Can you fix recurring Ischial Bursitis with saddle positioning?

Triathlon Forum
1

Post pretty much says it all.

40 years old and long-time rider and runner. Been riding for 16 yrs. I’ve done 3 double centuries and IM and about 18 marathons. I was injury free from 2003 (plantar fasciitis) until 2013 (prevailing diagnoses at this time are ischial bursitis and proximal hamstring tendonopathy).

The bursitis was probably brought on when I took time off from riding for family and because of my running and cross training (weights and rower) when I returned to riding, I picked up where I left off in terms of mileage and so it was a sudden spike in saddle time - that likely caused the unrelenting pain in the ass.

I’m pretty much free of pain, but when I sit on my bike(s) I still feel like the inflammation of bursitis is just a few miles away from overdoing it again.

Yes, I changed my saddle position, but I cannot find a height and fore/aft combination that fits me anymore.

Any thoughts about what I need to do on my saddle? I’m within the margin for error on saddle height because I have been fitted about 5 times in the last 3 years. The fits that I get are usually within about 6mm of each other, but they are always within 1.5 cm of each other (for saddle height). The fore/aft is also affects the reach, but I’m just at a loss for answers… and I could really use some constructive input.

2

Following this thread with interest as this has happened to me following a change in saddle to one with a split nose.
Damn painful, isn’t it.

3

Following this thread with interest as this has happened to me following a change in saddle to one with a split nose.
Damn painful, isn’t it.

That’s an interesting observation. I was riding mostly road at the time that my bursitis became inflamed, but if I get on my tri bike now the position of the split nose saddle (regardless where you sit on it) immediately sparks the sensitive spots in my sitting zone.

4

With the different fits, have the saddle itself or just the position changed?

5

With the different fits, have the saddle itself or just the position changed?

It’s been both saddles and positions. Sometimes position was changed based on a new saddle. All changes were efforts to eliminate the discomfort.

6

With the different fits, have the saddle itself or just the position changed?

One other thing that is noteworthy: I do not experience pain while seated on my mountain bike, and the pain is only on my road and tri bike.

Surely, because of the differences in geometry, this indicates that it is a position problem, right?

7

more likely root cause is further away than where the pain presents: the high hamstring tear is near insertion at pelvis?
so with plantar tightness, calf tightness, ham tight - everything is under tension. as you bend over, the whole dorsal line system tension is increased, especially noticable at the insertion at the ischial insertion. butt hurts.

so more upright, ie, mtb, less tension on the dorsal plane.

release/improve belly of hamstring muscle tension. release calf muscle tension. improve anterior pelvic strength (lower abs core etc)

8

If you’ve had 5 fits and multiple saddles, consider the possibility that hamstring tendonopathy/ishial bursitis/ pelvic whatever is not the prevailing cause. More often than not (and vastly backed by research), butt pain is actually referred lower back pain. It’s entirely possible that the increased flexion of the lumbar spine in the road and aero position is far more symptomatic.

The biomechanical explanation and subsequent treatment prescription by the FIST fitter is suspect at best. Find a PT and have your spine examined and likely treated.

9

I knew I shouldn’t have made that response after a long day riding and a huge dinner. I’m usually not ‘suspect’ so I will blame the brussels sprouts.

In my experience over the years with riders of similar complaint, it’s not the saddle or the body position per se, but a problem further ‘up’ or ‘down’ the body. Changing saddle height ad infinitum clearly hasn’t helped, so if I was bike fitter #6 in line and understanding his history I’d have to step back and say what is being missed.

While there are plenty of instances of ischial bursitis being related to pelvic/lumbar dysfunction, it has not been a primary feature of saddle pain discussions for cyclists at conferences such as Medicine of Cycling. I have learned much much more about ischial problems from triathletes because they are runners - ‘regular roadies’ don’t seem to have the same strain issues. If you have good reading on lumbar dysfunction and ischial bursitis I’d be into it.

