Bicycle Seat Neuropathy

author : AMSSM

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Is your bike seat uncomfortable? Are your parts going numb? This article discusses the important concepts of bicycle seat neuropathy, treatment and prevention.

by John M. Martinez, M.D.

Member AMSSM

What is bicycle seat neuropathy?
Bicycle seat neuropathy is a common injury experienced by both male and female cyclists. Symptoms can include temporary numbness or pain in the groin and perineal area (located between the testicles or vagina and rectum) and even erectile or sexual dysfunction. While most cases are reversible and temporary, there have been reports of long-term sexual dysfunction in some cyclists who didn’t seek treatment or make changes to their bike position or riding style after the symptoms started.

What causes the symptoms?
The symptoms of bike seat neuropathy are caused by the cyclist supporting his or her body weight on a narrow bike seat, and are related to temporary and transient ischemic compression of the pudendal nerve between the bicycle seat and the pelvic bones. Bicycle seat design and shape also appears to be a major factor in the development of bicycle seat neuropathy. Computer modeling studies of various bike seat shapes demonstrated that wider bicycle seats that support the ischial tuberosities (the sit bones) decrease pressure on the perineal area.

How common is bicycle seat neuropathy?
The incidence of bicycle seat neuropathy is believed to be underreported. A study of symptoms reported by cyclists participating in a 500-mile bicycle tour found that:

• 45% of the participating cyclists reported at least mild and transient perineal numbness, with
• 10% reporting the symptoms as severe, and
• 2% of the cyclists with symptoms severe enough to force them to temporarily stop riding.

Another study surveyed 260 cyclists participating in a 330 mile long bike tour. The researchers found that of the responding males,

• 22% reported symptoms of either numbness or pain in the pudendal area.
• Additionally, 13% of male cyclists reported symptoms of impotence, including 11 of whom experienced symptoms for longer than one week, and three of whom reported impotence lasting longer than one month.

Can women also suffer from bicycle seat neuropathy?
Bicycle seat neuropathy has also been documented in women cyclists. A study of 282 female members of a Dallas cycling club found that 34% of the women reported perineal numbness related to cycling on at least one occasion.

What are some of the treatments for bicycle seat neuropathy?
The main treatment for bicycle seat neuropathy is the adjustment of the bike seat and proper bike position, which may include tilting the nose of the seat down or lowering the seat height to relieve pressure from the perineum. Other recommendations include having the rider change the style of riding, such as frequently stopping or changing riding positions. Sometimes decreasing training volume can also help alleviate symptoms.

Bicycle seats with a split nose or a center cutout may help limit compression on the perineal area and as a result help to reduce the prevalence of neuropathy. Comparison of pressure measurements in the perineal area of cyclists on these different bicycle seats has demonstrated that some of the newer seats reduced perineal pressure by approximately 50%.

Profile Design Tri-Stryke	Blackwell Research ISM Adamo Road

How can I prevent bike seat neuropathy?
Prevention of bicycle seat neuropathy includes riding a bike that is properly fit by a trained professional, as well as changing positions frequently on the bike seat or standing intermittently to relieve pressure on the perineum. Newer designs in bicycle seats also allow for the reduction of perineal pressure.

When can I return to cycling and what is the prognosis?
Return to cycling is based upon improvement and resolution of the symptoms. Remember to change positions on the bike, such as riding with hands on the top of the handlebars versus having hands down in the drops or riding with aerobars, to relieve pressure on the perineum. Other tips include standing up intermittently to relieve pressure or to stop cycling temporarily until the symptoms resolve. Changing the type and shape of bicycle seat used may also be helpful. Elevation of the nose of the bicycle seat may worsen the condition, as more pressure is placed upon the pudendal nerve.

The prognosis and recovery from bicycle seat neuropathy is very good. The symptoms usually resolve once the pressure is relieved from the perineal region. However, the rate of recovery can be variable and may be influenced by the amount of time the athlete previously spent cycling. A few case reports reveal that some cases can take more than one month to resolve.

What are long-term issues and when should I see a physician?
Medical issues and complications of bicycle seat neuropathy include continued injury or insult to the perineum and pudendal nerve with persistent neuropathy and impotence. Continued symptoms despite changes in the bicycle seat position and training volume may indicate a different source of the symptoms such as diabetes or a cardiovascular problem, and should warrant evaluation by a physician.

John M. Martinez, M.D.
Medical Director
Coastal Sports and Wellness Medical Center
San Diego, CA
http://www.coastalsportsmedicine.com
 

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date: August 5, 2008