Why Do I Get Pain In My Pelvis When I Ride My Bike?

This article has been written for all the female cyclists out there who may not feel comfortable talking about their “issues” in a bike shop, or whose concerns have been pushed aside by their other halves (we’re not blaming them, they just don’t understand what a problem it can be!).
If you really want to know why you are getting these sores, pains or loss of sensations then a basic knowledge of anatomy is essential.

Anatomy

The bones…

skeletal_pelvis-pubis-svg

Lets start at the pelvis. The pelvis consists of:

1. Sacrum
2. Ilium
3. Ischium (pointy bit is the ischial tuberosity aka your sit bone)
4. Pubic bone
5. Pubic symphysis
6. Acetabulum
7. Foreamen obturanum
8. Coccyx aka the tailbone

Normally a male’s pelvis is “narrower” than a female’s. Please note the images below which show the typical variance in ischial tuberosity width. This can have some relevance when selecting a saddle.

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The joints…

Within the pelvis we have three main joints:
1. The sacroiliac joint x 2 – this is where the sacrum joins onto the pelvic bone
2. Pubic symphysis – where the pelvic bones join at the front
3. There is also the lumbosacral joint which is where the spine meets the pelvis. This has relevance as a lack of flexibility in the lumbar spine can impact directly on pelvic pain, and this what saddle might be the most suitable.

The nerves…

vulva

The nerves run near a lot of soft tissues within our pelvis and can thus be vulnerable to compression, especially when we have mobility issues within the lumbopelvic region. The main nerve we are interested in is the pudendal nerve.

The soft tissue…

There are a lot of muscles around the pelvis, too many to talk about in this article really. The pelvic floor muscles act as the “hammock” of the pelvis and can be a contributor and cause of some pain.

We also have a lot of other soft tissue structures within the pelvis such as the labia and perineum, which can vary greatly amongst women. In some extreme cases professional cyclists have required surgical treatment for these structures as they have been poorly managed conservatively.

To quote Cobb Cycling;

“The women’s sexual anatomy, the vulva, labia, and clitoris in particular, make up the women’s soft tissue that cause the most concerns and discomfort for female riders. The vulva and labia are the outer exposed soft tissue areas around the opening of the vagina. Because women’s sexual anatomy is lower in the pelvic region, and cannot be “adjusted” like men’s sexual anatomy, finding comfort can be more difficult on a bike saddle. Putting direct pressure on any of this soft tissue area can soon lead to pain, unhappiness, and short bike rides”.
As you can see there are many sources of pain, bony, soft tissue, neural or in the form of saddle sores.

Biomechanics

In addition to looking at what anatomical structures can be a source of pain, it is also useful to think about biomechanics.

Biomechanics basically refers to the structure and function of our body. The co-ordination of everything.

In an ideal world to optimise your comfort on the bike we would want:
1. Relatively good flexibility of the lumbar spine
2. Ability to maintain a good (slight anterior or neutral tilt if possible) pelvic tilt on the bike
3. Relatively good hip flexibility
4. Sufficient core strength to maintain the position held on the bicycle

If we are lacking one or several of these then our ability to maintain a pain free position may be affected – and we may need to think about changing some of the components on the bike.

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Having said all this, you must be thinking, what should I be thinking about to improve my comfort?
We have gone into detail here on a previous blog, but essentially things to think about are:

1. Sit bone (ischial tuberosity width) and saddle width – one school of thought is to find a saddle that bests supports your sit bones. This is certainly one thing to think about, but it depends on your riding position and where you load the saddle. If you have and can tolerate an aggressive position then you may not need something so wide at the rear, and the shape of the saddle at the front will be more important.
2. Saddle shape – some saddles are flat, others have a camber, some have a cutout and others are designed to be set up with a negative angle. Cervelo have a great guide to identifying the different kind of saddles here.
3. Do you need a cutout? Bear in mind sometimes a cutout can make symptoms worse as it reduces the surface area you are sitting on, and therefore pressure can be redistributed onto other soft tissues! However, in some cases a cutout can be extremely useful, particularly with perineum or pudendal nerve issues.
4. Will you need padding? Sometimes you do, but in a lot of cases, scary as it may seem, riding on a firm saddle is a lot more comfortable as it reduces the compression and shearing which can occur.
5. Chamois – just like with the saddle, you might find a think chamois better than a thick one, but not always!
6. Bike fit – crank length, saddle height, saddle fore/aft and cockpit set up are all wholly relevant and might need to be tailored to each inividual’s symptoms.
7. Other – do you need to see a specialist Women’s Health (or Pelvic Health) Physiotherapist?

Essentially our take home message is:

Do not suffer in silence

If you are experiencing pelvic pain on the bike there are things that can be done to alleviate it.

Thanks for reading,

Bianca @ Fit Your Bike

07534993680

bianca@fityourbike.co.uk

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