Perhaps he has a disc issue from weight lifting and rowing, lifting up the children, and being 40yrs old (sorry xsive). He did not mention any LBP or having had an MRI or other scan.

For LBP, I always send them off to my McKenzie technique Dr. whom I love, and has provided excellent solutions for many folks.

10

I knew I shouldn’t have made that response after a long day riding and a huge dinner. I’m usually not ‘suspect’ so I will blame the brussels sprouts.

In my experience over the years with riders of similar complaint, it’s not the saddle or the body position per se, but a problem further ‘up’ or ‘down’ the body. Changing saddle height ad infinitum clearly hasn’t helped, so if I was bike fitter #6 in line and understanding his history I’d have to step back and say what is being missed.

While there are plenty of instances of ischial bursitis being related to pelvic/lumbar dysfunction, it has not been a primary feature of saddle pain discussions for cyclists at conferences such as Medicine of Cycling. I have learned much much more about ischial problems from triathletes because they are runners - ‘regular roadies’ don’t seem to have the same strain issues. If you have good reading on lumbar dysfunction and ischial bursitis I’d be into it.

Perhaps he has a disc issue from weight lifting and rowing, lifting up the children, and being 40yrs old (sorry xsive). He did not mention any LBP or having had an MRI or other scan.

For LBP, I always send them off to my McKenzie technique Dr. whom I love, and has provided excellent solutions for many folks.

Thank you for your input.

No back pain. Never injured my back. All four of the PT’s have ruled out discogenic pain and referred back pain, but to be sure, I am having an MRI of my lumbar spine in 2 weeks. I am going to see a hip specialist after getting a second hip MRI (arthrogram) to rule out a torn labrum.

While waiting to see the specialist, I am taking off from all exercise for the first time since 2001. Usually, I am able to switch to cycling when I develop running pains and cycling has never caused me pain. I was swimming 2-5 times per week, but I’m taking time off from that for at least 10 days (this is day four of complete rest- although I still walk about 7-10 miles per day just working and chasing after kids).

The search for causes up and down the chain has been fruitless. It’s a specific area that hurts and because of 2 years of PT and strength training and stretching, I and my care providers have confined the problem and the root cause to my right hip.

The pain remains present despite taking 3 months off of the bike; therefore, it is unlikely due to increased tension from road or tri bike positioning. Nevertheless, your words show that you are thoughtful and insightful. It was my fault for not adding more info for you to work with.

Thank you.

11

Glad to hear about the McKenzie PT. However, research shows that athletes suffer from the same conditions as normal folk much of the time. Never be quick to rule out spine pain, it is incredibly mysterious and MRIs are mostly inconclusive. No MRI shows what actually is causing the pain. We believe they are helpful because it shows changes in anatomy, but many people never qualify that with degeneration itself doesn’t hurt and it is completely normal.

12

Glad to hear about the McKenzie PT. However, research shows that athletes suffer from the same conditions as normal folk much of the time. Never be quick to rule out spine pain, it is incredibly mysterious and MRIs are mostly inconclusive. No MRI shows what actually is causing the pain. We believe they are helpful because it shows changes in anatomy, but many people never qualify that with degeneration itself doesn’t hurt and it is completely normal.

Yea, but with a full patient history (showing a lack of generalized degeneration), the MRI is more useful and it is a diagnostic tool to help put together the pieces of the puzzle.

13

It’s not generally useful in non specific low back pain. In fact 50% of individuals over 40 would have. Positive MRI for back problems regardless of whether or not there is pain. MRIs are useful in radicular pain below the knee. This implies nerve compression and possible mytomal and/or sensation changes. MRIs should be used sparingly and according to clinical prediction rules, not just to see what is going on because the results will be useless.

14

What saddle did you use during your pain free riding?

What saddle are you using now?

What saddle do you have on your Mtn bike?

15

What saddle did you use during your pain free riding?

What saddle are you using now?

What saddle do you have on your Mtn bike?

I don’t think that I can hijack my own thread…

I’m looking at Selle Anatomica… any feedback on that brand?

16

What saddle did you use during your pain free riding?

