Wrist and hand pain cycling: causes, treatment and how to prevent

Wrist and hand pain from cycling: types, symptoms, causes and treatment

Types

Types of wrist and hand pain from cycling include issues related to bones, muscles, nerves, tendons, ligaments, and blood vessels, with specific conditions like Ulnar wrist pain, Radial wrist pain, and Trigger finger and trigger thumb.

• Bones: Cycling can lead to wrist and hand pain originating from the bones due to impacts, vibrations, and prolonged pressure, potentially causing stress fractures or joint discomfort.
• Muscles: Overuse or improper cycling posture can strain the muscles in the wrist and hand, leading to pain and fatigue.
• Nerves: Nerve compression or irritation, such as in conditions like Ulnar Neuropathy or Carpal Tunnel Syndrome, is common in cyclists due to handlebar pressure.
• Tendons: Tendinitis and other tendon-related issues can arise from repetitive cycling movements, causing pain in the wrist and hand.
• Ligaments: Ligament strain or sprains can occur from cycling, especially if the hand or wrist is positioned awkwardly for extended periods.
• Blood Vessels: Reduced blood flow or pressure on blood vessels during cycling can lead to discomfort or numbness in the hands and wrists.
• Ulnar Wrist Pain: Often results from pressure on the ulnar nerve near the wrist, common in cyclists due to handlebar grip.
• Radial Wrist Pain: This pain occurs on the thumb side of the wrist and can be caused by stress from gripping the handlebars or due to an injury.
• Trigger Finger and Trigger Thumb: These conditions, where fingers or the thumb get locked in a bent position, can develop from repetitive cycling motions and gripping.

Symptoms

Symptoms of wrist and hand pain from cycling include aching, throbbing, tingling, numbness, and loss of function.

• Aching: A constant dull pain in the wrist or hand, often due to overuse or maintaining a fixed grip on the handlebars for extended periods.
• Throbbing: A pulsating pain that can indicate inflammation or strain, typically exacerbated after a long ride or intense cycling session.
• Tingling: Sensations of pins and needles in the hands or wrists, often indicative of nerve compression or irritation, such as from holding the handlebars tightly.
• Numbness: A lack of sensation in the wrist or hand, frequently related to nerve pressure, possibly from an improper handlebar position.
• Loss of Function: Difficulty in moving the fingers or wrist effectively, which could result from severe strain, overuse, or nerve compression in the wrist or hand area.

Causes

Causes of wrist and hand pain from cycling can be broadly categorized into improper bike fit and equipment-related issues, injuries, and health conditions.

Improper Bike Fit and Equipment-Related Causes of wrist and hand pain from cycling

1. Bike Saddle Too Far Forward: Causes a forward shift in body weight, leading to increased pressure on wrists and hands.
2. Handlebar Height: Incorrect handlebar height can lead to awkward wrist angles, causing strain and discomfort.
3. Tyre Pressure: Incorrect tire pressure can affect bike handling and vibration absorption, leading to increased stress on hands and wrists.
4. Incorrect Positioning on the Handlebars: This leads to excess pressure on certain parts of the hand and wrist, causing pain and discomfort.
5. Insufficient Core Muscles, Excess Weight on Hands: Weak core muscles can result in over-reliance on arms and hands for support, increasing strain.
6. General Fatigue Increased Weight Bearing on Hands: As fatigue sets in, cyclists tend to put more weight on their hands, exacerbating pressure and pain. A study by Dr. Venu Akuthota, MD, from the University of Colorado School of Medicine found that long-distance cycling can lead to physiological changes in the deep branch of the ulnar nerve and worsen symptoms of carpal tunnel syndrome.
7. Ill-Fitted Gloves: Gloves that don’t fit properly can fail to cushion and support the hands properly, leading to pain.

