Thursday, July 21, 2011

Ulnar Neuropathy

Tools used in Graston® Technique for Ulnar Neuropathy Treatment
If you follow me on Facebook you already know that I lost the use of my ring and pinkie fingers on both hands after the completion of the STP last week. During the last 50 miles of the 200 mile ride, I started having significant problems shifting my front gear, especially into the biggest ring and, in fact, had to reach across with my right hand to shift up much of that time. I had been having problems with my front derailleur prior to the STP, had it repaired, and assumed that my derailleur was once again out of adjustment and therefore difficult to shift. Later in the ride, I also found that I could no longer squeeze my water bottles to drink and had to suck the water from them, and even later, found I could not even grasp the bottles and dropped them at every rest stop when trying to drink. I stopped drinking water while riding due to fear of losing my bottles on the ride. When I got home, my friend who drove me asked if I would play something on the piano and to my shock--I couldn't play, my hands would not work! Shock and dismay! I tried to do an Internet search on the computer to find out what was wrong with my hands but could only type with my thumb and index fingers.

Function was still impaired the next morning and after slowly typing and searching the Internet, I discovered that I had probably developed Ulnar Neuropathy or "Cyclist's Palsy." I contacted Russell Cree of Upper Echelon Fitness who immediately scheduled me to come in the next day for a complete sport's medicine assessment with him and his team to figure out what was going on, wanting to ensure that I did not have a spinal issue as the cause of my neuropathy. He also wanted to do a medical bike fit to see if something had changed from my initial fit he had done in February. I also had a physical exam with my physician who concurred I had a peripheral nerve palsy without any cervical involvement.

Ulnar nerve and its branches, courtesy of

Russell and his team concurred that I indeed had Ulnar Neuropathy caused by entrapment of the ulnar nerve at Guyon's canal, caused by pressure and vibrations from my grasp and hand position during the STP. Ulnar neuropathy is just like Carpal Tunnel syndrome except that it involves the ulnar nerve on the pinkie side rather than the radial nerve on the thumb side of the hand. The ulnar nerve passes through a tunnel between the pisiform and hamate bones and the pisohamate ligament that join them together. Your hand position on your handlebars can put pressure on the ulnar nerve within Guyon's canal; combined with road vibration, this can cause enough damage to inhibit nerve impulses to travel through this area, thus causing weakness and loss of function to the pinkie and ring fingers.

The good thing about this injury is that it is generally well self-healing with rest. I had chiropractic treatment on my neck, back, shoulders, arms, and hands to eliminate any sources of pressure or entrapment along the entire ulnar nerve, as well as deep tissue sports massage to loosen muscle and other tissue adhesions. The muscles of my forearms were very tight, probably contributing as well to ulnar nerve entrapment. They also suggested ice and stretching. Recovery is expected to be about a couple weeks.

The pad on the pinkie side of my palm (hypothenar eminance) was particularly tender. During my medical bike fit, we determined that during my ride, probably due to fatigue, I had shifted my hands in the hoods of my integrated shift/brake levers so that the hypothenar eminance (shown on the left in red) rested solidly on my handlebars rather than riding in the area between the hypothenar and thenar eminances (should ride in the area delineated in blue). This position most definately contributed to my condition.

To prevent this, I will have to be vigilant about hand position. I also purchased new riding gloves with more padding over Guyon's canal, and will add gel padding under the bar tape on my handlebars to reduce vibration transfer to my hands. It is also important to change hand positions during long rides, taking hands out of the hoods to the top bar during parts of the ride you don't need to be concerned with shifting, braking, or low body position. And furthermore, the dreaded core strengthening....I will need to work on continued core strength so I can hold my torso in the forward riding position without putting so much weight on my hands. Russell raised my handlebars 1cm to relieve hand pressure during my recovery. I will decrease this when fully recovered but remember to raise my handlebar height in the future during long distance rides.

