Perineal/Groin pain (warning, may be TMI); what professionals do i go see from here

Jun 6, 13 8:12

Post #1 of 21 (11754 views)

Here's the background: 28-yr old male, long time cyclist. I ride a very aggressive position (see pics below), and other than a stupid weight weenie foray into trying a light saddle that didn't work as well as i'd liked, i've been mostly fine on my current set up. Well, maybe i'm mistaken.

Memorial Day weekend, i did a 55 mile road race that was ~3 hours long, ending with a 5 mile climb at 7% to the line. Felt fine afterwards. The next day, i experienced tightness in my inner thigh, but it was only on one side. It's like the feeling you get when you load too much weight on the hip adduction machine and end up walking like a duck for the next 2-3 days. Mine wasn't as bad and went away after 2 days.

Last weekend (6/2). Went out to do a crit and spent 45 minutes in an aero position (pics below). Felt fine the day of, but got some sort of discomfort the next day. I can't really pinpoint what exactly, but it's a mixed feeling between tightness and tenderness. It wasn't really like the soreness i felt the week before, but it was somewhat concerning. I was actually a bit uncomfortable on my commute on Tuesday that i had to stand up for quite a bit.

I'll be seeing a primary care physician in about two weeks (earliest appointment i could get), and i'd like to have a list of possible causes to discuss with my PCP. Things i thought about (and some of these are kinda scary include):

Garden variety issues:
-pinched nerve.
-Muscle tightness; perhaps something that PT can take care of

And then the more serious ones:
-Iliac artery issues. I haven't felt a loss of power, and i felt pretty strong on my bike the last two weekends. But could this be an early sign that my position is too aggressive for my own good?
-And even more dreaded: maybe a visit to the urologist is in due order? I'm experiencing the discomfort on only one side (left), and sometimes the discomfort feels as if it's purely a muscular/connective tissue thing, but other times it feels that the discomfort is from within the scrotum, but only one side. A quick self-exam doesn't reveal any lumps, but wtf do i know as i'm not a medical professional?

So i have another 10 days to observe and convey things to my PCP. Is there anything else to which i should pay attention?

Also, my insurance is open network, which means i can go see a specialist without a PCP referral. Would a visit to an orthopedic and/or urology specialist be warranted at this time?

Thanks in advance to all

-----
Images courtesy of E. Fitzgerald

Re: Perineal/Groin pain (warning, may be TMI); what professionals do i go see from here [echappist] [ In reply to ]

Jun 6, 13 8:33

Post #2 of 21 (11733 views)

For many years I experienced a nagging discomfort (often aching sensation) in my groin area. Sometimes, it would radiate down into my inner thigh, and other times it would radiate upward into more sensitive areas. The symptoms typically presented on the bike, when in an aggressive position. I had one acute instance of pain following an ultramarathon in which I got a disabling cramp in my groin and could not straighten my leg - but aside from that it was always a rather dull pain.

To make a long story somewhat short, I spent about 6 months going to GPs, PTs, and ortho docs searching for some resolution. After all that time, an MRI eventually revealed that I had a torn labrum and a massive impingement in my hip. Four months later, I had a hip arthroscopy performed to cut the bone down and anchor the cartilage. Another 4-5 months after that, I was back to running with no symptoms, and eventually back to cycling with no symptoms (other than a lingering strength imbalance).

I'm not suggesting that our conditions are identical, but rather that it could be any number of issues (or even non-issues), the severity of which should dictate how diligently you seek out an answer. In my case, it had a minor effect on my sport, but a substantial effect on my quality of life as most of the pain curiously arose during routine activities (rather than during sports).

"The right to party is a battle we have fought, but we'll surrender and go Amish... NOT!" -Wayne Campbell

Re: Perineal/Groin pain (warning, may be TMI); what professionals do i go see from here [echappist] [ In reply to ]

Jun 6, 13 9:18

Post #3 of 21 (11670 views)

Probably a strain/sprain but be prepared to be violated in every possible way!

Re: Perineal/Groin pain (warning, may be TMI); what professionals do i go see from here [echappist] [ In reply to ]

Jun 6, 13 14:06

Post #4 of 21 (11556 views)

Shouldn't your outside (left) leg be straight going around that turn?

Re: Perineal/Groin pain (warning, may be TMI); what professionals do i go see from here [johnnybefit] [ In reply to ]

Jun 6, 13 15:38

Post #5 of 21 (11509 views)

johnnybefit wrote:

Shouldn't your outside (left) leg be straight going around that turn?

Not if he's pedaling through it.

who's smarter than you're? i'm!