Injuries related causes of wrist and hand pain from cycling

1. Cyclist’s Palsy: Cyclist’s palsy, also known as handlebar palsy, is a condition caused by the compression of the ulnar nerve at the wrist due to prolonged pressure while gripping bicycle handlebars. This compression can lead to numbness, tingling, and weakness in the ring and little fingers, impacting grip strength and causing discomfort in the hand.
2. Overuse and Repetitive Strain Injuries: Continuous cycling can cause repetitive stress on the wrist and hand muscles and tendons.
3. Wrist Tendinitis: Wrist tendinitis involves inflammation of the tendons around the wrist joint, often resulting from repetitive motion like cycling. It causes pain, tenderness, and sometimes swelling in the wrist, particularly during and after long periods of gripping the handlebars.
4. Ganglion Cysts: These are fluid-filled sacs that can develop near joints or tendons, and in cyclists, they often appear around the wrist due to repetitive strain. These cysts can cause pain, and weakness, and sometimes limit wrist mobility, affecting cycling performance.
5. Kienbök’s Disease: Kienbök’s disease is a rare condition where the blood supply to the lunate bone (one of the small bones in the wrist) is disrupted. In cyclists, the recurrent pressure on the wrist can aggravate this condition, leading to pain, stiffness, and in severe cases, a collapse of the bone.

Associate Professor of Orthopaedic Surgery J. Megan M. Patterson, MD, from the Department of Orthopaedic Surgery at Barnes-Jewish Hospital at Washington University School of Medicine, USA in a study mentioned that cyclist’s palsy occurs frequently among both experienced and inexperienced cyclists. Its incidence can be reduced by wearing cycling gloves, ensuring proper bicycle fit, and frequently changing hand positions.

Health Conditions related to causes of wrist and hand pain from cycling

1. Carpal Tunnel Syndrome: This syndrome occurs when the median nerve, which runs from the forearm into the palm, becomes pressed or squeezed at the wrist. In cyclists, the sustained wrist positioning and pressure from handlebar grips can exacerbate this compression, leading to symptoms like pain, numbness, and tingling in the thumb, index, and middle fingers.
2. Wrist Arthritis: Wrist arthritis involves inflammation of the wrist joint, leading to pain, stiffness, and reduced range of motion. In cyclists, the repetitive stress and strain on the wrist joint can aggravate these symptoms, making gripping and handling the bike painful.

In a 2023 study by Consultant Physician Dr. Conor P O’Brien from the Department of Sports Medicine, Blackrock Clinic, Ireland, it was found that overuse injuries, making up over 60% of all sports-related injuries, can lead to nerve injuries, including carpal tunnel syndrome in cyclists, caused by forced flexion of the wrist or direct trauma from bicycle riding affecting the median nerve.

Do cyclists get carpal tunnel syndrome?

Yes, cyclists can get carpal tunnel syndrome because the repeated pressure on the median nerve in the wrist from gripping the handlebars(especially in prolonged or intense rides) can lead to this condition, characterized by numbness, tingling, and pain in the hand and fingers.

Treatment

Treatment of wrist and hand pain from cycling includes rest, applying ice, taking anti-inflammatory medication like NSAIDs, making ergonomic bike fit adjustments, undergoing physical therapy, immobilization, corticosteroid injections, wrist splinting for Carpal Tunnel Syndrome, and in severe cases, surgery.

1. Rest: Allowing the affected wrist and hand to rest can significantly aid in reducing inflammation and promoting recovery.
2. ICE: Applying ice to the painful area helps in reducing swelling and numb sharp pain.
3. Anti-inflammatory medication (NSAIDs): These medications can alleviate pain and reduce inflammation in the wrist and hand.
4. Ergonomic Bike Fit Adjustments: Correcting the bike setup, such as handlebar position and saddle height, can reduce strain on the wrists and hands with proper cycling gloves. Professor Josh Slane from the Department of Mechanical Engineering at the University of Wisconsin–Madison, United States, in a 2011 medical research mentioned that wearing padded gloves and changing hand positions during cycling can significantly reduce hypothenar pressure and the risk of ulnar nerve damage, known as Cyclist’s Palsy, especially during extended rides.
5. Physical Therapy: Engaging in targeted exercises and therapies can help strengthen and rehabilitate the wrist and hand muscles.
6. Immobilization: Using splints or braces can stabilize the wrist, providing relief and aiding in the healing process.
7. Corticosteroid Injections: These injections can reduce inflammation and provide relief from severe pain.
8. Wrist Splinting for Carpal Tunnel Syndrome: Using a wrist splint, especially at night, can relieve symptoms by reducing pressure on the median nerve.
9. Surgery: In cases where conservative treatments fail, surgical intervention might be necessary, particularly for severe Carpal Tunnel Syndrome or other structural issues.

