SexyCoolguy - good to see you back here. I think many of us on this thread would love to get an update if you have the time.
Hey @Dtietz, unfortunately PN/Cyclists Syndrome and any other pelvic floor disorder from cycling really is a medical issue and I would strongly suggest you find a medical provider, pelvic floor physical therapist, or someone to help even though it can be difficult to find providers who are familiar.
I’m not comfortable giving out advice, personally. I don’t think exercises were very effective for me on their own, anyways, as I had central neuropathic pain and the most effective treatment for me was gabapentin (although I still believe in PT, yoga, and every other part of my multi-modal treatment plan!)
Good luck!
I realize I’m far overdue on an update to my situation. Here’s a small novel 
Initial Problem
So, Its been about a year and 5 months or so since I was first experiencing some extreme discomfort and what can only be described as an intense tightness in the pudendal area. For me, it tended to be more on might right side, but when it was really enflamed the side became irrelevant. I dealt with the discomfort for a couple months and was taking a lot more time off the bike assuming it would go away on it’s own in some way, but that definitely wasn’t happening. Figuring time off the bike was the solution, I switched to running, but honestly when the nerves in that area are angry, any activity at all was almost too much. I remember having a day where I was having a hard time walking the dog. That was around the time I wrote my initial post.
Symptoms
Symptoms included: numbness (not just riding, but all the time), tightness (the muscles were so tight all the time that it felt like I was sitting on a golf-ball at certain times, and a sharp tight pain that would run down the inside of my right groin area (this was the most persistent symptom throughout this whole process.
Treatment
After talking to some awesome people on this forum as well as doing some research. I did the usual stuff, I went to a doctor and confirmed my prostate was okie dokie, as well as urologist to make sure things were where they should be (I consider myself lucky that I didn’t have any issues without going to the bathroom, or other functions that I would like not to stop functioning).
The next thing I did was start doing twice-a-week visits to a pelvic-floor PT. When the symptoms were at their worst, this was key. Although I’m a little dubious about this treatment actually curing the cause of the affliction, they were imperative in getting the nerve reactions under control. This involved some initially very awkward treatments where they are putting their fingers in places you usually like to keep to yourself. I don’t completely understand the methodology of all of it, but all I can say is, it works. In addition to the invasive manual treatment from the therapist, they also advices some different kinds of stretching that focused on the lower abdomen, piriformis, hamstrings, glutes etc. Lastly there were exercises that focused on releasing tension of pretty much everything from your chest to your knees. It takes some practice, but you need to learn how to “relax” down thing. I realize that I have a tendency to “clench” in my pelvic area as well as my abdominals, pretty much all the time, which might’ve had a big contributing factor to the initial problem.
Starting Recovery
So I did the PT thing for a couple months and followed the stretching and relaxation exercises. Looking at my calendar on TrainerRoad, I even started doing a couple rides a week in mid August 2019, but nothing more than 60 minutes. I remember having a lot of fits and starts. I’d be good for a day or two and then the symptoms would flare up and I’d be off the bike for another couple days. I quickly realized I had to make a “never consecutive days” rule for myself. I needed at least a day between every ride.
In late September 2019 I started a low volume plan. I was able to keep at it, I remember that i was at my absolute max as far as activity tolerance. The 90 minute rides were the absolutely longest I would do, and I’d often spend the rest of that day feeling pretty tight and uncomfortable. All the while I was keeping up with stretching, and breaking up my workouts with some running and elliptical.
So this is where things get get a little interesting. So I was going for a run one day at lunch at I was stepping down a slight slope and got sharp pain in my left glute area as well as my lower back. Being the genius I am, I ran the rest of the run back, and then ended up almost not being about to walk for about a week afterwards. After consulting both the pelvic floor PT ( I just happened to still be seeing them at the time ), as well as a regular PT. It appeared that my pelvis was quite a bit out of wack. To be more specific there was a rotation in it that led to my leg length seeming like there was more of discrepancy than there was. In the case of the running, this cause an injury to my SI joint, but I wonder if this asymmetry also led to exacerbating my symptoms on the bike. So I ended up adding yet another set of stretching that I do that are expressly to force my pelvis back into symmetry after every workout. When I first started doing them, I could actually feel a “pop” in my inner thighs when things shifted back into position.
