I have a bit of an update. Much has been written on here about saddle selection/replacement and I’d like to also validate that. I’ve stayed off the bike to do the PT and mind-body work, the only exception being a visit to a bike fitter which resulted in some adjustments to my geometry but also caused a flare after 45 minutes or so on the trainer during the fit.
Based on that feedback my fitter (who’s also a PT and coach) immediately went to the saddle as the next focus. It took about a month and a half to align on schedules, which I was in no hurry to do because I wanted more rest and PT work anyway.
Finally made it to the fitter yesterday and he ran through 5 Selle SMP models (he’s a dealer and keeps a large range of test saddles at his studio). First one was a no fucking way, second was slightly better but still not there—could feel perineal pressure and constriction in groin. Third we moved narrower (closer to what the book dictates for my sit bones) and to more of a V shape and it was like night and day. It was like the saddle disappeared from under me it felt so right. I could feel the sit bones planted on it but little else. When we moved to a narrower and slightly different shape it was off again with pressure in the wrong place. Stayed narrower with more of a T shape on the fifth and still no.
The one we settled on is the Selle SMP Dynamic -and I now have the test saddle on my bike to trial it for a few weeks (which will be my first outside rides in nearly 5 months). But what I’ve learned here is the Dynamic is for my geometry—not every SMP was close (this helps explain why they have about 5 gazillion models in their line). The point is DO THIS PROCESS. If you look on Selle’s website it specifies where there are Selle SMP dealers that carry the testing saddles. I think they tend to also be fitters, so you may have to pay for a fit analysis as well. I would imagine there are similar options for other manufacturers.
I also want to try the VT20, which others on here have had success with and which the Selle SMP website recommends to me when I enter my dimensions and other info, but my fitter didn’t have a test saddle for that model so I’m planning to follow up with him to try that after a more extensive trial of the Dynamic.
But this was an eye opener. I’d recommend this process even to those who don’t have specific PN issues.
@Rumpus Thanks for this. My experience was similar. Replacing my previous saddles, I had self-selected the SMP VT30C Gel for my trainer bike. Brought that to the fitting and the fitter was satisfied with that one. For my road bike. my fitter put me on Zeta Optimus (maybe the Modus) along with a RedShift Shocktop seat post. We also shortened the stem by 10mm, to reduce pressure while reaching forward.
Like Rumpus, my fitter is a PT and had a range of saddles to try. He’d dealt with PN with other riders and had a good understanding of the needs.
Bottom line, a really good bike fitter is critical. I’ve spent $600 USD on the fit sessions, but if it gets me safely back on the bike, it’s worth it.
@Journey thanks for asking. My updates are very recent. I’ve mostly been doing short trainer rides to get used to being in the saddle again. I’m doing every other day at this point.
So far so good. Maybe some minor discomfort for a while afterwards but it doesn’t linger. Getting my road bike cleaned up so I can start doing some short outdoor rides.
My only comment is to focus less on the timeline and more on how you feel. My suspicion is that there’s a long tail on this — getting to 80 or 90% may seem predictable, but getting closer to 100 isn’t. That’s my experience so far, YMMV.
I agree with @MrBirchling. I feel patience is key, both to not overdoing it too soon, but more importantly to not getting down (anxious) when there are setbacks. If this thread teaches anything it’s that recovery can take TIME and is typically non-linear. Stay positive through the troughs and don’t get discouraged if you have a bad day. Keep things as chill as possible—observe the pain but don’t fear it. Stretch, breathe, be kind to yourself.
Mine has returned… I am 99% convinced that it is down to stress though as i have been frantically job hunting for a month and very very stressed about money. Not helped by what is being done to the stock market at the moment Grrrrrr…
I’m trying to stay un-tense and un-stressed as much as possible and going for long runs instead of cycling to keep it under control.
Oh man that blows. ( So the “stable genius” has literally kicked you in the pudendals?).
Yeah I feel the stress too—be it the market, politics, my school aged children being feral lunatics, all of it can lead to flares (though it’s always a bit of a fools errand trying to “connect the dots” and assign causation).
Come to think of it, my symptom onset was also right around a somewhat frantic and stressful job search. My father also passed away, so I think that was the more acute stressor. Crazy how the mind-body combos works. (I got a new position, as will you!)