In a 2016 study, David Brogan MD, a hand and wrist surgeon at Washington University in St. Louis, USA, outlines that ulnar-sided wrist pain treatment involves nonoperative methods like immobilization and corticosteroid injections, and surgeries like peripheral capsular repair or ulnar shortening osteotomy, depending on specific pathologies.

What is the fastest way to heal tendonitis in the wrist of cyclists?

The fastest way to heal tendonitis in the wrist of cyclists is through a combination of rest, applying ice to reduce inflammation, using anti-inflammatory medication like NSAIDs, and engaging in targeted physical therapy exercises, because these approaches directly address the inflammation and promote recovery of the affected tendons.

What is Guyon’s Canal syndrome cycling?

Guyon’s Canal Syndrome cycling is a condition where the ulnar nerve gets compressed in Guyon’s canal near the wrist, leading to symptoms like numbness, tingling, and weakness in the hand and fingers, often experienced by cyclists due to prolonged pressure on the handlebars.

What are the common diagnoses for cyclists presenting with wrist and hand pain?

The common diagnoses for cyclists presenting with wrist and hand pain are Carpal Tunnel Syndrome, Cyclist’s Palsy (Ulnar Neuropathy), Wrist Tendinitis, De Quervain’s Tenosynovitis, and Guyon’s Canal Syndrome.

Can cycling cause wrist and hand pain?

Yes, cycling can cause wrist and hand pain due to various factors such as too much pressure through hands and nerves, wrists held in an extended and fixed position, insufficient core muscles leading to excess weight on hands, high saddle or low handlebars, over-inflated tires and small wheels, general fatigue, ill-fitted gloves, improper bike fit, worn-out handlebar padding, and incorrect shape or size of handlebar.

1. Too Much Pressure Through Hands and Nerves: Continuous pressure on hands and nerves can lead to conditions like cyclist’s palsy or carpal tunnel syndrome. In a 2011 study by Biomechanical Engineer Kyle Owen Russ from Ohio State University, it was found that handlebar grip positions significantly affect median palm pressure and wrist posture in cyclists, leading to handlebar palsy, and this data informs the design of handlebars for better pressure distribution and wrist posture.
2. Wrist Being Held in an Extended and Fixed Position: This position can strain the wrist, leading to discomfort and repetitive strain injuries.
3. Insufficient Core Muscles: Weak core muscles can cause cyclists to over-rely on their hands for support, increasing strain.
4. High Saddle or Low Handlebars: This imbalance can cause undue stress on wrists and hands.
5. Over-Inflated Tires and Small Wheels: High tire pressure and small wheels can increase vibration, leading to discomfort in the hands.
6. General Fatigue (Increased Weight Bearing on Hands): Fatigue can cause a cyclist to put more weight on their hands, exacerbating pain and strain.
7. Ill-Fitted Gloves: Gloves that don’t fit properly can fail to cushion and support the hands properly, leading to pain.
8. Improper Bike Fit: An improperly fitted bike can lead to awkward hand and wrist positions, causing pain.
9. Worn-Out Handlebar Padding: Lack of adequate cushioning can increase pressure and vibration, leading to hand pain.
10. Incorrect Shape or Size of Handlebar: Handlebars that don’t suit a rider’s size can lead to unnatural hand positions, causing strain.
11. Improper Saddle Height: An incorrect saddle height can affect overall posture, impacting wrist and hand comfort.

Sports physician Dr. Ramsey Shehab, MD, from Henry Ford Health System, Detroit, USA, in a 2013 study found that ulnar neuropathies of the wrist typically present as wrist discomfort with sensory changes in the fourth and fifth digits, often caused by activities like cycling that involve repetitive or prolonged wrist extension, with electrodiagnostic tests being crucial to identify the area of nerve entrapment and the extent of the pathology.

Mountain bike wrist and hand pain

Mountain bike wrist and hand pain is a common discomfort experienced by riders due to the rugged and uneven terrain of mountain biking, which causes repeated jolts and vibrations through the handlebars, leading to strain and stress on the wrists, exacerbated by the specific demands of gripping and maneuvering on challenging trails.

Road bike wrist and hand pain

Road bike wrist and hand pain typically arise from prolonged periods of riding in a fixed wrist position, often exacerbated by the lower handlebar setup on road bikes, which can increase pressure on the wrists and lead to issues like nerve compression, tendinitis, or strain from maintaining a constant grip and posture.

