@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.
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
final
Update, just in case it’s helpful. IIRC, I had one terrible (unbelievably unbearable) flare-up of what I think was pudendal neuralgia, and I think I detailed it in this thread. I recall it lasting for maybe weeks but not months?
Since then, I think I’ve had one other tiny flare that lasted a couple days.
I’ve also had some “warning shots” that something in the same bodily region have fired over the proverbial bow. Little twinges or sharp zingers that remind me of that one horrendous flare I had. The warning shots are noticeable enough that I immediately stop or back off whatever I’m doing.
Here are the things that seem to be triggers, (sorry some are very, VERY obvious, but I’ll err on the side of comprehensiveness and accuracy regarding when I get a zinger because for those of you who have had longer term stints with this, or more recurrent issues, you deserve what little info may helpful and this seems like a rational crew of pragmatic folks that won’t over-limit their exercise out of fear. Anyway, here’s the list:
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Non-splitter saddles. If I feel a zinger and I happen to be stupidly risking riding a non-splitter saddle for some stupid reason, I get off the bike and do not look at it, touch it, or imagine riding on it ever again.
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Some particular valsalva scenarios and not others, in particular:
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Straining while on the toilet. Hemorrhoids usually are an earlier warning sign but sometimes pudendal neuralgia zing beats them to the punch.
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Heavy full squats. Especially pause squats. Especially full depth jump squats. (former bobsledder here… I just like doing them. But I listen carefully for any signals from down under and it’s always a full stop, workout over, when I feel anything)
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Stiff legged deadlift, when heavier.
That’s the list.
I’m a fortunate one, I think. My symptoms are very intermittent. I’m utterly religious about a “stop and do not pass go” approach if I feel even the slightest twinge from the pudendal region. I think I’m more just lucky (and exceedingly grateful because it’s awful).
Interesting observations.
I found the same - deadlifts, Cossack lunges fire it up. And so do the recommended stretches like happy baby.
I cannot look at my trainer (says the gal who used to ride Uber Pretzel on Zwift and round it out to a 100 miler cause of Ego). My $$$ saddle makes no difference, I can ride only heavily lubed up with lidocaine and then I have to pay back for it for days after the ride.
I think this is just how I am going to be from now, this is my new reality - my underparts burn. And I try to be stoic about it.
Quick update – continue with 2 steps forward and 1 step back. Been able to ride but must continue stretching. non-linearity of recovery is for real.
Also managed to do a 3 day regatta trimming headsails on a J70 which involves alot of relatively aggressive hiking (siting out over the side of the boat). Was very concerned about this and potential for flare-up, but the distraction sailing provided actually made me feel better (hello mind body).
Have become 100% convinced that at least a component of the acute injury for me was hip impingement. As I’ve said before, when I stretch I feel it mainly in my right groin, obturator internus, etc. Have added soft tissue work (foam roller, sitting on tennis ball) to work hip specifically. Interestingly, when I went to find hip mobilization exercises and stretches I found a yoga routine that, lo and behold, was almost EXACTLY what my pelvic PT prescribed. So I dont think its a huge stretch (no pun intended) to say hip = pelvis.
Could you share that routine? Is it something on the YouTubes?
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@LittleGardener You should really see a pelvic floor specialist. The basic issue is that nerves don’t stretch the way muscles do. You likely have some sort of nerve entrapment but the specialist will be better able to determine that.
I don’t disagree @JSampson that (a) you can’t stretch nerves, and (b) you should definitely consult medical professionals when suffering from this.
However, everything I’ve read and learned about this condition (set of conditions?) suggests that it is frequently an issue of muscular hypertonicity/imbalance, whether in the pelvic floor, hips, lower back, etc. So while it is true that you can’t stretch nerves, you certainly can relax muscles in the area that are causing nerve irritation. This is what the majority of the therapies are directed toward.
My pelvic PT also has me doing nerve “glides”, the idea there being to mobilize the nerves in the sheath.
@LittleGardener, try to stay positive. Rest, stretch, repeat. Listen to your body and don’t press too hard.
Well, one good thing I can say is that I suffer from this for 2 years now, but lately it got a lot better even to a point where I don’t think about it most of the time. And I didn’t do much lately, I guess time is also an important factor…. I can even get on the bike again and it is not worse after it.
But let see how it evolves in the next months.
Latest update. More clarity, some progress, more to come.
My symptoms over the past few months seem to be abdominal/digestive system related, but still affecting the bladder. Got appointments with a gastroenterologist. Colonoscopy was clean. Really increased fiber intake, with supplements, and added a laxative. Latest testing indicated I have pelvic floor dysfunction. Waiting for a referral to a physical therapist.
I’m hopeful for the first time in a while. Understanding a root cause is encouraging. The supplements are helping, to the point I only woke up 3x last night, the first time in over 3 years.