So with my newfound knowledge of my pelvic asymmetry. I continued doing a low-volume plan until mid-April of this year. This is where I was really starting to feel like things were improving. and I switched to a mid-volume plan, and I started doing my workouts in Zwift (mostly for visual interest during lock-down). I’ve been able to stick with it while managing my symptoms since then, and have even done some epic indoor rides lasting over 6 hours on the trainer.
I attribute this to strict stretching routine after EVERY workout, even if it’s not a bike ride. Also, if I’m questioning whether or not I need a day off the bike due to pelvic tightness, the answer is always YES. It sucks sometimes, because you really want to ride, and achieve your goals, but it’s just not worth it.
Takeaways
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Pelvic floor Physical Therapist. Just do it, it’s weird, it’s awkward, but they know what they’re doing, and they can help you with initial symptoms.
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Bike fits, saddles, bibs, etc early on. These might help, and it might be worth getting a bike fit early on to make make sure that there is nothing egregious going on, but don’t spend too much time here. I got two bike fits and went through about 6 or 7 saddles. The bottom line is, even if you somehow magically get your bike into the perfect position and get the best possible saddle, it won’t “feel” right until your symptoms are under control. So spending too much time here is just going to drive you crazy and cost you lots of money. Once your symptoms are under control, you can totally feel when the bike saddle or position aren’t quite right or are making things worth, that the point to start dialing things in. Also I found bike fitters not super helpful because most have never heard of this condition, and might put you in the perfect riding position that’s destroying your undercarriage. In the end, I ended up with an Selle SMP saddle that I’m still not sure is perfect, but it’s working for me for now. I also tried ISM, Infinity, Selle Italia, Specialized, Fizik…
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Do the work. Do the stretching, do the relaxation exercises. It sucks, it adds about 20 minutes to the end of every workout, but it works.
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Take your time, this is hardest part. Recovery for this kind of thing takes FOREVER. Even as I write this, I can feel a little bit of tightness down in “that” area, and I’m thinking I’ll probably kick today’s workout to tomorrow. The worse thing you can do is rush things, and send yourself back down a hole where you’re laying on the couch lamenting that you can’t exercise for another week.
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Keep positive. I was probably at my most depressed in July of 2019 when I was just laying there watching my fitness going away, wondering if I’d ever get it back. Not only did I get it back, but I’m the strongest I’ve ever been. I’m actually looking forward to my FTP test next week because I feel like I’m going to crush it.
My Routine (take this for what it is, these are the things that are working for ME, some might be doing nothing for me, some might be redundant, but it’s working and I’m doing them :). Also, everyone’s medical situation, and flexibility are different, so I’m not suggesting anyone else do what I’m doing.
Stretches
Note: some of these things might be better served at the beginning of a workout (particular the hip symmetry stuff), but my routine is to always workout first and stretch after.
Workout ( Running, cycling, rowing, strength )
I do one of these things, and bend over each leg. I feel it more in my lower back, but it’s all good.
These are my jam, I hang out here for a while on each side, and I push off the floor and stretch my hip flexors at the same time.
I do a lot of these, I also add a movement to each side where I bring my leg up on one side opened up to the floor and stretch out my lower ab muscles. I usually come back into “childs pose” after to give my back a little break.
These feel pretty good, and I do a version of it with the knee down if I’m feeling lazy, If you sit up and do a back bend it also stretches out your hip flexors nicely.
On my way to doing this I pull my leg into my chest, you’ll know when you’re doing it right because it you feel it right in your butt. This final position also (if you’re like me) produces some awesome popping sounds in your back.
Calves, because before all this I used to get plantar fasciitis if I didn’t stretch the heck out of them.
Quads/hip flexors, because we’re cyclists and yay
Hamstrings, there is some debate over whether or not touching your toes is the best for your hamstrings, but I always use it as a measure of my flexibility.