This week I was also seen by an Occupational Therapist who specializes in hands for further assessment and treatment. She went over a whole host of stretches and "nerve glides" to increase my flexibility and free up any catches or constriction on my ulnar nerves. In addition, she referred me for Graston® treatment. Graston® Technique is a procedure used to detect and treat adhesions in muscles and other structures. We all develop adhesions, or scar tissue, as our bodies work to repair themselves. Training causes micro tears in tissue, which leads to more scar tissue. This scar tissue is not flexible nor as strong and actually shrinks and shortens muscle fibers, which can decrease strength and even entrap nerves. Scar tissue also blocks blood flow to tissue, further decreasing strength. During Graston® treatment, the practitioner runs metal instruments along the muscles, tendons, and ligaments and can feel areas of scar tissue, which they can then "break up" with the tools. It is similar to deep tissue massage, but the tools do not yield to scar tissue as a masseuse's hands would, thus Graston® can break up more areas of adhesion. Like deep tissue massage, this procedure can be painful and lead to soreness and even bruising as scar tissue is broken up and blood supply rushes back into the tissues. My session had the same sensation as a deep tissue massage and the skin of my arms got very red and flushed like you'd get from an "Indian rub burn," but when it was done, they felt extremely energized, probably from the increased blood flow. I had some soreness the next couple of days, but no visible bruising. I will have this done once a week for the next few weeks.

Here is a video with more information on Graston® Technique. It shows a treatment for carpal tunnel  syndrome, which, again, is similar to my condition but involves the radial nerve rather than the ulnar nerve.

So my prognosis is great! By Sunday, a week after the condition started, I was significantly improved. I was even able to play the piano, not perfectly, in fact I still had some problem with spatial awareness with my pinkies and decreased stretch, but I did go for a bike ride at the Oregon Coast without any hand issues. I will be continuing weekly deep tissue massage and Graston® treatment, sports chiropractic treatments every other week, stretching, and acupuncture.

Fort Steven's State Park

Due to my hand issues, I opted out of the Girlfriends and Dudes Triathlon so I could rest and and heal before the Midsummer Triathlon July 31st. Girlfriends and Dudes is a charity event, not USAT sanctioned....Midsummer is a USAT event and held at Blue Lake where my last tri with my 2nd place finish time, so I really want to be healed up for it and do well in comparison. So, instead of the tri, I went to the Oregon Coast with my friend Kevin and we rode from Warrenton to Ft. Steven's State Park. 

It was misty and rainy, but a great ride. No hand problems. I did have tire and tube problems, though. During the STP I realized my tires were pretty much shot and prayed and hoped that my tires would hold together for my ride--they did, but that was the end of them. At mile 12.5 of this ride I developed a rear flat (which caused a low-speed crash, but I was fine). I changed the tube, found no sharp objects in my tire, proceeded on and developed another rear flat at mile 12.75. This time I could hear air pouring out of my tire, not just my tube, and found several large holes in the tire. Long story short, we got a ride back to the start by some very nice people and I will be purchasing new tires for OJ this week.

So, I should be back up and training this week. Hope everyone is doing well and talk to you soon!

Thursday, July 14, 2011

Seattle to Portland Ride 2011

Fun with refrigerator magnets at the halfway point

I've crossed something off my Bucket List! As a little girl growing up in Longview, Washington, I would watch for the bicyclists in the Seattle to Portland bike ride to come through town every summer. I remember being at the intersection of Fisher Lane and Westside Highway, waiting for cyclists to pass and telling Mother Superior, "I'm going to do that some day." Well I did, finally! Bucket List pic to the right, taken on West Side Highway, one mile north of that intersection!

The Seattle to Portland Bicycle Classic (STP) is a 204-mile supported ride organized by the Cascade Bicycle Club. It started in 1979 as a race but is now a noncompetitive ride capped at 10,000 participants.

Team Awesome, AKA Dan and the smyelin' babes!
I participated in this event with high school friend, Theresa Heim-Stohler and riding friend, Dan Kalowsky. None of us had done the STP before.

