This is where I'm at. Calcification at the injury site has led to an 1.5 inch long ossification, ie, a bony bump in my butt. Surgical consult suggested that removing the ossification would do more harm than good, and no guarantees that it wouldn't just reform.

It is very painful when sitting on a saddle. I've tried improvising cutouts, foam pads, etc but have not yet found anything that works. TT position is less painful than road position. Even moderate, low intensity training has been impossible.

Have you found any solutions?

---

No coasting in running and no crying in baseball

my last instance of this was over 10 years ago. My remedy was staying off the bike and a ton of PT at the insertion point.

---

36 kona qualifiers 2006-'23 - 3 Kona Podiums - 4 OA IM AG wins - 5 IM AG wins - 18 70.3 AG wins
I ka nana no a 'ike -- by observing, one learns | Kulia i ka nu'u -- strive for excellence
Garmin Glycogen Use App | Garmin Fat Use App

If for your entire TT cycling career you had been sitting rotated forward on pubic bones instead of on sitbones where the tendons insert do you think that would have made any difference?

ERic

---

Eric Reid AeroFit | Instagram Portfolio
Aerodynamic Retul Bike Fitting

“You are experiencing the criminal coverup of a foreign backed fascist hostile takeover of a mafia shakedown of an authoritarian religious slow motion coup. Persuade people to vote for Democracy.”

when you've got no ass like me even when you're fully rolled over your sit bones are still hammering hard on the saddle.

should also note that the injury doesn't result from riding, it happens while running but continued riding prevents it from healing. (at least in all the cases (7-8) that i've been party to)

---

36 kona qualifiers 2006-'23 - 3 Kona Podiums - 4 OA IM AG wins - 5 IM AG wins - 18 70.3 AG wins
I ka nana no a 'ike -- by observing, one learns | Kulia i ka nu'u -- strive for excellence
Garmin Glycogen Use App | Garmin Fat Use App

Yeah, completely on board with you about the continued riding aspect on the injury and healing.

I’d like to focus on saddle and position in this thread but should say that doing deadlifts is the best way to heal and/or prevent this kind of stuff IMO. Deadlifts, RDLs, Nordics, etc. Work that ass...

Now, that said, do you think you were still on your sit bones so much because your cranks were too long, making hip angle too acute at top dead center?

Also, with the trend toward tilt as of late and getting weight onto the front end thru this mechanism, any more thoughts on 2000s MarkyV’s hammies and lack of a butt in light of today’s modern positions and modern fitters making bike work for athlete instead of other way around? I’ve got a theory going about this...

Eric

---

Eric Reid AeroFit | Instagram Portfolio
Aerodynamic Retul Bike Fitting

“You are experiencing the criminal coverup of a foreign backed fascist hostile takeover of a mafia shakedown of an authoritarian religious slow motion coup. Persuade people to vote for Democracy.”

Dealing with it now. Got really bad in October. But, there were probably some tell tale signs that I ignored like what felt like tight piriformis. Took 5 months off of running, but continued swimming, riding, skiing (up and down and XC). Tried Chiro, MT, Accupuncture, Dry Needling, Shockwave, PT. After PT and likely some Shockwave....and really working the strengthening excercises, I started running again in April. It's been a slow go, but I've been able to increase from running 3m on, 2 m off to running a full hour. Now I'm trying to get enough fitness back to race Nats in August.

---

Pat Dwyer
@pdwyer99

 
I'd be careful about saying anything that could prevent this stuff. You can do all that and still overreach with the running and have something like this happen. I haven't looked any time recently but last i checked there's zip in the literature to suggest that lifting weights "prevents" injury. The literature is also incredibly exacting.

¯\_(ツ)_/¯

Not sure what this trend is, help a brother out? :)

I always fit myself and it was always based on pseudo FIST principles and fundamentals. Sure we know more, but time and again my fit was seen as outside of norms by most but i always found it very comfy. Enough so that when i was really exhausted I'd have to be careful not to close my eyes cuz i was so comfy in aero that i very well might have been able to drift off to sleep 😬

---

36 kona qualifiers 2006-'23 - 3 Kona Podiums - 4 OA IM AG wins - 5 IM AG wins - 18 70.3 AG wins
I ka nana no a 'ike -- by observing, one learns | Kulia i ka nu'u -- strive for excellence
Garmin Glycogen Use App | Garmin Fat Use App

With regard to your fit, you and I are the two mutant dots way out to the lower right quadrant of the graph, so I know what you’re talking about re: comfort.