Fingers crossed but I feel like it’s finally heading in the right direction.
I owe an update. I remember when I first found this forum noting how the OG OPs were talking months to years recovery, and some would return after periods of 6+ months, saying that they had experienced flares, etc. Again this turns out to be spot on with my experience (as this thread has tended to be). I got back to riding 40 to 50 miles with very little symptoms ever. Then got Covid. Got lazy about stretching, foam rolling, pressure point release, and boom. Once again I feel like it started in my hip and, as I stretch, that’s where I feel at the most. I’d say the upshot is: don’t get lazy with stretching! Getting better again now. Paused on the bike and back in the recovery/maintenance routine. I think I’ll just always need to do the stretching routine moving forward, which is probably a good thing for a number of reasons.
I don’t know if this is worth posting but I am lost and don’t know where to go for help on this so its worth a shot.
I was training 10 to 15 hours a week until late November 2025 I started to get this aching sensation right at the top of my hamstring almost on the sit bone but its more general than acute. Shortly after I got an anal fissure ( I have Crohns disease ) and I stopped cycling for 5 weeks. Its confusing because the fissure and aching basically presented at the same time and its hard to say if they are linked. Over the following 5 weeks following self care the fissure seemed to heal well and the aching subsided. I went back to specialist who said It was healed and I could resume exercise with caution.
I rode my a bike several times and felt ok for short duration but the aching came back. Visually no change to the fissure, externally from what I could see. I should say I never had typical fissure pain, with bowel motions etc. Stopped riding and all exercise at this point.
Early Feb I was feeling symptom free and tried getting back into some running. I developed a feeling around my tail bone I can only describe as tenderness. Very subtle initially and I didn’t think much of it. After running one particular morning it really worsened through out the day and became quite intense. I had to go to urgent care and was prescribed endone to relieve that pain. Thankfully by the next morning it had settled. I stopped all activity again and this tail bone pain went away eventually.
Again feeling good and symptom free again and thinking running caused my tail bone issue I started doing some short rides on my bike. It was going well so I gradually increased frequency duration until I was able ride around 7 hours a week. After 2 weeks of this the initial aching in the top of my hamstring returned but it was more subtle and not really uncomfortable to ride with. Then all of sudden things started feeling weird. The best way I can describe it as the skin more so on my scrotum and groin on the right side felt really irritated almost as though it was chaffed or raw except visually the skin was fine. Hamstring ache also worsened. Again I stopped.
Start of March I saw specialist again and they confirmed that the fissure was not completely healed internally so there’s that. They ordered MRI of pelvis, which I recently had and am awaiting follow up for results.
Shortly after this appointment. I had tingling and slight numbness in my right foot that persisted for around seven weeks but has now gone thankfully. I don’t know if this is related but again like all my symptoms it was on my right side.
I also saw a physio who determine I had high hamstring tendinitis. It did seem plausible as the ache in my hamstring does get worse throughout the day sitting at my desk working. I followed the strength exercises for a few weeks but felt it eventually made symptoms worse. My gut feeling is it is a nerve issue.
It was early March that I started doing research to look for answers and learnt about pudendal nerve irritation / pudendal nuralgia via this thread. Some of my symptoms did line up but a lot I didn’t have. For example I have never had numbness or tingling no pain in the penis etc. Maybe at most when I have tried to ride I have noticed some slight aching in the testicles that lasted half a day or so. I did also notice during periods of trying to ride I started noticing my perineum area when sitting. Didn’t feel like sitting on a golf ball etc that I have heard described more like the perineum was slightly swollen. Its been more a general feeling of something not being right down there along with the aching in the top of hamstring. I should add the aching in the hamstring area isn’t present most mornings and worsens typically throughout the day. I sit at work and have been using a donut cushion. I got a standing desk last week and it seems to have helped slightly alternating between sitting and standing. Now having read a lot of this thread its possible that I have just been hypersensitive to anything going on down there. I’ve been fairly stressed and slightly depressed having lost my outlet and my love of riding so I have to consider that as well.
I saw a physio based off advice here in this thread. However I live in a small town and its not easy to see a PT who specializes in this area. After describing my symptoms, he believes I have high hamstring tendinopathy. None of the tests designed to exacerbate symptoms did anything on me so I had my doubts. I decided to follow his advice of a strength routine for the symptoms but after approx 2 weeks of following this strictly I felt the aching became worse. I am now at a bit of a loss as to what I am dealing with.