What saddle are you using now?

What saddle do you have on your Mtn bike?

I don’t think that I can hijack my own thread…

I’m looking at Selle Anatomica… any feedback on that brand?

I don’t understand. I’m curious because it may be the saddle itself causing the problem. I have experienced something similar myself and it’s very saddle specific.

17

What saddle did you use during your pain free riding?

What saddle are you using now?

What saddle do you have on your Mtn bike?

I don’t think that I can hijack my own thread…

I’m looking at Selle Anatomica… any feedback on that brand?

I don’t understand. I’m curious because it may be the saddle itself causing the problem. I have experienced something similar myself and it’s very saddle specific.

Yea man, my point is that I’m happy to discuss anything about this condition and swim/bike/run.

I have changed saddles about 10 times, but all of the saddles that I’ve tried have caused at least some degree of discomfort.

It looked like you proposed your questions to Calvinbal, but in case that you were asking me, then I’ll gladly share…

Road saddle: Specialized S-Works Toupe 130mm
Tri saddle: Last three saddles were Adamo TT, Cobb Max, and the Specialized Sitero.
Mtn: Specialized S-Works Phenom

18

Thanks for the info.

On my road bike it flares when I use a saddle that doesn’t have “sides” to it. For example, a Fizik Antares causes the pain whereas a Fizik Alisnte does not. a Phenom does, the Chicane does not.

On my TT bike it happens on my ISM road or ISM prologue on hilly courses where I push back to in effect relax the seat angle (to get more setback when climbing).

I’ve concluded that for me it’s an issue of either 1) using a road saddle that doesn’t have sides to it and I pinch the upper hamstring against the pelvis or 2) I try to simulate higher setback when in the aero position (forward pelvic rotation, more compressed hip angle) and I jam myself back onto the widest part of the saddle.

This doesn’t quite explain why the Phenom works for you on the Mtn bike. Do you happen to have significantly more setback on your Mtn bike than your road bike?

-Chris

P.s. I am a bike fitter so I think about this stuff a lot.

19

Thanks for the info.

On my road bike it flares when I use a saddle that doesn’t have “sides” to it. For example, a Fizik Antares causes the pain whereas a Fizik Alisnte does not. a Phenom does, the Chicane does not.

On my TT bike it happens on my ISM road or ISM prologue on hilly courses where I push back to in effect relax the seat angle (to get more setback when climbing).

I’ve concluded that for me it’s an issue of either 1) using a road saddle that doesn’t have sides to it and I pinch the upper hamstring against the pelvis or 2) I try to simulate higher setback when in the aero position (forward pelvic rotation, more compressed hip angle) and I jam myself back onto the widest part of the saddle.

This doesn’t quite explain why the Phenom works for you on the Mtn bike. Do you happen to have significantly more setback on your Mtn bike than your road bike?

-Chris

P.s. I am a bike fitter so I think about this stuff a lot.

It seems like you might be onto something here…

I’m not sure how to compare the setback of the mtn bike to the road bike, but based on the mtn bike’s slacker geometry and the seat tube angle, then it seems like that the mtn bike has to be setback more more compared to the road bike.

Even the stem choice affects the pelvic angle and also the amount of pressure placed on the perineum.

20

Hopefully we can come up with something significant here.

You can easily measure setback on the two bikes by dropping a plumb (weighted string) from the nose of the saddle and measure distance to the center of the BB. Make sure the bike is level, or at least make sure the two bikes are on the same piece of floor when you measure them (to ensure that whatever angle they are that it’s the same for both bikes).

It takes some finagling to make sure theplumb line isn’t being caught on the bike anywhere (I.e. Dragging on the frame) but you’ll get it.

If you have a vertical laser line (like for home projects) you can use that to project a vertical line through the bottom bracket and then Measure setback to the nose of the saddle.

Since different saddles have different lengths and proportions I prefer to mark a consistent point on the saddle (I usually mark it at the point where it’s 70mm wide) and then measure to that point instead of the nose.