As to prevention, I meant with my own post-hamstring problem self, not the general population.

E

---

Eric Reid AeroFit | Instagram Portfolio
Aerodynamic Retul Bike Fitting

“You are experiencing the criminal coverup of a foreign backed fascist hostile takeover of a mafia shakedown of an authoritarian religious slow motion coup. Persuade people to vote for Democracy.”

Your experiences are very enlightening. I've been dealing with this since February 2021, not really knowing how bad it would get, continued to race through Sept 2021, only to be completely sidelined after that and a lot of walking in the IM Marathons. After stopping all three sports at different times from Oct 21-Apr 22, I finally got the proximal hamstring tendonopathy diagnosis, stopped everything but swimming, had 2 PRP injections and followed up with 8 weeks of intense PT and strength training. Finally was able to return to running and am good through about 10-11 miles until the fatigue starts to flame up the tendon. I started cycling again 4-6 weeks after I was running, but that lasted only a few months. I have been off the bike now for about 3 weeks, pain is subsiding even though I'm running more now. I believe you are spot on that it's the pressure on the sit bones, right where it connects to the scar tissue/tendon/sciatic nerve, that causes my pain. While cycling, I couldn't even do dead lifts, couldn't sit in my "special old man cushion" at work or in the truck. With 3 weeks off the bike, I'm already seeing about 80% improvement in the flair ups. The only issue with this is that I want to return to some level of competition which will be impossible if I can't ride any of my bikes.

If I read your comments well enough, time off the bike was the best medicine so you aren't compressing your sit bones/soft tissues. I'll dedicate this winter to running, swimming, therapy, and strength with hopes that a few months off the bike (again) will remove this pain. I just fear the scar tissue will never fully let me return to all sports.

Thanks!

I have had it forever. Worst mistake I made was trying to stretch it or do intense yoga. I had PRP about 8 weeks ago and stopped running, stayed off bike for about a month. I am back on the bike and have been doing intense PT starting with concentric first, building strength and now am on eccentric strength. I had to find a very, very knowledgeable PT who really understands this injury and will work on a strength protocol to gradually build strength rather than treat the symptoms.....PT has me working on hip strength, lower leg strength and overall stability.

I also had some pain from sitting that related to the sciatic which was entangled in the tendon. This may explain your pain while on the bike because the two are right next to each other and the compression of sitting can aggravate the tendon and or the nerve. Check out Brodie Sharpe podcasts. I steer clear of very aggressive treatments, stretching, yoga and I finally stopped trying to just run through it because that just made it worse.....that's what caused the tendon to be inflammed and thickened. Also, tendons take a lot longer to heal.

Good luck!

KK

i would guess your situation has more scar tissue and thus is more susceptible to recurrence. Ask a PT or ortho about what the best non-surgical remedy to that is?

---

36 kona qualifiers 2006-'23 - 3 Kona Podiums - 4 OA IM AG wins - 5 IM AG wins - 18 70.3 AG wins
I ka nana no a 'ike -- by observing, one learns | Kulia i ka nu'u -- strive for excellence
Garmin Glycogen Use App | Garmin Fat Use App

Thanks for your feedback...working on that now.

Yes, agreed to all that. I think sitting is definitely making it worse for me, likely due to scar tissue and the sciatic nerve. Nerve glides are my friend, strengthening it seems really solid, just need the scar tissue to get smoothed out somehow.

I'd be interested to see if there's a way to sort out scar tissue. I had 6years off the bike due to this. The thing that finally sorted the issue for me was seeing a physio who essentially said that there was a crap ton of fear and stress in my head to do with the injury and that every time I tried to run and ride I was stressing about it which led to suffering not pain. So I started a chronic pain meditation plan, slowly began to run again and then after about a year started to ride again. I know run between 60-80mile weeks generally off road, and am getting to the very pointy end of trail marathons and short ultras, I commute on my bike (an hour each way) maybe once or twice a week. There are days when the bike is uncomfortable and days when it's fine, I find *smooth* sit bones makes a massive difference to comfort. In short, it passes but it can be a proper pain in the arse, be gentle and kind to yourself, and maybe find another hobby for a bit (bouldering is a lot of fun! As is multipitching!)

