Cyclist’s Syndrome / Pudendal Neuralgia, recovery advise and how to move forward?

hi did you have success with resolving the nerve issue

hi did you get your pn symptoms under control? what were the things that you did to get better?

Hi @Jimmyc,
I am better than earlier in the summer but defo not back to normal…I haven’t been back on my bike and when I tried in October, the pain came right back…I still feel there is a lot of tightness in the perineal area and any stretches/exercises to the piriformis or obturator internus end up causing me days of pain…the only thing that has given me relief is abdominal breathing and using the therawand…but relief is short lived…I can walk for exercise and swim will a pull buoy between my thighs but no cycling, jogging or yoga has been possible all of 2021…

This forum has a lot of useful tips…hope you find relief soon…do ask if you need any further info…

Cheers,
Abhi

I’m a bit better. I am back on the bike a couple of times a week. I make an extra effort to get out of the saddle a lot more and keep it limited to harder sessions - no long endurance rides! I bought a new saddle: Selle SMP with a big cutout which is a big help.

I have tried to concentrate on releasing pelvic tension. It’s like the opposite of a Kegel move. Several times a day i’ll lie on the floor and do a Happy Baby pose (or whatever it’s called) and this releases the tension and takes away the discomfort for a while. Belly breathing helps too. I have also mostly cut out gluten although my wife keeps making pasta and moans if i don’t eat it or try and cook rice so i give in. I have given up bread at least. This has actually been good in many ways, not just related to inflammation. I’ll never go back to eating lots of bread.
I have a standing desk and i try to limit sitting time but i’m back in the office now part time and i’ve been sat down for 10 hours today and feel discomfort again.

All in all it’s like a 3/10 that goes up to 4 or 5/10 and then back to 3/10. I am having to live with it. It sucks. But not too much. It could be worse.

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Hi mate thank you for the reply, as long the symptoms don’t get worse that’s a good sign, i brought a ezwand and my PT is going to teach me to use it, can i ask if you are pursuing this as prudendal nerve entrapment, and if so have you had any scans MRIs etc to identify the problem , i have had a mri which was clear, but i am seeking a MRN as it shows the nerves to show entrapment inflammation etc, there is a surgery route but this is considered as a last resort, but the medical view is the longer you leave the more problematic it can be, please let me know if you get any relief from ant new methods or treatments you might try out.

Hi Anchorman
can i ask where you got your mrn as i cant find place in the uk, they all do mri but not mrn

Hi di the prudendal block do the job

I had a Ganglion Nerve Block not Pudendal
It has made no difference
I am still quite bad overall

@Jimmyc

I had the MRN at the European Scanning Centre close to Harley Street

After I had it done the Doc said that it only ever shows up entrapment one person a year and doesn’t mean no PN

Pre Ganglion block I was getting a little better actually

Make it it want you will ……

I am trying to arrange the Pudendal Nerve Block for January

Hi @Jimmyc,
Unfortunately, there is a lot of confusion on this debilitating condition…many people who get this after arduous activity have Pudendal irritation due to neighbouring structures, muscles & tissues being inflamed is what I can glean from what’s available on the internet…really bad entrapment which gets worse and needs surgical intervention is quite rare…also, success rates post surgery (if you find a skilled neurosurgeon who understands this condition) seem patchy. It seems difficult to see and confirm the location of irritation/entrapment through imaging as well…

Having said all of the above, I can’t say that physio alone has made me better…I have good days in between all the flare ups which last several days…stopping offending activity like cycling, anything that puts me in a squatting position frequently and sitting for long periods definitely helps…but solving this has not been possible because in my case, I don’t know what caused this in the first place. I had no pain during my cycle rides across 2k miles…I took a break of 2 weeks over Xmas 2020 and when I tried to get back on the bike, I initially got back ache and sciatica like symptoms followed by adductor, quad aches, nerve referral into butt, knee, heel and toes…for the first 3 months, GP, Physio, Spinal surgeon (private) all told me it’s a herniated disc but back MRI was clear. Then I had a Hip MRI which didn’t show any labral tears, tendinopathy, bursitis etc…finally a pelvic physio studied my symptoms and diagnosed me with Pelvic pain due to Pudendal irritation in August.

Sorry about the rather long story but I am still in a bit of pain but hoping it’s not getting worse with just normal activities of the day, use a standing desk at work and do the wand and belly breathing exercises which are supposed to relax the pelvic muscles …on really bad days, a muscle relaxant like Diazepam has helped and the GP had also prescribed Amitriptyline for most of 2021.