For hips/pelvic symmetry
This one is all about activation and release of your hamstrings, you lay next to a door jam, or in my case a post in my basement so you can pretty much lay with your butt almost up again the surface, and your other side straight. Then push your heel into the door jam/post with a good amount of force, then release. You can pull your leg towards your in-between and get a nice hamstring stretch, but the activation and release is the important part. I do this a few times on each side.
Stretches the inner thigh, and at least for me, an area that always feels light when my nerves are freaking out
IT band and piriformis
Makes the hips feel pretty good and stretches that inner thigh some more
i do a variation of this where i actually put the one foot down flat on the floor and pull the leg so the knee goes to the outside of my chest giving a strong stretch to the hip. I hold this for a 10-count, and then do the other-side. I do this a few times.
More of these, this time it’s more about pushing your hips down to the ground. Similar to the previous exercise, I hold for 10 seconds then I do a quick “down dog” and then go back. I do this several times as well.
This one is fun, you get a yoga block and a yoga strap, and tie the strap tight around your knees (can’t find a picture, but imagine both pictures as the same time). The goal is to squeeze the block as hard as you can for a few seconds, and then try to open your legs as hard as you can. Your legs will look like they aren’t moving much, but you’re pushing hard. If your hips are out of alignment, you might feel a pop when you squeeze the block, that’s the sound of it going back where it’s supposed to be.
Lastly, just lay there and take huge belly breaths for 5 minutes. This one is easy to want to skip when you just want to get on with your day and be done already, but it’s really helpful. You’re forcing yourself to let the muscles in your pelvis relax, additionally the big belly breathes (and I mean BIG, like push it out) will actually stretch and release those muscles that you can rarely even feel down these. I actually try to do this occasionally throughout the day, or even in best before I go to sleep if I’m feeling “tense” down there.
These seem like a lot, but once I had them in a routine, I can get through the whole deal in about 20 minutes.
So that’s that. I usually ride my bike 4 days a week, row and do light strength stuff a couple days a week, and take one day completely off. I try to keep my core, and inner and outer thighs strong to stabilize my hips with leg raises, butterflys, side planks, forearm planks, a couple times a week.
I hope this was at least a little helpful and maybe gave some of you a couple ideas of things to try. I will say, I’m not completely out of the woods, and maybe I never will be, but I feel like I figured out a way to manage things that has worked for me. You guys rock, and I hope to see you all on the roads chasing watts in no time :).
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I think I mentioned before that I’ve been back in the saddle since June. Well, I’m averaging 7 hours a week now after a slow ramp. Now for the most important update of all:
I’m feeling so confident about my recovery that I signed up for a year of TrainerRoad! It feels good to be back.
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Phenomenal update! I love all the detail and the stretch routine. I have to say, I’ve been to pelvic PT for five weeks now and I always look forward to learning some new stretches. Stretching and yoga are helping in so many ways.
I also wanted to provide a brief update and say that five weeks into therapy, I feel like a few of you have mentioned earlier three steps forward, two steps backwards - and as Dr. Weiss (noticed his mention on data driven cyclist above) also stated in his book - it’s like peeling an onion. I’ve greatly reduced my major issues - finally I can sit down for a good thirty minutes and I can now sleep on my back again! Considering where I was when I started PT this is just huge. Additionally a lot of the sharp electric pain in the groin has dissipated. Yet, with all of that, I now notice a dull and almost constant buzz in the groin while I’m doing anything active. So I wonder if all the mega issues just masked this dull pain or did this materialize along the way? Either way, it is definitely a slow roll and not at all linear. My PT still has me on light exercise only (walking and no weight workouts) which is a huge bummer, but with the help of this thread it’s clear that taking it slow is what is required. I’m editing this to add that my PT has advised to relax the stretching when the nerves begin to tingle. When you feel the tingling, she suggests backing off the stretches to just below that point. Evidently “working through” nerve pain will only make them more angry.
As always, I appreciate everyone for sharing their stories and I wish everyone continued success on their road back to the maillot jaune!
Hey guys,
First of all, thank you Guys for all the responses! It’s awesome that this thread exists and I really love that we talk about this and not make it a taboo. The problem obviously exist and there should be a standardised path to recovery.
My story is very short and simple but might be related and I’m curious what you think.