Theresa and I loaded our bikes on my car and headed up to Seattle the night before with Mother Superior. Thanks, Theresa, for the wonderful suggestion on staying in the Seattle area the night before rather than driving up at 2AM! We met Dan at 5AM at the start in the parking lot of the University of Washington. Mom then drove my car back home to my house. Thanks, Mother Superior! We couldn't have done it without you and all your driving!!!

I volunteered as part of the medical support team on this ride. To accommodate the first aid supplies I wanted to carry, I added a rear rack and bag filled with various dressings and bandages, ice packs, Benadryl, Chamois Butter, glucometer and glucose gel, etc. I also wore a special red jersey with a star of life on it to designate I was part of the medical response team. I have to admit, I was so surprised by all the thank you's from other cyclists during the ride when they recognized my jersey--I didn't expect that at all. I would have carried all the first aid supplies anyway, I always do, so it made sense for me to participate officially in that capacity.

Kent REI Rest Stop
We couldn't have asked for more perfect weather. There were broken clouds, cool but not cold, at our 6AM start. They started us off in waves as riders accumulated at the starting line. The route took us past Lake Washington, to the first major stop at the Kent REI. This was the best stop of the whole event, with 70s disco music, a costumed emcee at the entrance, girls carrying trays of food for the riders, etc. We were energized...I danced the whole time we were there!

STP Day 1
 We headed back out on the road toward "The Hill" in Puyallup, a 7% grade one mile climb. At mile 53 we hit Spanaway and pulled into the High School for the midway food stop. Volunteers had free food for us, wraps, fruit, bars, cookies, water, juice, Nuun electrolyte drink, Jamba Juice, etc. We just kept filling the pouches on the back of our riding jerseys then had a little picnic on the football field. The sun was out but it wasn't too warm.

The next half of the trip skirted behind Fort Lewis Army Base, a road with a narrow bike lane and fast traffic. We stayed on this path until Yelm where we hit the Yelm-Tenino Trail for 14.5 miles. It was nice to have a dedicated bicycle trail after miles of fast traffic roadway.

Theresa and Dan enjoying beers!
After a quick stop in Tenino for water and a snack, we finished the last 15 miles into Centralia. We enjoyed a free orangesicle, stashed our bikes in the secure bike corrall for the night (Centralia PD provided security), and headed to the beer garden for a couple cool ones (and pizza). The midpoint stop is held on the Centralia College campus. A lot of folks packed tents (you are allowed to check two bags each that STP transfers from Seattle to Centralia and from Centralia to Portland) and camped on the grass, others threw sleeping bags on the gym floor for the night. We were lucky enough to have one of my high school BFFs, Seriny, who lives in Chehalis, come pick us up and host all three of us for the night. Seriny and Jason, you are both awesome! Thank you for the hospitality, food, drink, comfy beds, and ride from and back to Centralia!

We dropped off our bags, picked up our bikes and hit the road at 6AM for day two with similar weather, perhaps just a shade cooler. We started out ahead of the bulk of the riders so it was nice and sparse, but after stopping to do a medical assist at mile 4.5, we were taken over by a huge crowd of riders. (I'll do a medical assist summary in a bit.) This was a beautiful section of riding, rural, little traffic. We pulled into Lexington, just north of Longview, at mile 144 for the midpoint lunch break. Just as the day before, volunteers had free lunch for us.

Mother Superior noticed prior to the ride that the route was going to pass right in front of the Canterbury Inn where Grandma Janet lives. So we gave a heads-up text to Mom when we left Lexington and stopped to visit Mom Sup and Grandma four miles later. It was so great to stop and visit Grandma and be greeted with cold washcloths for our faces and fresh fruit from Mom! Mom and Grandma had been sitting out front for an hour enjoying watching all the riders pass...they were cheering and clapping for them and the riders waved and hollered back and rang their bicycle bells as they went past.

From there we hit the Rainier Bridge to take us over the Columbia River into Oregon. The Goldwing Touring Association escorted us over the bridge in big groups, shutting southbound traffic occasionally to let us have the roadway to ourselves. The bridge wasn't nearly as difficult as I had psyched myself fact, pretty easy (but hey, thanks to Dan's Skyline Blvd. tour the week before, EVERY hill was easy!)