Indoor cycling wrist and hand pain

Indoor cycling wrist and hand pain often result from the static, unchanging position of the hands on stationary bike handlebars, combined with the lack of natural body movement and terrain variation found in outdoor cycling, leading to increased pressure and strain on the wrists and hands.

Can cycling cause nerve damage in the hands?

Yes, cycling can cause nerve damage in the hands, specifically conditions like Cyclist’s Palsy or Carpal Tunnel Syndrome, because prolonged pressure on the handlebars can compress the ulnar and median nerves, leading to symptoms such as numbness, tingling, and weakness in the hands and fingers.

Why do my bike handlebars hurt my wrists?

Your bike handlebars hurt your wrists because, in mountain biking, the rough terrain causes repeated jolts, while in road cycling, the lower handlebar position can lead to prolonged wrist extension, and in indoor cycling, the static posture on stationary handlebars increases pressure, all contributing to strain and potential nerve compression in the wrist.

Why does my wrist hurt after cycling?

Your wrist hurts after cycling because the repetitive motion and sustained pressure on the handlebars can lead to strain on the wrist tendons, compression of the wrist nerves, or inflammation in the joint, resulting in conditions like tendinitis, carpal tunnel syndrome, or cyclist’s palsy.

Why does my ulnar wrist hurt after cycling?

Your ulnar wrist hurts after cycling because the prolonged pressure on the handlebars, especially in positions that strain the ulnar side of the wrist, can compress the ulnar nerve, leading to discomfort and conditions such as Cyclist’s Palsy or ulnar neuropathy.

Why does my ulnar nerve hurt when cycling?

Your ulnar nerve hurts when cycling because the sustained grip on the handlebars, particularly during long rides or in a bent wrist position, puts pressure on the ulnar tunnel at the wrist, leading to nerve compression and resulting in pain or numbness in your ring and little fingers.

Why do my wrist and hand hurt after cycling as a beginner?

Your wrist and hand hurt after cycling as a beginner because you may not have yet developed the proper riding posture or grip strength, and your body is still adjusting to the pressure and repetitive motion involved in cycling, which can strain the muscles, tendons, and nerves in these areas.

How do I fix wrist and hand pain when cycling?

To fix wrist and hand pain when cycling, you can stop and stretch your hand and wrist, change your hand position on the handlebar more frequently, adjust your bike fit, use padded gloves, and strengthen your core muscles.

• Stop and Stretch Hand and Wrist: Regularly pausing to stretch can relieve tension and improve circulation in your wrists and hands.
• Change Hand Position on Handlebar More Frequently: Regularly altering your grip and position can prevent sustained pressure on any one area, reducing the risk of nerve compression and strain.
• Adjust Your Bike Fit: Ensuring your bike is properly fitted to your body can reduce undue stress on your wrists and hands, particularly adjusting handlebar height and angle.
• Use Padded Gloves: Padded cycling gloves can absorb some of the vibrations and pressure exerted on your hands and wrists.
• Strengthen Your Core Muscles: A stronger core reduces over-reliance on your hands and arms for support, thereby decreasing the strain on your wrists and hands during cycling.

Will handlebar palsy go away?

Yes, handlebar palsy can go away only if you take adequate rest, modify your cycling practices, and use ergonomic adjustments because handlebar palsy, caused by prolonged compression of the ulnar nerve at the wrist, often resolves with these measures aimed at reducing nerve irritation and aiding recovery.

How long does it take for handlebar palsy to heal?

It takes typically a few weeks to several months for handlebar palsy to heal, because the recovery time depends on the severity of the nerve compression and the effectiveness of measures taken, such as resting, adjusting cycling habits, and ergonomic improvements to alleviate pressure on the ulnar nerve.

How to stop pins and needles in hands when cycling?

To stop pins and needles in your hands when cycling, you can adjust your handlebar position and grip, use padded gloves, take regular breaks to stretch and change hand positions, ensure proper bike fit to distribute weight evenly, and strengthen your core to reduce excessive pressure on your hands, as these steps help alleviate nerve compression and improve circulation.

How to prevent wrist and hand pain from cycling?