Had you been doing anything notable on the bike? Higher intensity/volume or anything of the sort?
I don’t need to tell you this, but stay positive. You already know all the tools!
One quick, real time update. I’ve been on Effexor for about a year. It was to calm down the nerve pain. Average dosage was 100 mg, but was as high as 150 mg for a brief period.
I’ve been weaning myself off of it. I’m down to about 18 mg per day (half of a 37.5 mg tablet).
Two observations: I didn’t realize how much it impacted my mood, energy and focus. I knew it, but it’s been the past few days that I’ve really noticed how differently I feel.
It is also takes a long time to come off the Effexor. I tried to just quit after about 2 weeks of the 37.5. Within 48 hours, I was experiencing what the web called “brain zaps”. My analogy was matrix glitches. It’s like I dropped a frame or two in a video. I went back onto the full 37.5 for a few days and then dropped to half a dose for the past week. I’ll do this a bit longer and then go to every other day, then quit.
All that said, I’m glad I had it. It allowed me to live better and let the other symptoms calm down.
I figured out one of my triggers. For a brief period, I was using a steady dose of NSAIDs, dealing with a toothache. I realized that was irritating my bowels, which put more pressure on the nerve.
Backed off the NSAIDs, bowels were less irritated, pain lessened. Otherwise, I kind of felt like a switch was flipped. I didn’t feel much pain at all. So, I started lowering the dose. Because of all the dosage changes, I had about 3 different dosages at home, which allowed me to gradually lower.
I’d do a jump down, stay steady for at least a week and assess. If there was no change in the pain, do it again. That’s what got me to where I am.
I just called the doc to get guidance to get to 0. It was also to update them on my progress.
This is all very real time. I need to be careful over the next few weeks as I start to add in more saddle time. I’m 62 and not in shape, since I’ve been off the bike for over a year. I will very gradually add time in saddle and see how I’m doing.
Sorry I missed this previously. Yes, the pain reprocessing therapy book I linked talks about this—you use these facts as evidence to convince your mind that the pain is not a threat and you don’t need to fear it. Precisely these types of facts, where your worry/anxiety is leading to pain but when out and distracted it goes away, or when it is gone in morning and only comes on as the day progresses (likely because you’re worrying about it, even subconsciously). Everyone’s facts will be different, but it sounds like you’re building your evidence.
Update for me—I rode 10 miles on Saturday and 20 miles today (both rides outdoors on the Selle SMP Dynamic on my TCR set up pretty aggressively). Doing the stretching and PRT. Baby steps but no bad flaring. Definitely feeling the lack of saddle time though. Will continue to update.
I don’t know if any of the OGs are still on here or tracking, but would be interested to hear about the longer term management (if any) that people have implemented. I know @RCC recently mentioned he was feeling it a bit again.
On thing that jumped out at me on your note was the distances. My PT, who is experienced with PN patients, has insisted that I keep the saddle time low and very slowly start building it back up. He was clear that the measurement is saddle time, not miles.
He said start at 30 minutes, preferably outside, no more than every other day, ideally for a couple of weeks. Flat routes, no climbing. Keep cadence around 85 rpm, to minimize bouncing. As that gets comfortable, add 5 minutes. Repeat the cycle.
He emphasized the outdoor rides, as there’s more variability and the body moves more than on the trainer.
Given the 2 years of hell I went through, I’m listening and following his instruction. So far so good. My symptoms have changed a bit, in a good way – if there’s discomfort, I notice it immediately (wasn’t true before) so I can adjust my position. I may be a bit tired and sore that day, but it usually passes by the next day. If needed, I take an extra day off.
It’s been great to get back on the bike and I don’t want to lose that, so I’m staying diligent to my PTs instructions.
. I feel patience is key, both to not overdoing it too soon, but more importantly to not getting down (anxious) when there are setbacks. If this thread teaches anything it’s that recovery can take TIME and is typically non-linear. Stay positive through the troughs and don’t get discouraged if you have a bad day. Keep things as chill as possible—observe the pain but don’t fear it. Stretch, breathe, be kind to yourself.
).