Chronic buttock and groin pain is a common complaint of cyclists. This pain is caused by the pressure of the saddle during prolonged sitting and can result in injury to several anatomical areas. These injuries can include saddle (pressure) sores, perineal folliculitis and furuncles, callosities, ubcutaneous fibrosis, and subcutaneous perineal cystic nodules. Male cyclists can develop pudendal neuropathy, resulting in numbness or tingling in the scrotum or the penis. Prolonged compression of the pudendal nerve, usually following repeated and multi-day rides and resulting in transient impotence in male cyclists, has been documented. Traumatic urethritis and torsion of the testis have also been described. Female cyclists may experience a variety of vulval trauma, including superficial abrasions, lacerations, contusions and haematomas. The management of these injuries involves the treatment of the acute phase by means of antiseptic creams or powders, as well as corticosteroid creams or antibiotics if required. However, the most important advice for cyclists is to prevent these injuries by observing the following principles:
Use a modern, anatomically designed saddle. Saddles are gender specific. Be sure to choose a saddle that is specific to your riding, as there are a number of different designs on the market with snoop nose/split saddle/traditional.
Pictured below are a variety of different saddles
As always a correct bike fit is imperative. With a correct set up the saddle itself will be both level and in correct alignment with the front stem. With a large number of bikes that I examine, the seat is off by several degrees in both of these directions. This is not dramatic in a short ride but with longer rides the seat nose can cause micro trauma as mentioned above. Males are at greater risk of damage if the seat is positioned to be lifted at the nose. This is usually done to take pressure off the ischial tuberosity. However, by lifting the nose of the seat, there is an increased risk of compression of the pudendal nerve. Split saddles and snoop noses help to reduce this loading but each rider has a different body shape and getting the right saddle means working with your local bike shop to help test the optimal saddle for each rider.
The bike fitting must also be performed by a cycle professional or physiotherapist/exercise physiologist who is trained in this area. It is certainly a very difficult task to fit your own bike and get all the angles exact. Some of the worst bike set ups I have seen have come from health professionals! One of my friends who is a keen cyclist (and emergency department specialist) presented to our clinic with his beloved mountain bike to be informed he had been using a woman’s seat to his immense horror. A female and male seat is of different lengths and widths and just because the bike came with that particular seat does not always mean that is the seat that you should be using.
The other problem that can occur with the seat is actual wear of the seat itself and if this occurs there is increased pelvic movement on the saddle. Test the seat by trying to move the saddle, pushing down on either side and if there is significant movement the support is reduced. Often in groups you can see the rider in front moving on the saddle. This will increase the likelihood of pelvic issues both with groin pain and buttock pain.
If you are suffering from any of these issues or have concerns over the quality of your saddle, then be sure to:
- Use padded cycling shorts that are cleaned daily (multiple dayrides)
- Consider shaving the perineal area to avoid traction on hair follicles and reduce the chance of infection.
- Purchase a new seat. Most bike shops can help work in with the rider and may have demo seats available.