Resolving Cyclist Saddle Discomfort Through a Comprehensive Physio Bike Fit

Understanding How to Manage Saddle Pain and Numbness in a 28-Year-Old Endurance Cyclist

A 28 year-old cyclist, presents with specific symptoms of numbness and saddle sores after a multi day bike packing trip last year. She is normally fit and well but in the last 6 months has been unable to ride her bike even to work due to the continued symptoms.

She previously sort advise from a specialist doctor who advised her peroneal nerve is likely damaged and if the symptoms don't resolve she is likely to need surgery. She then came to me to see how I could help by offering both a physio assessment and a bike fit.

Jake assessing hip range of movement to see what the client can achieve on the bike.

Physiotherapy Initial Assessment

Carrying out a leg length test I found the right leg was longer than the right by 6mm. This discrepancy resulted in her standing posture where the left iliac crest appeared higher than the right.

Movement Analysis

During squatting, significant over-pronation of the left foot was observed compared to the right. This imbalance is exacerbated during lunges and single-leg squats.

Physiotherapy Assessment and Tests

Pelvis and Lumbar Spine Assessment

She had good movement in her Sacro Iliac joints and lumbar spine which was important to understand and rule out being a cause of her saddle discomfort.

Muscle Strength and Flexibility Tests

Some weakness in her gluts and hip abductors but other wise 5/5 power in legs and arms. functional core strength Good flexibility in her hamstrings.

Hip Joints

Full range of movement in her hips and no pain reported, as would be expected with someone who is 28 and no history of traumatic injuries.

Feet Detailed Assessment

Measuring her feet I found the right was longer than the left and she had low arches. her feet were wider than her cycling shoes with evidence of big toe deviation and bunions forming. Important to resolve to make her more stable when pedalling but also to avoid worsening symptoms and potentially surgery.

I fitted her to a pair of Lake wide fitting shoes with Sidas medium arch inner soles. Both allowed her feet to expand into the shoe without restriction and stopped her feet from over pronating.

Exercise Plan

I prescribed a tailored strength program targeting glut and hip abductor strength. The aim was to make her more efficient when pedalling as I suspected her weak hip abductors were playing a part in the lack stability in her feet.

Bike Fit - Initial Observations

Assessing her on the bike fit, it became clear that the saddle was too narrow and lacked any cut out. It was also angled nose down 4 degrees.

Her saddle was 20mm to high making her rock side to side on the saddle and loading her sit bones excessively.

First Saddle Pressure Mapping Test showing loading of peroneal nerve

Saddle Pressure Mapping Assessment

It was obvious she needed a cut out saddle but finding the correct one for her pelvic anatomy and one that would offer no loading onto her peroneal nerve was a challenge.

The initial pressure mapping recordings revealed asymmetry in her sit bones with the left loading more than the right due to the leg length difference previously found in the physio assessment. This was also confirmed with the right knee tracking out at the top of the pedal stroke and the left knee over extending.

Pelvis Model Demonstrating Client's area of Peroneal Loading

Saddle pressure mapping showing with the first test saddle found the peroneal nerve was still loaded and at risk.

Saddle Pressure mapping of the Sella Italia saddle with a full cut out and improved flexibility through stopped any peroneal loading.

Changes to Bike Setup

The saddle height was adjusted down by 20mm to enhance hip mobility and facilitate proper hamstring engagement. The saddle angle and for/aft position was also modified to open up the hips. Additionally, I extended and lowered the handlebar stem to reduce her very up right position and improve her pelvic angle. A shim was placed under the right cleat to improve symmetry between the left and right sit bones, as evidenced by the saddle pressure mapping retest.

Finally I fitted a full cut out Sella Italia saddle which matched her pelvic width and stopped any loading into her peroneal nerve.

Follow-up Appointment

During the follow-up, she reported no peroneal numbness and no pain in her sit bones. She is now able train properly for her next endurance event which required riding 4 to 6 hour rides 3 times a week.

I also retested her glut and hip abductor strength which are both 5/5. This has allowed her to improve her pedalling technique and posture on the bike further after the initial bike fit adjustments.

Get In Touch

Contact Jake at Physio Fit Bristol to find out how I can help you ride pain free with a bike fit tailored to your symptoms and cycling goals.