Numb Bum

Welcoming the Tour de France to our shores in June combined with the lighter evenings and sunny weather means cyclists are hitting the streets in their droves.

Advances in saddle and bike technology and the essential and ever glamorous padded shorts mean our bottoms have never been so well looked after! BUT when does saddle soreness turn in to something requiring a bit more attention?

Saddle area nerve entrapments are surprisingly common in long distance cyclists; however left untreated they can have adverse and unwanted affects.

What is it?
‘Pudendal neuralgia’ is a term which describes one form of nerve entrapment syndrome often seen in cyclists. The pudendal nerve supplies the tissues in the perineal (saddle) region, including the rectum, pelvic floor and genitals. Due to its anatomical position in between the ischial tuberosities (see diagram 1) in the saddle region, this nerve and associated blood vessels are often exposed to prolonged compression and stretch forces. Repetitive mechanical trauma as well as prolonged reduction in blood flow can cause damage to the nerve and result in impaired function. Symptoms associated with pudendal neuralgia include numbness in the saddle area, pain along the course of the nerve and urinary or erectile dysfunction.

How to diagnose symptoms
Diagnosis is usually determined from a range of clinical signs. The function of the nerve can be investigated with nerve conduction studies in the more chronic (long term) and debilitating cases.

How to treat this
In the initial stages modification of training schedules to reduce the duration of compressive and stretch forces is essential as well as changes in seat position and type. A professional bike fit can be beneficial to ensure an optimum position for efficiency and appropriate distribution of forces. Conservative management will likely include a musculoskeletal and biomechanical assessment, to ensure that factors which may impact the orientation of the pelvis in the saddle are addressed. Physiotherapists are likely to administer treatments and exercises to facilitate a better function and reduce the load within the affected region. In those instances where conservative measures and training changes fail to improve symptoms a referral to a specialist may be required.

At Richmond Physiotherapy we have good links with bike fitters in the local area and have a team of highly skilled physiotherapists who are experienced in musculoskeletal assessments around the pelvic girdle and lumbar spine to help treat these symptoms before they become well established.

To book an appointment please call the Richmond based clinic on 02083321132 or visit our website
We are recognised by all major health insurers.

Opening hours: M-F 8am-8pm, Sat 9am – 3pm, Sun 10am-2pm

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Lawton Gate House,
7 Hill Street, Richmond,
London, TW9 1SX

020 8332 1132