Re: Perineal/Groin pain (warning, may be TMI); what professionals do i go see from here [echappist] [ In reply to ]

Jun 6, 13 16:18

Post #6 of 21 (11493 views)

.

Re: Perineal/Groin pain (warning, may be TMI); what professionals do i go see from here [veganerd] [ In reply to ]

Jun 6, 13 17:23

Post #7 of 21 (11454 views)

burnman wrote:

For many years I experienced a nagging discomfort (often aching sensation) in my groin area. Sometimes, it would radiate down into my inner thigh, and other times it would radiate upward into more sensitive areas. The symptoms typically presented on the bike, when in an aggressive position. I had one acute instance of pain following an ultramarathon in which I got a disabling cramp in my groin and could not straighten my leg - but aside from that it was always a rather dull pain.

To make a long story somewhat short, I spent about 6 months going to GPs, PTs, and ortho docs searching for some resolution. After all that time, an MRI eventually revealed that I had a torn labrum and a massive impingement in my hip. Four months later, I had a hip arthroscopy performed to cut the bone down and anchor the cartilage. Another 4-5 months after that, I was back to running with no symptoms, and eventually back to cycling with no symptoms (other than a lingering strength imbalance).

I'm not suggesting that our conditions are identical, but rather that it could be any number of issues (or even non-issues), the severity of which should dictate how diligently you seek out an answer. In my case, it had a minor effect on my sport, but a substantial effect on my quality of life as most of the pain curiously arose during routine activities (rather than during sports).

thanks for sharing that. i'm really hoping that it's something muscular/fit related more than something more serious

veganerd wrote:

johnnybefit wrote:

Shouldn't your outside (left) leg be straight going around that turn?

Not if he's pedaling through it.

it's a downhill, immediate uphill turn, so right after the bike goes through the apex, you need to start pedaling. Also, thanks to the knowledge i gleaned here at ST, 165mm cranks help quite a bit.

Re: Perineal/Groin pain (warning, may be TMI); what professionals do i go see from here [echappist] [ In reply to ]

Jun 6, 13 19:13

Post #8 of 21 (11397 views)

Well there are inguinal hernias, groin pulls, hip flexor issues, torn labrums, iliac artery (though you would have claudication (pain and other issues with that typically...and you are not really at the age where folks worry about that).

My guess is that the first thing your GP will do is check for the inguinal hernia. They will also have to do a DRE (finger up the butt) most likely to check for any nerve related issues (or they may wait on that, but it can help with looking at pudendal nerve entrapment). That type of pain will radiate to the bum typically and to the scrotum and penis in men (lady bits in women). That is not an uncommon occurrence for cyclists but it doesn't really relent.

I would not think worse case scenario. The GP will have ways of helping to figure out what this is via some leg and hip maneuvers. Hopefully it is as simple as a groin strain.

Re: Perineal/Groin pain (warning, may be TMI); what professionals do i go see from here [burnman] [ In reply to ]

Jun 6, 13 20:01

Post #9 of 21 (11376 views)

burnman wrote:

For many years I experienced a nagging discomfort (often aching sensation) in my groin area. Sometimes, it would radiate down into my inner thigh, and other times it would radiate upward into more sensitive areas. The symptoms typically presented on the bike, when in an aggressive position. I had one acute instance of pain following an ultramarathon in which I got a disabling cramp in my groin and could not straighten my leg - but aside from that it was always a rather dull pain.

To make a long story somewhat short, I spent about 6 months going to GPs, PTs, and ortho docs searching for some resolution. After all that time, an MRI eventually revealed that I had a torn labrum and a massive impingement in my hip. Four months later, I had a hip arthroscopy performed to cut the bone down and anchor the cartilage. Another 4-5 months after that, I was back to running with no symptoms, and eventually back to cycling with no symptoms (other than a lingering strength imbalance).

I'm not suggesting that our conditions are identical, but rather that it could be any number of issues (or even non-issues), the severity of which should dictate how diligently you seek out an answer. In my case, it had a minor effect on my sport, but a substantial effect on my quality of life as most of the pain curiously arose during routine activities (rather than during sports).

Recovered from the same thing myself and the symptom description seemed similar to what I experienced. Had the hip arthroscopy in late November and now back to essentially 100%. S/B/R just as badly as I always have! :)

Re: Perineal/Groin pain (warning, may be TMI); what professionals do i go see from here [echappist] [ In reply to ]

Jun 8, 13 22:52

Post #10 of 21 (11190 views)

It could be an isolated strain of the adductor longus, but sports hernia (different from an inguinal hernia) should be ruled out. So, I recommend seeing an ortho doc. I am guessing that the problem involves the origin of the adductor longus and its connection to the rectus femoris. An MRI would be helpful. Until sports hernia is ruled out, I would avoid soft tissue mobilization (massage and stretching) to the anterior lower abdominals and insertion sites of the adductor and inguinal muscles for at least 3-4 weeks.

