performed correctly, low impact exercise decreases joint stiffness and improves overall health and well-being. Cycling is considered a low impact exercise but individuals with thumb CMC joint arthritis may not be able to comfortably ride a bicycle because of thumb pain. Adaptations of the bicycle handlebars may allow an individual to return to cycling without thumb pain.

Begin by examining the bicycle handlebars. Are they correctly padded with handle bar tape? Handlebars with worn tape make gripping more difficult, resulting in discomfort and requiring tape replacement. Handlebar tape should be replaced every four to six months.

Handlebar tape comes in varied thicknesses; it is important the thickness of the tape padding is optimal. Applying the ideal thickness of handlebar tape results in both increased grip comfort as well as reduced road vibration. See Figure 1.

Figure 1: Optimal thickness of handlebar tape

If the handlebars are too large (padded with a tape that is too thick) pain and fatigue may result; extra force is required to grip a thicker handlebar. Additionally, a thicker handlebar in the first webspace applies more torque to the thumb CMC joint, resulting in greater discomfort.

The most common bicycle gear shifters require isolated loading of the thumb, but other shifters are available. Grip shifters can be used on flat handlebars (called flat bars) which are found on mountain bikes. These grip shifters require use of the entire hand instead of just the thumb. See Figure 2.

Figure 2: Flat handlebars with a grip shifter

For drop handlebars found on road bikes, shifters integrated with the brakes can be controlled with the index and middle fingers and do not rely on the thumb for changing gears. See Figure 3.

Figure 3: Drop handlebars with integrated shifters

A bicycle has three points of contact for weight distribution: the seat, the pedals and the handlebars. Placing a disproportionate weight onto the handlebars overloads the hand and thumb. A more upright position on the bicycle shifts weight off the hands and the thumb. One way to achieve this is to raise the handlebars vertically with a stem extender to reduce the load on the hand/thumb. (See Image 4.)

Figure 4: Upright bicycle with a stem extender added

Many cyclists relieve their thumb pain when cycling by wearing the Push® MetaGrip® thumb brace. See Figure 5. When wearing the brace, the weight borne through the arm cannot be transmitted directly to the CMC joint, thus protecting it from loading.

Figure 5: Push MetaGrip thumb brace stabilizes the CMC joint when cycling.

If these modifications do not relieve thumb pain, the cyclist should consult a local bicycle service technician to explore additional options to shift the load away from the thumb/hand.

 

Download Clinical Pearl No. 62, Cycling with Thumb CMC Joint Arthritis: Keep Moving Forward!, May 2020

© BraceLab; 2020 all rights reserved

 

Disclaimer: BraceLab Clinical Pearls are intended to be an informal sharing of practical clinical ideas; not formal evidence-based conclusions of fact.

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