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.
Thanks @Rumpus for reply. I will definitely read the book when it arrives and take it on board.
The PN is a peripheral nerve that CAN and DOES remylinate (unlike CNS ones). Nerves repair slowly over 3 months to 2 years so recovery and ongoing improvements are very realistic. A lot of repair happens between 3 and 9 months but continues to repair over 2 years.
It’s frustrating there is not more information on neuropraxia (irritation) of PN. The internet is heavily skewed towards PNE nerve damage and terrible outcomes. There really isn’t good research on neupraxia cases of PN when there should be as its hugely underestimated how
many people are going through this.
This thread follows more typical cases of PN that happen due to mechanical compression causing irritation that IS reversible for many people. Removing the compression, allowing the nerve to remylinate and strengthen over several months will correspond to recovery of functionality and symptoms.
Once the injury has healed, remaining pain may be caused by incomplete remylination (I don’t know why though), centralisation (meds helpful to promote neuroplasticity) and pain processing/mind body work.
I am about 75% there and seeing some quicker gains now as the nerve repairs. Symptoms have improved in last week. Leg and feet pain almost gone except if on feet for many hours. PN symptoms reduced to 0-2 and no longer bumping up post activity. Endurance has improved a lot. Feeling more like myself again. Optimistic I can recover fully in next few months.
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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.
@SexyCoolguy @cosgroveb @ValeCyclist @Dr_Alex_Harrison @PDXcyclist @pdworks.cc, anything to be mindful of if you’ve got the time to share?
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.
@MrBirchling @Rumpus great to hear your progress and wins on the bike. It’s good you have an expert to guide you with a pacing plan.
Looks like a lot of people have left this thread, which I will take as a good sign that people recover and move on with their lives.
I try to gain perspective that this is temporary and the body can heal. One of my family members broke their leg and it took months to heal. It was in a cast and everyone accepted it would take some time but the body would do its thing and repair the bone. He is back to full sports and routine now but it took 6 months. Nerves are the same, they take months to heal too but it’s more invisible. There is no cast, no expected timeline. I’m going off around 6 months for my case but accept it could be longer.
I can see improvements now week by week, only small but 2% each week adds up. Progress is compounding as I get stronger. No big flares for nearly 2 months and no small flares for over 2 weeks. Still fearful of flares, going backwards etc so not ticking the emotional reactivity/CNS stabilisation boxes yet. Have a cold this week which hasn’t helped and sleeping too much. When I get past this virus will push on with recovery.
I also agree about the saddle time. I had a couple of weeks of no cycling and then the past 2 days i’ve done 1.5 hours each. I make a point of standing up every now and again to stretch a bit and get off the sit bones. I feel slight aggravation today so it’ll be a run day instead of a bike day.
Good to hear that you’re back active @rcc and about progress generally @journey and @MrBirchling
Re saddle time, ive had mixed messages from the care team (saying that makes me feel like an NBA athlete or something 
). My sports med doc didn’t give any restrictions (though I truly think I was the one who told her what condition I suffered from rather than the other way around, largely thanks to this thread.)
My pelvic PT was more aligned with what you guys @MrBirchling and @RCC are saying, lower time than what I’ve done—she prescribed like 20 minutes and gradual build, so I about doubled that on the 10 mile ride and the 20 mile ride was not a gradual build. But she was also saying as of a few weeks ago that I could reasonably target Unbound (100 mile) at the beginning of June which obviously does not track (and which I will most decidedly be deferring).
My fitter/PT/coach (he’s not my actual coach, but you get the idea) said simply that getting back on the pedals is never a bad thing if the body is feeling right. (He also emphatically advised that I be deferring though.)
I took that combination and kinda came out with what I’ve done. I wanted to go long enough to retrain my brain that the body can do this and not to fear the saddle, but not blow things out. When I felt good for a few days after the 10 I just went out and did 20 without really planning it—it was a nice day, lakefront was beautiful, honeys was out, was feeling good, so I went with it. (But damn, my HR was way outta whack with my power!! Fitness has flown the coop.)
I get small waves where I’m aware of tightness and get a bit of a tingly feeling, but I think it was brought on more by doing my body weight resistance routine than by the riding. Experienced it last night but then went and played a soccer scrimmage with a bunch of 8 year olds (I’m a “coach” for both of my sons’ teams) and it actually made my body feel better (mind body for you?? I’m surprised my leg didn’t fall right off with some of the shots I took.)
Anyhooo, I’m growing more and more convinced, as has been discussed elsewhere on this forum, that the initial injury was SI joint impingement and over-tight psoas. Combined with stress/anxiety about life shit, excessive time on the trainer with a suboptimal saddle and bike fit, this lead to pelvic floor freaking out. When I’m doing stretching I can really feel things most prominently in my right hip and propagating to my right groin. So I think my split squats and abs work can sometimes cause a bit of strain in this department, activate the pain feedback loop, and bring on symptoms, even when a 20 mile ride had no impact. Still early days so I’ll keep ya’ll posted.
Damn I just wrote a lot
@Rumpus thats a positive update, sounds like symptoms have improved a lot.
My PT says same about SIJ involvement. Some PTs have dismissed this but if you look at anatomy it makes a lot of sense. My L5 nerve root irritation is also from here and everyone said was from spine. If not spine the next default is piriformis syndrome.
My L5 issue nearly resolved now, some feet tingling if on feet many hours. PN tingling reduced and some sensations of healing coming through. No longer going up after dynamic activity. About 80% there, working on recovery by end of June. Healing occurs in chunks that can be noticed over time eg every 2-4 weeks rather than daily changes.
There needs to be greater understanding of these issues. Otherwise nerve gets too sensitised from being irritated too long and makes journey back much more difficult.
Update 6/5 Feeling more back to normal, eating better, sleeping well and not excessively like I was. Interacting more with family and now have periods I don’t think about it. My body is still a bit weak but I am confident I can make rapid gains pretty soon. Am about 85% there now. Goal is to be 90-95% by end of May. Main goal is to get stronger to achieve this.
Update 10/5 Had massive weekend partying with friends and walking over 10km. No increased reaction to activity. Symptoms are fading although still nerve sensations, less intense and less painful. I can see end in sight and confident I can be nearly recovered by end of May (90%+) and fully recovered end of June. Back to lifting weights and sport (modified) in the last few days.
I’ve been good since correcting my saddle straightness and easing back into it. I’ve also been applying chamois cream more posterior.
Have you had a recent bike fit? Saddle height is probably a big factor. Maybe it would be worth going in for a Fizik custom saddle fit where they pressure map your perineum?