That's very interesting Herdwickmatt. Yes, my plan is to give this until the end of the year with zero cycling and continuing to ramp my run mileage while continuing my swim and strength/PT work. I'd like to have a new MRI done in the new year with my last doctor to see how things have improved or if he can see a lot of scar tissue, etc. There's definitely a mental component to this, being "are you hurt or are you injured" mentality. What I have discovered personally is the bulk of mine is really the sciatic nerve entrapment through that tendon. I have had other nerve injuries related to my bike saddle and I know very well the difference between nerve pain and tendon or muscular pain. I'd like to hope I can race iron distance again, but really just want to be able to ride my bike pain free whenever I want, even if that means I'll never ride 112 miles again. Until I can sit on any surface for more than 45 minutes without pain firing, I won't consider myself cured from this ailment. I sit on a special cushion right now that has cutouts for my sit bones and use it on long road trips and when I sit at work in my home office.

This is the best I have felt since probably February 2021, so I'm counting my blessings that I'm running the distances I want right now. I am a little gun shy about pushing the pace, but I know that in time this is all part of the mental side of things to feel confident in my body.

Hi everyone, wanted to bring some more of this to the surface, based SOLELY on my experience. Short preface, been battling HHT for 2 years with significant sciatic nerve entrapment issues in my glute down to my foot. 2xPRP injections in my hamstring tendon, 12 or so weeks of intense PT and strengthening exercises, on and off running for months at a time, on and off cycling for months at a time, with "some" relief in the past 6 months. After laying off the bike for about 5 months last summer, I got back on the bike in August, had been running for 6 weeks or so with good success. Come early November 2022, I was unable to continue cycling due to the nerve pain. My dr. wanted to get more MRIs done to see if it was nerve entrapment, scar tissue or what was causing the nerve pain since it seemed the hamstring tendon issues had been resolved. I got an MRI and found out I have an L5-S1 herniated disc that is causing issues with the sciatic nerve in my lower back that is referring pain down my leg. I stayed off the bike and am still not on it. It's been 10 weeks today since I rode the bike, but in that time, my nerve pain is completely gone. I can sit on any surface for any length of time without it causing me pain, including a 6 hour road trip without my "old man seat cushion". I still use the cushion in the office and on road trips, just forgot it for that one. So now I have an accurate diagnosis for the nerve issues and am working on some PT to help the pain, which seems to be working. I'm so scared and hesitant to get back on the bike again and will probably give it another month or so in hopes of resolving the nerve pain in my back so it's not referred down my leg again.

Hope this helps someone else on their journey, but for me, not sure long course triathlon is in my future.

     Problem in the US (since the post originated in the US) is there are not enough PT's and Chiro's and especially orthopedists who focus on and do pelvis work. And...then know how to apply it to bike position. So it can become a debilitating injury, especially in those old enough where it takes longer to heal (i.e. low testosterone etc) and those of us refusing to back off training when it gets aggravated. Dan, it's a good topic.
Read the papers on how hamstring injury often really is piriformis and they often go hand in hand. It's a common mistake and often over read by radiologists as a hamstring injury.... as piriformis syndrome can be so hard to diagnose. Good PT's please chime in.
PRP/Prolozone with targeted Laser/photomodulation will usually accelerate recovery dramatically (Please....the German pain clinics chime in....they are too busy taking care of the US pros). However, need an experienced PT or Chiro who checks pelvis alignment, rule out limb length discrepancy, low spinal column alignment....and be careful not to overdevelop the quads and neglect strength workouts. i.e. when spending so much time on a bike/run and developing those quads and neglecting the backside. Perhaps when we spend many winter months on a road bike, MTB, or gravel bike overdeveloping quads.
And let us not forget, the older we get, the longer it takes to warm up before we start inducing micro tears. It now takes me 11-13 min to get my Moxy Sm02 up to a reasonable level in the quad formis but even longer in my biceps formis/hamstring. Probably because my bike position indoor on Wahoo Smart bike over emphasizes the quads.
Sorry for jumping in on the thread.


Bill

Was one of your symptoms numbness in your lower leg and foot?

Yes, numbness and pain in my calf and foot was from scar tissue engulfing sciatic nerve near insertion. Keep training with tears, scar tissue will build. Thats one of the reasons the ortho said I had to get surgery asap once numb foot started happening. Over 2 hours of my surgery was cleaning all the scar tissue off nerve then reattached tendon for another couple hours. The crazy thing is, when I woke up from surgery- all the pain and numbness was gone. 6 years later... I still say that surgery (fab ortho important) was best thing I ever did. I paid the price for pushing myself hard as a long distance athlete (9:53 IM at 45 yrs female) but worth it for all the fun and achievements. I stopped racing but still swim bike and run 100% pain free today for joy..... but slow and shorter. I think If I returned racing, I would have re-injured with speed and distance.... but dial back and lived happily ever after!