To prevent wrist and hand pain from cycling, you can optimize your bike fit by adjusting your cycling posture, handlebar height, and using wider tires, performing stretches like wrist extensor stretches, hand flips, and wrist rotations, and engaging in exercises such as wrist strengthening, using a gyroscopic ball, and enhancing core muscle strength.

Bike fit to prevent wrist and hand pain cycling

Bike fit to prevent wrist and hand pain cycling includes adjusting the road bike position, shortening the reach, increasing stack height, decreasing saddle drop, setting the right handlebar height, tilting the handlebar forward to back, using wider wheels and tires, lowering tire pressure, using a mountain bike suspension fork, wearing cycling gloves, and using the right handlebar tape and grips, as well as considering an integrated bar or separate bar and stem.

• Road Bike Position: Proper positioning on a road bike can reduce strain on the wrists by ensuring a balanced distribution of weight.
• Shorten Reach: Shortening the distance between the saddle and handlebars can prevent overextension of the arms and reduce wrist strain.
• Increase Stack Height: Raising the stack height can help achieve a more upright position, reducing pressure on the hands and wrists.
• Decrease Saddle Drop: Adjusting the saddle drop to be less aggressive can alleviate wrist pressure by shifting some weight back.
• Handlebar Height: Raising the handlebars can relieve wrist pressure by allowing for a more natural hand position.
• Tilt Handlebar Forward to Back: Adjusting the tilt of the handlebar can help find a comfortable wrist position, reducing strain.
• Wider Wheels and Tyres: Wider tires can absorb more road vibration, reducing stress on the hands and wrists.
• Lower Tyre Pressure: Lowering tire pressure within safe limits can increase shock absorption during rides.
• Mountain Bike Suspension Fork: On mountain bikes, a good suspension fork can absorb shocks and reduce impact on the wrists.
• Cycling Gloves, Handlebar Tape and Grips: Quality cycling gloves and proper handlebar tape or grips can cushion the hands and absorb vibration.
• Integrated Bar or Separate Bar and Stem: Choosing the right bar setup can affect hand positioning and comfort, impacting wrist and hand strain.

In a 2016 study, Dr. David L. Jackson from West Phoenix Clinic, Arizona, USA, found that cyclists’ discomfort due to prolonged riding in a fixed hand position on rough roads was alleviated by modifying cycling techniques and adjusting bicycles for better body fit.

Stretches for wrist and hand pain from cycling

Stretches for wrist and hand pain from cycling include wrist flexion and extension, hand flips, wrist radial and ulnar deviation, wrist extensor stretch, wrist flexor stretch, the Prayer Stretch, Wrist Rotation, Side-to-Side Stretch, Seated Clenched Fists, Palm Pulses, and Thumb and Upper Wrist Stretch.

• Wrist Flexion and Extension: This stretch helps relieve tension by flexing and extending the wrist, which can alleviate tightness from cycling grips.
• Hand Flips: Flipping your hands helps improve circulation and flexibility, reducing stiffness from prolonged gripping.
• Wrist Radial and Ulnar Deviation: These movements stretch the sides of the wrists, helpful in reducing strain from holding a static position.
• Wrist Extensor Stretch: Stretching the wrist extensors can alleviate tension on the top of the forearm, beneficial for cyclists who experience strain from handlebar gripping.
• Wrist Flexor Stretch: This stretch targets the muscles on the underside of the forearm, relieving the tension caused by maintaining a grip on the handlebars.
• Prayer Stretch: A gentle stretch for both wrists and forearms, the Prayer Stretch is effective for reducing tightness and improving flexibility.
• Wrist Rotation: Rotating the wrists helps maintain mobility and reduces stiffness from repetitive cycling motions.
• Side-to-Side Stretch: This stretch alleviates lateral tension in the wrists, beneficial for cyclists handling varied terrains.
• Seated Clenched Fists: Clenching and unclenching fists, while seated, can help relieve tension and improve blood flow in the hands.
• Palm Pulses: Gently pulsing the palms can improve circulation and relieve the strain of gripping the handlebars.
• Thumb and Upper Wrist Stretch: This stretch targets the thumb and upper wrist area, often strained from cycling, and helps in releasing tightness.

Dr. Mike S. McGrath MD from Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, USA, found that a static progressive stretch orthosis effectively improved wrist motion in 47 patients with posttraumatic or postsurgical stiffness, especially after conventional physical therapy plateaued.