Re: Perineal/Groin pain (warning, may be TMI); what professionals do i go see from here [echappist] [ In reply to ]

Jun 9, 13 12:47

Post #11 of 21 (11076 views)

Is your saddle dead center? Maybe you need to turn it a little to one side or another like John cobb recommends if you're going to go that low.

Re: Perineal/Groin pain (warning, may be TMI); what professionals do i go see from here [Silvercivic27] [ In reply to ]

Jun 9, 13 14:00

Post #12 of 21 (11041 views)

thanks to all who responded. I'm making a list of things to discuss with my PCP/GP when i have the appointment in a week. Also made an appointment with an urologist just to rule out the worst possible case scenario and besides i probably should make a visit anyway as testicular tumors is all the rage with men my age

Silvercivic27 wrote:

Is your saddle dead center? Maybe you need to turn it a little to one side or another like John cobb recommends if you're going to go that low.

That is a very good point. I'm on a Cobb Saddle, but i can't get it off center b/c the seat tube is elliptically shaped, and i can't turn the seat post relative to the seat tube.

for a good 3 weeks, i had a V-Plus Saddle (my old one, used for 20 months) on there; no problem, though i really didn't hammer in the drops much. Then for 2 months, i had a Cobb SHC, but the saddle just felt "off", but no problem like the one i'm getting. For the last 4 weeks, i've been using a new V-Plus Saddle (and did a road race of 55 miles and crit of 20 miles on it, spent most of the time in the drops), which feels fine for the most part, but i'm wondering if the ridge may be just a bit too hard or something.

I think i've been able to isolate the source of the pain to somewhere near the ball-and-socket joint, and it feels as if the bone is contused. The pain then radiates around and makes it feels as if it's coming from the scrotum.

Last edited by: echappist: Jun 9, 13 14:02

Re: Perineal/Groin pain (warning, may be TMI); what professionals do i go see from here [echappist] [ In reply to ]

Jun 9, 13 14:23

Post #13 of 21 (11026 views)

I'm guessing its a saddle issue more than a medical problem, but it never hurts (except in the wallet and possibly the brown eye) to get checked out. Maybe the Cobb saddles are a little wide for you? You look like you have a small pelvis (Not that I'm checking out your pelvis, and not that there's anything wrong with that). Have you tried an arione or selle slr?

Re: Perineal/Groin pain (warning, may be TMI); what professionals do i go see from here [Silvercivic27] [ In reply to ]

Jun 9, 13 14:38

Post #14 of 21 (11020 views)

thanks for the suggestions

i have tried Arione in the past and didn't like it. I may have tried the SLR but don't remember. The thing is that the cobb v-flow plus worked for quite a long time in the past, and it's odd that it's giving me issues now, though granted i did lower my bars by a good 2 cm in the process and will be raising my bars to see if that helps.

The cobb saddle was the best one out there for me: comfortable in an aero position (i go OTF a lot and use the aero position to my advantage) and comfortable climbing. We shall see if a bit of rest and a more relaxed position may change things.

Re: Perineal/Groin pain (warning, may be TMI); what professionals do i go see from here [echappist] [ In reply to ]

Jun 9, 13 15:32

Post #15 of 21 (10990 views)

I had a pair of torn abdominal muscles around the same area typical of a hernia. The symptoms sound similar but they were most evident from running, although I do recall an ache/soreness from certain hard bike efforts. It took a few different doctors to get a proper diagnosis, which ultimately came from a guy who treated the SJ Sharks hockey team.

Re: Perineal/Groin pain (warning, may be TMI); what professionals do i go see from here [echappist] [ In reply to ]

Jun 9, 13 18:08

Post #16 of 21 (10950 views)

Was it the Tour of Tucker County that you speak of?

Might consider sacroiliac joint dysfunction in your list, along w/ myofascial pain referral from trigger points or generally elevated muscle tone.

Re: Perineal/Groin pain (warning, may be TMI); what professionals do i go see from here [wvtrigeek] [ In reply to ]

Jun 9, 13 18:13

Post #17 of 21 (10944 views)

Carl Spackler wrote:

I had a pair of torn abdominal muscles around the same area typical of a hernia. The symptoms sound similar but they were most evident from running, although I do recall an ache/soreness from certain hard bike efforts. It took a few different doctors to get a proper diagnosis, which ultimately came from a guy who treated the SJ Sharks hockey team.

will add it to the list

wvtrigeek wrote:

Was it the Tour of Tucker County that you speak of?