I don’t know if this has been helpful but I would like to exhaust all non surgical avenues if poss because I feel I haven’t really had a conclusive diagnosis for someone to prod correctly through surgery…

I’ve heard the block can wake it worse so do your research some people have had relief, this conditions a bummer, put my life on hold, I know the London pain clinic do blocks…all the best mate, if you find something helpful drop a message thanks

I’m taking the amitriptyline helps but just masks the symptoms mine gets worse with walking so it’s stopped me doing things, I’m 6 months in and it’s a getting a bit worse so will be looking at all Avenues if treatment, physio and amitriptyline keeps me going but need normality of some kind, keep in touch if you come across any new info or treatments, the London pain clinic does the blocks if you want to try…

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Hey Guys,

It’s been a really long time since I checked in here, and the reason for that was that for the most part I’ve been doing well and have actually gone through a few base,build,specialty cycles at mid-volume with decent success.

So the reason I’m posting is not to gloat, as I know when you’re in the thick of this condition, the last thing you want to hear is how other people are hunky-dory.

Over the last couple months I started trying to cross-train more running into my workout plan. I’ve been slowly building up to more mileage, and have been accruing the hip/knee pain that is pretty common to it.
I kinda just assumed I’m getting older and that’s just how it goes, so I power through.

Low and behold today I was doing a pretty challenging TR workout at lunch and afterword an all-to-familiar kind of discomfort started to flare up.

It’s literally been almost 2 years since I’ve felt this, and the only thing I’ve changed is that now I’m running again. So I was digging around online and found this video.

Now I don’t think this guy is going to win any awards for “Most Charismatic” anytime soon, nor do I necessarily buy into prolotherapy, and I’d sooner try physical therapy. But I wonder if there is some credence to the source of the problem, as least for some of us, being general pelvic instability. Like perhaps if we addressed asymmetry and instability in our pelvis if that is the root cause of the pudendal nerve irritation.

I’m a little uncomfortable going to a physical therapist yet with the virus but I think I’m going to do do some focused exercises on building strength and flexibility around my hips and pelvis, and take a break from running for a bit to see what happens. It just so happens that when this whole thing started for me, i was running then too.

I’m curious how many of you also run or do other activities that might cause some pelvic asymmetry or instability that might cause discomfort that is seemingly unrelated to the pudendal nerve. For me I tend to get SI-joint pain on the opposite side from where I’ve gotten the nerve pain.

I’m not suggesting that physical therapy on the hip/pelvis area would be treating the existing nerve irritation, but more that it may have been the root cause. Once the irritation is already flared up, I think regardless of the cause everyone needs to find the solution(s) that work best for them, whether it be pelvic floor PT, medication, or even surgery.

Anyway, just wanted to throw this out there. Maybe there’s a common denominator we hadn’t realized.

Hi @SexyCoolguy,

I don’t run but you defo have a point about hip instability…I got this condition only after upping my cycling mileage and feeling like I was worse doing some of the yoga poses which were quite straightforward previously…overuse, instability and hip/pelvic muscle imbalances all play a part.

Hop you have success and get better with the exercises you are planning to follow. Let us know how you get on.

Hi @SexyCoolguy and @Abhijit_Rao
Sorry for slow reply
I don’t do any running , my cause was time in the saddle for sure and a new more aggressive riding position
Re the pelvic symmetry it’s hard to comment , I did play a lot of rugby when younger and get bashed about a lot with various injuries so it may be a factor
I’m going to do more of the pelvic symmetry exercises and see what happens
I have a Pudendal Nerve block booked for 6th Jan , CoVid permitting which follows the largely ineffective Ganglion Block
Best wishes all
Thank you

Has anyone had any luck with doing anything with the obturator internus muscles? I’ve read some stuff about physio massage of it, and doing certain stretches but i’ve not seen it universally discussed as the way forward.

My PT had me doing stretches that hit that area. It’s difficult to figure out the exact culprit, but definitely worth doing some work on given it’s interaction with the nerves in that area.

It’s interesting because even when my nerve pain subsided, those muscles would often get really tight after activity.

So did yours get better? Mine is hovering at a consistent 5/10 on the pain in the arse scale at the moment.

Would you get able to share some of the stretches?

Hi @Abhijit_Rao and anyone interested

I’ve had my Pudendal Nerve Block ( both sides ) which numbed everything downstairs ( very weird ) .
Sadly it has made things worse and am back doing intense breathing and stretching in the hope it makes it better .
The Doc says this isn’t good and means I am probably not right for PRF.
I still have the issue of not being able to wear trousers with a belt as the pressure below the belly button triggers pain and tightening- anyone else got that ?
It is what it is …,
Thanks

Hi @Anchorman,

Sorry to hear you are not better after the Pudendal block…I am sure you have thought of this but have you consulted an urologist re prostrate or other abdominal issues as your pain onset seems to be linked to pressure applied beneath the belly button?

I haven’t had this…my pain seems to have no causative factors at all…it just slowly developed as I increased my cycling mileage in 2020.

My current status is I get flares if I sit on flat, hard surfaces and the pain is around sit bones, inner thigh and weirdly into my heels…