In summary day to day If I dont ride I am really just dealing with this aching in my hamstring / sit bone its more general than acute. If I do ride some of the other symptoms mentioned that fall more in line with pudendal nerve stuff come on. I guess I am hoping that anyone with knowledge and experience on this can offer me any thoughts or advice. Yes I am going to take any medical advise on the internet with a grain of salt. As mentioned due to my location its been really hard getting professional support. Anyone I have seen and mentioned pudendal nerve to doesnt even know what I am talking about. I am just searching for any help I can get at this point. Thank you if you took the time to read this and my heart goes out to anyone dealing with this crap.
I feel you.
Dealing with it for years and I am progressing very slow. Your story is almost identical as mine.
I did all doctors in the down there area and had a nerve block (twice) on both sides and pelvic floor therapy (dry needling, very funny down there #not) seems to work. I didn’t had sexual problems, only anal, groin and adductors. It’s a bitch of an injury.
I also believe stress is a big, if not THE most important factor in this. But it’s a down spiral. You can’t do what you love to do and you are even more stressed about it. The only internet advice here would be: get help. It’s not resolving overnight without help. I also read a lot but in the end, save your time because everybody is different and it get’s in your head.
I was Mr Birchling but changed accounts because my TR sub is idle because of “all of this”.
Still not over my symptoms but here’s what I’ve learned so far. I’m not currently riding, mostly due to symptoms. I got to the point where the pain is managed but not gone
The Effexor I was using to manage the pain was also wrecking my gut, which was causing a bit of a spiral. For now, no NSAIDs and I’ve been off Effexor for months. Diagnosed with gastritis and being treated for that.
MRI was finally performed. No noticeable nerve impingement. MRI observed hamstring tendinosis. Added PT to help address hamstring issues.
Got referred to a different urologist to start down a new path on the chronic pelvic pain. First try is steroids to see if inflammation is a factor. Initial response is really good — it seems pretty clear that tamping down inflammation is helping. Symptoms are getting a bit clearer but who knows on next steps.
So, do I/did I have PN? Who knows. The Effexor and gut issues definitely sidetracked me for a year. Feeling a glimmer of optimism but we’ll see.
I am hearing you. I often find myself noticing something down there and then questioning if I have always had similar feelings and I am just now fixating on it because I have read all this stuff on the internet. It definitely gets in your head. For me I am just not convinced that its a Pudendal nerve issue. Too much doesn’t line up but I also cant rule it out. Interestingly yesterday after making my initial post I was using a trigger point ball on my hamstring. I used it just above the knee which I haven’t really done before as the pain is hight up near the sit bone. It gave me instant relief and its the first thing I have done out of many massage / stretching etc etc. that’s had a direct impact on the discomfort. I cant help but think now maybe my problems are my hamstring and possible tendon issues. I am going to force myself to stay off the bike now for an extended period, unfortunately the thing I love is causing me too much stress and worry that its not worth doing for the time being. I am determined to get back to consistent training though and return to the level I was at. All the best
Sounds like a bumpy road mate. You have my sympathy that’s for sure. All the best for a full recovery.
Hi @dan1989 sorry to hear about your problems, I have experienced similar high hamstring pain like you describe and also more classic pudendal nerve issues, difficulty passing urine, waking up with an urge to urinate, genital pain.
I had a bikefit in June 2025 at my local (35 miles away) bike fitter, they only offered specialized saddles and the best they could offer was still too painful to bear, at least they were gracious enough to offer a full refund for the saddle. In December 2026 I made a 55 mile drive to another fitter who offered a much wider choice of saddles I ended up with an Ergon womens saddle which offers comfort like I had never known, it fits like a glove.
With my nerve issues sorted let me tell you about my tendinopathy
I suspect my proximal hamstring tendinopathy (PHT) was caused by sitting on a hard chair in my home office and an incorrectly fitting bicycle saddle ( Specialized Power 155) . It first flared up summer 2024, it has been so bad that sitting on any surface was painful. I was unable to ride a bicycle for 18 months, strangely I’ve been able to continue running the whole time.
Physios have told me that tendinopathies need to be loaded to rehabilitate and make the structural changes in the tendon required to function without pain. Every medical professional I’ve seen has reiterated that the worst thing to do with a tendinopathy is rest.
Things that have reduced the pain and enabled me to be more active.
The exercises given to me by the NHS Physio at my local GP practice.
Heavy weights, I started in the gym later summer 2025, focusing on machines that load the tendon, in my case leg press and hamstring curls in the 5 rep range.
My GP referred me to the spinal clinic at our nearest hospital on the basis that the pain is in my pelvic area and the waiting list was much shorter than at other departments. My appointment came through within a few months and the Doctor I saw confirmed the PHT diagnosis and was referred to the physio clinic for a 4 week programme of ESWT ( extra corporeal shockwave therapy). that was in Jan-Feb earlier this year, soreness increased immediately after the sessions and settled down after 2-3 days. After the last session the pain was as bad as it had been but it must have been what my hamstring needed because 3 months later I’m back to my pre 2024 activity levels.