Cycling wrist and hand pain exercises

Cycling wrist and hand pain exercises include wrist strengthening, gyroscopic ball exercises, core muscle exercises, forearm muscle exercises, and exercises targeting wrist and hand muscles.

• Wrist Strengthening: Engaging in wrist strengthening exercises, such as wrist curls and reverse wrist curls, can build the muscles around the wrist, offering better support and reducing pain from cycling.
• Gyroscopic Ball Exercises: Using a gyroscopic ball helps improve grip strength and wrist stability, which can prevent pain and injury from the repetitive motions of cycling.
• Core Muscles: Strengthening core muscles for cycling, through exercises like planks and bicycle crunches, can alleviate the reliance on wrists and hands for support and balance while cycling.
• Forearm Muscles: Exercises targeting the forearm muscles, such as wrist rollers and grip squeezes, can enhance strength and endurance, reducing the likelihood of pain and strain from prolonged cycling.
• Wrist and Hand Muscles: Focusing on exercises that specifically target wrist and hand muscles, like finger stretches and squeezing a stress ball, can improve flexibility and strength in these areas, directly addressing the common pain points for cyclists.

In a 2020 study, hand/physical therapist Dr. Freek J.B. Lötters from Hand and Wrist Rehabilitation, Goes, The Netherlands, described a modified sensorimotor control-based exercise program (SMoC-wrist) for chronic wrist pain, showing promising results and grounded in current scientific insights.

How do I strengthen my wrists for cycling?

You can strengthen your wrists for cycling by engaging in specific exercises like wrist curls, reverse wrist curls, using a gyroscopic ball for grip strength, practicing wrist rotations, and incorporating forearm strengthening activities like squeezing a stress ball or using a wrist roller.

Is cycling good for wrist and hand pain?

Yes, cycling can be good for wrist and hand pain if it’s done with proper bike fit, ergonomic handlebar positioning, and by incorporating regular wrist and hand stretches and strengthening exercises, as these measures help in reducing strain and improving the overall resilience of these areas.

Is cycling good for carpal tunnel syndrome?

Yes, cycling can be good for carpal tunnel syndrome if it is performed with correct bike ergonomics and hand positioning to avoid excessive pressure on the median nerve, along with using padded gloves and taking frequent breaks to stretch, as these measures help alleviate symptoms and prevent further nerve compression.

Is cycling bad for carpal tunnel?

Yes, cycling can be bad for carpal tunnel syndrome because maintaining a prolonged grip on the handlebars and the pressure exerted on the median nerve in the wrist during rides can exacerbate the symptoms and potentially worsen the condition.

Do cycling gloves help with wrist and hand pain?

Yes, cycling gloves help with wrist and hand pain because such cycling equipment as gloves with grips provide cushioning and reduce vibrations and pressure on the nerves and joints of the hands and wrists, which can alleviate discomfort and prevent potential strain during cycling training sessions.

Is cycling good for your wrist and hand?

Yes, cycling can be good for your wrist and hand if it is done with proper ergonomic practices such as correct handlebar positioning, using padded gloves, and maintaining a relaxed grip, as these can help strengthen the muscles and improve joint mobility without excessive strain.

Is cycling good for neck pain?

Yes, cycling is good for neck pain if it’s done with correct posture and bike fit, as it helps strengthen neck muscles without putting undue stress on the area.

Is cycling good for lower back pain?

Yes, cycling is good for lower back pain as it can strengthen the lower back muscles while providing a low-impact form of exercise, reducing strain.

Is cycling good for hip pain?

Yes, cycling is good for hip pain, particularly when done with proper posture and seat adjustment, as it can help maintain hip mobility and strength without excessive joint stress.

Is cycling good for groin pain?

Yes, cycling can be good for groin pain if performed with appropriate saddle positioning and bike fit to avoid undue pressure and strain in the groin area.

Is cycling good for knee pain?

Yes, cycling is good for knee pain, as it offers a low-impact way to strengthen the knee muscles and improve joint mobility, but correct bike fit is crucial to prevent stress on the knees.

Is cycling good for foot pain?

Yes, cycling is good for foot pain as long as the bike is properly fitted, with suitable pedal and shoe alignment to avoid undue pressure on the feet, aiding in strengthening without overstraining.