This season on a road was my biggest one ever. Unfortunately, I think that something bad is starting to happen. I don’t have any sharp pain flare-ups like you guys say but for some time I think that my penis is constantly a little numb (not just during right or short after). It’s not like I’m having ED or something, but I really think that my erection is 5-10% worse and feeling in that area is worse too. It’s VERY concerning because obviously I don’t want to this to become worse!
I’ve had a bike fit so it seems that my position is OK. I’ve played with different saddles too. However, after longer rides I feel that my perineal area hmm… maybe not hurts but there’s an obvious feeling that it was under some stress.
Do you think it might be very a tiny level of pudental neuralgia? Have this started like this in your case? I’m still far from the stage where things are very bad, right now it’s just concerning. I’d love to know how you feel about. Haven’t been to PT yet, doctors obviously don’t help much.
I don’t have any sharp pain flare-ups like you guys say
It didn’t start with sharp pain flare-ups. It built over about 9 months for me before it really became sharp flare-ups and burning pain 24/7. I think for most folks, PN starts slow and builds which makes it so confusing and difficult to get a diagnosis. If your doctor is clueless keep trying different urologists until you find one who has heard of PN. It sounds like you could have it, but you need to talk to a medical expert who can make an accurate diagnosis.
I would stop riding, to be honest, until you start to see a reduction in symptoms. Nerve damage can become permanent. Your saddle very likely does not fit you. Beyond that, you need a PT with pelvic floor expertise, and a doctor or two in your corner (urologist or gynecologist, or maybe neurologist or anesthesiologist - I have a urologist and an anesthesiologist on my care team) .
I agree with @cosgroveb.
The symptoms you describe are very similar to how things started for me. Lingering numbness, and just generally feeling “weird” down there.
You have the benefit of catching it before it gets REALLY bad. So I’d see a PT and give some time for things to get back to normal down there. Then I’d ease back into it and just be really mindful of how things are feeling while you’re riding, and adjust the saddle or swap it with different kinds that differ in how they interact with your sit bones. For me a tiny adjustment in tilt/height/fore-aft can have huge implications for how I feel during and after the ride.
But to reiterate, you really can’t judge what is/isn’t working until your symptoms calm down. Otherwise, everything makes them worse, even if your fit is perfect.
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I concur with Cosgroveb and SexyCoolguy. Listen to your body - I sure wish I would have. And definitely find a therapist and/or doctor very well versed in the pelvic floor - they’ll help you get blood and oxygen flowing to the right areas and give you a better opinion on what exercise you should/should not be doing.
Hi all
Real appreciate all the comments and advice given on this thread as it’s so similar to what I’ve experienced.
Like many I was diagnosed with prostatitis and given loads of antibiotics which didn’t help.
Went to see a urologist who did a load of scans that didn’t really show up anything.
Finally stumbled upon this thread.
Been seeing a pelvic physio which has helped along with the breathing and stretching exercises. As a result pain has dropped off noticeably and I’m keen to try a bit of cycling.
I know every is different but any recommendations for good saddles that help with this ?
I think the key is finding the saddle that hits your sit bones at just the right angle so as to support you without causing irritation ( easier said than done ). This also depends on what riding position you spend the most time in. Personally, I have slightly less issue in the drops than I do in the hoods, when I’m tilted more to the front of my sit bones. As far as specific saddles, I’d try ISM and Selle SMP saddles as their approach to where your pelvis is supported is less traditional and might get you off the parts that are causing your symptoms to be triggered. Both take a little bit of a body adaptation period, as well as a decent amount of adjustment to get in the right position.
Nice one. You are right it’s trial and error at the minute. I’ve got poor flexibility so prefer the hoods personally. Any particular ISM saddle you would recommend for a roadie? I thought they were for mainly TT bikes?
Infinity Saddle is also worth a look. It works by cradling your pelvis outside your sit bones which seems really safe for the pudendal nerve and pelvic musculature.
I’ve been riding it since June. Put in a 3hr ride yesterday and this is already a 10.5hr week!
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I tried that one as well. The only problem I had was that I have particularly wide sit bones and found that they just barely touched the inside of the seat and actually made things worse for me. But I’m a little wider than average.