Waiting at Rainier Bridge
So we followed Highway 30 all the way into Portland from here. Notably, the worst part of the ride, trafficwise. Highway 30 is horrible in a car, let alone on a bike, as it's narrow, curvy, and fast traffic. We fortunately missed a patch of tacks in the bicycle lane ( between Scappose and Cornelius Pass. Right at Sauvie's Island, at a crest in the road, we got our first glimpse of Portland in the form of the spires of the St. John's Bridge spanning the Willamette River! Woooooo Hooooo! We exited Highway 30 to the NW Bridge Avenue hill approach to the St. John's Bridge, wound through North Portland and along the bluff, and finally crossed the finish line at mile 204 at Holladay Park by Lloyd Center Mall!

That's us...Dan, Theresa, and me, approaching the Finish Line!
A terrific event! So well organized! I would do it again in a heartbeat and encourage all my riding friends to do the same!

I had seven total medical assist stops on the route; two the first day and five the second. Most were sore knees, scrapes from minor falls. I did treat two bee stings to the lips, fortunately no allergic reaction component to either. The most significant injury was a broken clavicle sustained during a low-speed collision and crash at the Winlock food stop. Will definitely do medical support in the future and have a list of things to include next waaaaaay more ace bandages!

Elevation Profiles
Day 1

Day 2
 So until next time...Ride Safe!

Have a Great Day...Don't Forget to Hydrate!

View of Mt. Rainier, St. Helen's, and Mt. Adams on Skyline Ride

We have finally gotten into some beautiful weather here in the Pacific Northwest! Blue skies and sunshine...and sun block!

Being just a week before the Seattle to Portland (STP) ride, my friend Dan suggested we go for a last hurrah ride of 50-60 miles. He picked a route I've heard of but never ridden before, Skyline Boulevard in Portland, to Hillsboro. Beautiful ride...very picturesque...very hilly.

My friend, Kevin, and I met Dan at Overlook Park in Portland (across the street from Interstate Kaiser for my Portlandia readers) and headed over the Broadway Bridge, through NW Portland to Cornell. I had driven on Cornell as far as the Audubon Society when I took an injured bird to them years ago and knew that section was uphill...

We skirted along Forest Park, the scene of my recent slide-into-home-plate trail running maneuver. Just a beautiful scenic area.

The ride profile tells the tale! First hill is Cornell Road, next Skyline Blvd., flatter section is 185/West Union in Hillsboro, then up Highway 26 bike path to the Oregon Zoo at the top of the last hill. Total elevation gain for this ride: 4,180 feet!

This ride WORE ME OUT! First ride I've ever bonked on--thanks Dan! By the time we hit the bike path along Highway 26 I was riding about 7 mph and when I slowed to 5 mph I got off and walked my bike...WALKED MY BIKE! Holy cow! Great training ride though. Dan offered taking Max in from Cedar Hills, Beaverton, but I figured I could make it. At the Zoo, about ten miles later, I was ready for Max, but Dan convinced me that the best part of the ride was just a few short meters away...

And he was right! The absolute BEST part of this whole ride was the final descent from the Zoo into NW Portland. This section goes down through Washington Park and the International Rose Test Garden, which was in full bloom and gorgeous. This route is known as ZooBombing and is so fantastic and fun it even has its own website! Seriously, it was so fun that when we reached the Goose Hollow Max station I considered taking Max back up to the zoo and going down again, even as tired as I was! AWESOME, AWESOME, AWESOME!

Dan split off at Goose Hollow since it was near his home and Kevin and I gladly took Max the last little bit back to my car. We just couldn't fathom riding the last little section back up Interstate! Well, I'm sure Kevin the Hillslayer could have...I was spent!

As we were getting off Max with our bikes, an old man sitting on the train hollered out to us..."Have a great day...Don't forget to Hydrate!" Cracked me up. Perhaps the best line ever shouted out of a Max train!