Bicycle Seat Neuropathy

John M. Martinez, M.D. asked:

What is bicycle seat neuropathy?

A common, but underreported cycling injury is bicycle seat neuropathy. Both male and female cyclists can experience symptoms which may 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. Fortunately, the majority of these cases are temporary, however there have been reports of long-term sexual dysfunction.

Compression of the pudendal nerve between the bicycle seat and the pelvic bones is believed to be the main cause of the symptoms. The compression results from the cyclist supporting his or her body weight on a narrow bike seat.

A major factor in the development of bicycle seat neuropathy appears to be related to the design of the bicycle seat. Several studies of various bike seat shapes demonstrated that wider bicycle seats decrease pressure on the perineal area and result in a decrease in symptoms reported by cyclists.

One study of bicycle seat neuropathy surveyed cyclists participating in a 500-mile bicycle tour found that almost half (45%) of the bicyclists suffered from mild and transient numbness, while 2% experienced symptoms severe enough to force them to temporarily stop riding. Researchers of a second study of 260 cyclists participating in a 330 mile long bike tour found that of the responding males, 22% reported symptoms of either pain or numbness in the pudendal area with three male cyclists whom reporting symptoms that lasted longer than one month.

Bicycle seat neuropathy is an equal opportunity injury and has also been documented in female cyclists. A study of women members of a Dallas cycling club found that over a third (34%) of the female cyclists experienced perineal numbness related to cycling on at least one occasion.

The main treatment and cure for bicycle seat neuropathy is the adjustment of the bike seat and proper bike position. These changes may include tilting the nose of the seat down or lowering the seat height to relieve pressure off 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 due to bicycle seat neuropathy.

Newer bicycle seats with a split nose or a center cutout design may help limit compression on the perineal area and improve or resolve symptoms. Studies of cyclists on these newer seats have demonstrated up to a 50% reduction on perineal pressure and a resulting decrease in reported symptoms.

Prevention of bicycle seat neuropathy usually requires a proper bike fit and adjustments by a trained professional. Changing positions frequently on the bike seat, such as standing to relieve pressure on the perineum or changing hand positions from the handlebar drops and hoods can change pelvic position.

A return to cycling depends upon improvement of the symptoms. 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.

Persistent symptoms of neuropathy and impotence can continue despite changes in the bicycle seat position and training volume, and may indicate a different etiology 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

e-bike

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