Might consider sacroiliac joint dysfunction in your list, along w/ myofascial pain referral from trigger points or generally elevated muscle tone.

it indeed was. how did you know?

will add tht two to the list as well

Re: Perineal/Groin pain (warning, may be TMI); what professionals do i go see from here [echappist] [ In reply to ]

Jun 9, 13 18:29

Post #18 of 21 (10937 views)

There aren't many events that end in a 5 mile long uphill on Memorial Day weekend. It's a tough race on several folks because the recovery takes longer than your typical road race.

Re: Perineal/Groin pain (warning, may be TMI); what professionals do i go see from here [Carl Spackler] [ In reply to ]

Jun 14, 13 8:30

Post #19 of 21 (10780 views)

thanks to all who replied.

Just got back the urologist, and there's nothing wrong with the family jewels, per se. One vein, however, is defective, and the condition is known as a varicocele, which is pretty similar to what happened to the veins on Hincapie's legs. The fitting likely contributed somewhat to all this as the strained ligament probably put more pressure on the vein than normal.

I'm saddened to say that i'm no longer running a -17 stem, but OTOH, i am now slamming my -6 stem

Re: Perineal/Groin pain (warning, may be TMI); what professionals do i go see from here [echappist] [ In reply to ]

Jun 14, 13 11:48

Post #20 of 21 (10730 views)

Thanks for follow-up. Odd that you didn't notice a lump in scrotum. Hope you are out of the woods, but symptoms seem more complicated since varicocele is generally painless.

Re: Perineal/Groin pain (warning, may be TMI); what professionals do i go see from here [echappist] [ In reply to ]

Jun 20, 18 19:54

Post #21 of 21 (5585 views)

echappist wrote:

Here's the background: 28-yr old male, long time cyclist. I ride a very aggressive position (see pics below), and other than a stupid weight weenie foray into trying a light saddle that didn't work as well as i'd liked, i've been mostly fine on my current set up. Well, maybe i'm mistaken.

Memorial Day weekend, i did a 55 mile road race that was ~3 hours long, ending with a 5 mile climb at 7% to the line. Felt fine afterwards. The next day, i experienced tightness in my inner thigh, but it was only on one side. It's like the feeling you get when you load too much weight on the hip adduction machine and end up walking like a duck for the next 2-3 days. Mine wasn't as bad and went away after 2 days.

Last weekend (6/2). Went out to do a crit and spent 45 minutes in an aero position (pics below). Felt fine the day of, but got some sort of discomfort the next day. I can't really pinpoint what exactly, but it's a mixed feeling between tightness and tenderness. It wasn't really like the soreness i felt the week before, but it was somewhat concerning. I was actually a bit uncomfortable on my commute on Tuesday that i had to stand up for quite a bit.

I'll be seeing a primary care physician in about two weeks (earliest appointment i could get), and i'd like to have a list of possible causes to discuss with my PCP. Things i thought about (and some of these are kinda scary include):

Garden variety issues:
-pinched nerve.
-Muscle tightness; perhaps something that PT can take care of

And then the more serious ones:
-Iliac artery issues. I haven't felt a loss of power, and i felt pretty strong on my bike the last two weekends. But could this be an early sign that my position is too aggressive for my own good?
-And even more dreaded: maybe a visit to the urologist is in due order? I'm experiencing the discomfort on only one side (left), and sometimes the discomfort feels as if it's purely a muscular/connective tissue thing, but other times it feels that the discomfort is from within the scrotum, but only one side. A quick self-exam doesn't reveal any lumps, but wtf do i know as i'm not a medical professional?

So i have another 10 days to observe and convey things to my PCP. Is there anything else to which i should pay attention?

Also, my insurance is open network, which means i can go see a specialist without a PCP referral. Would a visit to an orthopedic and/or urology specialist be warranted at this time?

Thanks in advance to all

-----
Images courtesy of E. Fitzgerald

We’re you able to resolve this? I have a dull ache in my perenium for weeks after cycling, and it’s always there but particularly bad after cycling.

Had any sort of pelvic floor issues ruled out.
Currently thinking it may be a myofacial issue with my left adductor referring pain to my perenium. Currently stretching and foam rolling and feel better than I have since this started last summer, but scared to get back on the bike cause I know it will flare me right up.

I even bought a recumbent bike thinking it would allow me to bike this summer till I got it figured out, but it flares me just like a regular bike

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