It may seem obvious, but sitting on a bike seat is not the most natural way to sit and it can place forces on the body (including genitals and pelvic floor) that can adversely impact health. Furthermore, adopting prolonged postures such as the flexed forward position needed for much of cycling may contribute to musculoskeletal dysfunction including those injuries related to the areas of use or of awkward positioning such as low back, upper back, pelvis, and hips. If you are a cyclist and consistently exposed to this type of body “loading” it may be wise to consider addressing some of the potential harms with targeted therapy such as pelvic health physical therapy. In this post, I would like to briefly discuss common causes of pain and dysfunction in cyclists and how some of these can be best addressed with pelvic health physical therapy.
Common injuries or pain/dysfunction that we see in cyclists in which the pelvic floor may play a part are:
· Stress urinary incontinence
· Sexual dysfunction
· Low back pain
· Upper back pain
· Hip or groin pain
· Numbness, tingling, or nerve injury/entrapment (especially of the pudendal nerve)
· Pelvic pain
· Genital pain or soreness
As you may expect, pressure from sitting on a bike seat and sustained postures from biking have the potential to contribute to orthopedic issues in individuals who identify as female, male, and/or transgender. Some of these issues may present as pelvic floor related problems to reproductive anatomy, urinary structures, and the related muscles and functions of the pelvic floor muscles. In one study, female cyclists were found to have an increased incidence of urinary dysfunction, sexual dysfunction, and potential nerve symptoms and/or injury (Trofaier, 2016).
There is also data to suggest that pelvic floor dysfunction could be more prevalent in men who engage in high intensity cycling (Molina-Torres, 2021) and this may present as urinary dysfunction, reduced sexual function, and/or impaired prostate function. In one sample of male cyclists, there was a higher incidence of genital numbness in high intensity cyclists and higher incidence of urethral stricture as compared with other endurance athletes (runners and swimmers) (Awad, 2018). So, we can conjecture that cycling, beyond exercise overall may have some contributors to these issues.
Different aspects of cycling can make a difference, such as trying to optimize “bike fit” and choose the best bike seat or saddle for your comfort but also unique anatomy. Just like the idea that running shoe selection may be best when individualized to comfort (i.e., there is no one “Perfect” shoe or bike seat), a person’s individual anthropometrics (anatomical makeup) could impact which bike seat is ideal. For example, in one sample of female cyclists it was found that narrower saddles and cutout saddles led to increased overall pressure and peak pressures at the perineum, which could potentially increase risk for nerve compression or chafing at those areas (Guess, 2011).
Figure above from: Guess, 2011
So, what do we do? Stop cycling? NO! This is where pelvic health physical therapy can be valuable! As we see commonly in our patients, pelvic health and pelvic floor muscle health can be intimately related to regionally close areas of the body like the lumbar spine, hip and even abdominal and adductor regions. Working on appropriate strength, motor control, and mobility of the pelvic floor muscles (similar to muscles in other areas of the body!) can drastically help to improve some of the issues mentioned above that may develop from cycling postures and equipment. Pelvic health physical therapy for cyclists often includes components of manual therapy to optimize soft tissue health, neuromuscular reeducation to optimize “tone” of the pelvic floor muscles and even may include strengthening exercises for the pelvic floor muscles (HINT: there is MUCH more to this than simply doing a “kegel” exercise!). We also want to work to put all of those strengths and pieces back into functional movements such as squatting, lunging, pushing, pulling…and CYCLING!
If you are interested in pelvic health physical therapy, give us a call today to schedule with one of our pelvic health specialist physical therapists!
Awad MA, Gaither TW, Murphy GP, et al. Cycling, and Male Sexual and Urinary Function: Results from a Large, Multinational, Cross-Sectional Study. Journal of Urology. 2018;199(3):798-804. doi:10.1016/j.juro.2017.10.017
Guess MK, Partin SN, Schrader S, et al. Women’s Bike Seats: A Pressing Matter for Competitive Female Cyclists. The Journal of Sexual Medicine. 2011;8(11):3144-3153. doi:10.1111/j.1743-6109.2011.02437.x
Molina-Torres G, Ochandorena-Acha M, Echazarreta-Aparicio Y, et al. Is Cycling Practice Related to Men’s Pelvic Floor Dysfunctions? A Hypothesis-Generating Observational Study. IJERPH. 2021;18(4):1923. doi:10.3390/ijerph18041923
Navot S, Kalichman L. Hip and groin pain in a cyclist resolved after performing a pelvic floor fascial mobilization. Journal of Bodywork and Movement Therapies. 2016;20(3):604-609. doi:10.1016/j.jbmt.2016.04.005
Trofaier ML, Schneidinger C, Marschalek J, Hanzal E, Umek W. Pelvic floor symptoms in female cyclists and possible remedies: a narrative review. Int Urogynecol J. 2016;27(4):513-519. doi:10.1007/s00192-015-2803-9