As far as ISM, I tried the PL 1.1 and the PN 3.1. Out of those two I’d have to say the PN model was a bit better as it locks your position in a bit better, the PL is designed to allow you to shift position a little easier for climbing and such, but for our condition I think it’s better to find the sweet spot on the saddle and stay there.
All that being said, I’m currently running an Selle SMP and I feel like that one is the closest to perfect for me. It locks my pelvis in place but allows for support both in the front and underneath depending on how low I want to get in the cockpit.
@SexyCoolguy @cosgroveb @Klev thanks guys for your suggestions! I’m gonna take a proper care of it, I’m already having a visit to urologist, if USG is fine then I’ll go straight to PT. I also started stretching hip flexors and working on my ABS and glutes strength. Also ordered shorter stem (bike fitter said I could have it 1cm shorter) and will play with different saddles.
@SexyCoolguy I have a question regarding Selle SMP. I also have a saddle from them too, and it was very comfortable however I’m thinking that it actually could make my condition worse. However, I’ve read some info about leveling SMP saddles and it turns out that if you put a straight line between two highest points, it actually shouldn’t be 0 degrees, but there should be some downward tilt there. What’s the angle you’re having?
Currently, i have it where it’s level at the two highest points, but I find that I end up changing the angle of the seat depending on the fore-aft placement of the seat to get my sit bones resting on the right spot. If i tilt too far forward, often feel like the back of my sitbones are getting irritated. If I tilt too far back, I can get too much pressure on the front of my sit bones and some numbness. It’s definitely a balancing act. At first I went with the Avant, because I just wanted something with a nice big seating area with padding. That worked great until my symptoms calmed down, but I realized recently that it’s just too wide for me. Now I have the Dynamic which fits me much better, but the lack of padding makes anything more than 90 minutes a bit rough. I think my sweet spot is going to be the Drakon, which has the same shape as the Dynamic but with more padding…or I’m just going to give up and get a banana bike with a basket and training wheels…
So I’m just over two months into pelvic PT. Been making progress, but right now I find myself in the middle of a pretty nasty flare. I seem to get minor flares every now and then that I can usually relax, stretch and breath through. But this one has been steady for a few days. Muscles tense up quickly and I find myself urinating often again.
Looking back, many of you have said that you had flares as well, but no one seemed to get too deep into the subject.
I’m super happy because I’m going to pt tomorrow and I’m hoping that the timing helps lead to some new flare coping strategies.
I am curious though, how long do/did your flares last, were they always the same, did the coping mechanism you came up with always help?
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After my two months of pelvic PT I did make a lot of progress and I tried to get back on the bike a bunch but had a lot of flare-ups. The solution for the flare ups for me? Quit cycling for awhile. I’m not sure if you are cycling right now. Maybe you aren’t? In any case, everyone is going to be different but I was off the bike for a year.
That wasn’t enough on it’s own, though. Honestly, I think in most cases in PN there is nerve injury and central nervous sensitivity involved beyond just muscle tension and things PT can help. A few months after PT and rest I was still getting flare ups and my doctor put me on Gabapentin. Neuropathic meds made an immediate improvement and the flareups subsided over the course of the next 6 months until I could start riding again.
Thanks for the info. My doc has a few different drugs that she’s considering - but she wants to wait a few more months to see where we can get to naturally.
No cycling here - taking everything very lightly. I’m basically just walking, stretching and doing yoga for exercise. Seems like I get a minor flare every week, but this one is definitely different.
That’s good to hear, @Klev. It’s good to be conservative with drugs. “Time heals all wounds.” Although I feel like gabapentin was right for me and wish I had started sooner, I can’t be sure that time isn’t what really healed me. Good luck. I don’t have any specific insights for flare-ups except for one thing… The only thing that consistently still causes minor flare-ups for me is sexual activity, orgasms specifically. I have no shame and am fine sharing this, sorry if it’s TMI. The PN was awkward timing for me as it was the same time my wife and I decided it was time in our lives to get pregnant so suddenly my husbandly duties were really painful. Any chance that’s also a factor for you?