Two factors that can cause/exacerbate sit bone pain are:

1. Underfueling, in particular carbohydrate, being chronically short of muscle glycogen. This can leads to many "aches and pains" not normally present when properly fueled.

2. Seat too high. Too much pressure on saddle because legs unable to take any pressure off the saddle.

But, you would not expect an athlete to always be underfueled, and of course you're a fitter, so ideally you've adjusted saddle height.

I think there's a possibility that this athlete has bruised that area, and no saddle will feel good until it heals. Unfortunately, looking at time off the bike for that. Would pursue medical diagnosis of bone bruising and also prognosis for healing. If she was riding a crap saddle and tolerating the pain for years, that kind of chronic injury could be bruising and require time away from the bike to heal.

A final possibility is tendonitis in that area (upper hamstring connective tissue) or even upper hamstring strain, possibly related to recent increase in running duration/intensity.

I imagine that you tried an Adamo or something that would unload the sit bones entirely and put more load on the Pubic Ramus. Maybe try the Attack or a Dash?
Perhaps experiment with a super steep position to drive home the point?
Does she experience the pain doing anything else besides riding?

Sounds like a tough one...good luck!

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Jonathan Blyer,
ACME Bicycle Co., Brooklyn, NY

Shorts that are too tight cause the skin or soft tissue to double over at the sit bones. Is she sitting directly on skin at the sit bones or on doubled over soft tissue? I would have to roll off one sit bone and open up the leg to get the shorts to let go of / allow the affected side glute/cheek/skin to open up in order to get off the soft tissue. Examine what she does for short term relief and make a long term fix. good luck.

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http://www.mybicyclefit.com

Thanks for the replies guys, since my original post she and I got together again. We did try the Adamo, and the pain was even worse for her. Cutout, no cutout, still painful at any seat angle. I did a lot of thinking and reading up on 'painful saddle' everywhere I could. She'd also mentioned in our original interview that she'd had twins at full term naturally. I have had a handful of experiences with post-birth ladies having difficulties on what used to be a comfortable saddle; sometimes the cutout helped, sometimes not.

We made some progress, and I learned a little more about exactly where she's got the 'problem'. Part bike fit, part trust exercise.
It really isn't "sit bone", it is much more on the inferior ramus of the pubis. Lessons learned...she was identifying the painful area as the 'sit bones' and I was 'hearing' sit bones, but after additional pointing on her part and closer 'inspection' on my part I realised the difference. She experiences the MOST pain when she rotates forward.... sitting upright is fine.

For the past two years the only saddle she can tolerate is this: www.selleanatomica.com. I asked her about the childbirth, and also asked if she'd ever had a hamstring avulsion. She said yes, how did I know? She pulled her right hamstring in High School so badly she could barely walk. Before the twins were born, riding a bike was fine. Afterwards, misery. Hence the Selle Anatomica saddle.

Found some mildy interesting reading on "Pelvic Girdle Pain", but how this relates to women sitting on a saddle I don't know. Beyond my knowledge to know if having twins (both were 7lb boys) will completely rip up the pubic symphysis, the attachments of the gracilious, adductors or crack the bone.

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Anne Barnes
ABBikefit, Ltd
FIST/SICI/FIST DOWN DEEP
X/Y Coordinator
abbikefit@gmail.com

Try getting in touch with Kaja Rudinow, a physical therapist's assistant at the Polyclinic in Seattle, WA. Known as Knotted Yet on TeamEstrogen forum. She is amazing, and deals with pelvic stuff (including rehab) in patients as part of her regular job, with an eye toward cycling as well. Fantastic woman!

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Damon Rinard
Engineering Manager,
CSG Road Engineering Department
Cannondale & GT Bicycles
(ex-Cervelo, ex-Trek, ex-Velomax, ex-Kestrel)