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Road Cycling It is by riding a bicycle that you learn the contours of a country best, since you have to sweat up the hills and coast down them. Thus you remember them as they actually are, while in a motor car only a high hill impresses you, and you have no such accurate remembrance of country you have driven through as you gain by riding a bicycle. -- Ernest Hemingway

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Old 12-01-12, 10:05 AM   #1
motorthings
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sitbone pain (specifically ischial bursitis)

due to what I am guessing is a combination of ill-advised 2 week saddle switch mid-season, and muscle imbalance and increase in miles/strength this year, I have developed bursitis in my left ischial bursa. this is not a saddle sore, but is simply an inflammation of the bursa on the ischia. the pain has come and gone over a 6 month period, despite a couple of separate full weeks off the bike.

i switched back to my original toupe expert saddle that has served me without issue for the last 3 years, but the pain has not gone away. recently i switched to a fizik antares versus saddle, and the pain is better, but is still not resolving.

i get pain for the first hour or so of a ride, then it mostly goes away, but comes back when I am sitting (off the bike), or falling asleep at night. finally i started to take it more seriously, and have been icing it 5-6 times per day, taking naproxen, and sitting on an extra pillow in my office chair. i had a trigger point treatment for it the other day, and am scheduled to see a bodywork fitness guru who gets high praise from local cyclists for his ability to find and correct muscle imbalances and mis-fires.

i am curious if anyone else here has dealt with this kind of pain, and if they found relief in any other kinds of treatment (like cortisone injection).
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Old 12-01-12, 10:12 AM   #2
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due to what I am guessing is a combination of ill-advised 2 week saddle switch mid-season, and muscle imbalance and increase in miles/strength this year, I have developed bursitis in my left ischial bursa. this is not a saddle sore, but is simply an inflammation of the bursa on the ischia. the pain has come and gone over a 6 month period, despite a couple of separate full weeks off the bike.

i switched back to my original toupe expert saddle that has served me without issue for the last 3 years, but the pain has not gone away. recently i switched to a fizik antares versus saddle, and the pain is better, but is still not resolving.

i get pain for the first hour or so of a ride, then it mostly goes away, but comes back when I am sitting (off the bike), or falling asleep at night. finally i started to take it more seriously, and have been icing it 5-6 times per day, taking naproxen, and sitting on an extra pillow in my office chair. i had a trigger point treatment for it the other day, and am scheduled to see a bodywork fitness guru who gets high praise from local cyclists for his ability to find and correct muscle imbalances and mis-fires.

i am curious if anyone else here has dealt with this kind of pain, and if they found relief in any other kinds of treatment (like cortisone injection).
I have, it was unbearable and would start within 5 minutes of riding, for me on the right side, and requiring shifting and lifting throughout the ride. This was on a Specialized Romin. Went to a Toupe, no luck, then a Fizik Arione and Antares with no luck I found complete relief literally immediately with a Brand new, Rock Hard, Brooks Professional which has become the greatest saddle I have ever ridden, in 40 years of cycling, ever.
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Old 12-01-12, 10:29 AM   #3
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Take a look at where the new saddle makes contact with your body an try to match the fit of the old one. I had those symptoms but was cured by adjusting fit. In my case it was a combination of cleats too far forward, saddle too high, and saddle too far rearward.

The change resulted in a fit where the saddle did not contact the inflamed bursa over the course of the pedal stroke, but applied pressure properly on the sit bones instead.

Use of a bike trainer at 15-30 minute stints per fit trial were helpful.


Best of luck.
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Old 12-01-12, 10:44 AM   #4
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i know a fair amount about fitting (having worked at a bike shop and trained in doing basic fits for a couple of years), but have been studying the kinds of alterations you are mentioning, and will give some of those adjustments a try. thanks!
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Old 12-01-12, 10:46 AM   #5
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i know a fair amount about fitting (having worked at a bike shop and trained in doing basic fits for a couple of years), but have been studying the kinds of alterations you are mentioning, and will give some of those adjustments a try. thanks!
Don't forget though....."Brooks, there is no other".
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Old 12-01-12, 11:51 AM   #6
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Yes there is, Selle Anatomica

After having surgery to remove cysts over my right sitbone, I could no longer sit on regular saddles because I was now asymmetrical (less tissue on the right than the left). First day I sat on the Anatomica, zero pain. If you have a tenderness issue on the sitbones or any sort of asymmetry, leather is the solution.
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Old 12-01-12, 11:53 AM   #7
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Never liked the gap idea.
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Old 12-01-12, 11:57 AM   #8
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I appreciate the suggestions, and am continuing to explore saddle possibilities, but don't want this to turn into just another saddle thread...anyone with experience in non-saddle treatments for this?
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Old 12-01-12, 11:59 AM   #9
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Well you did mention fitting, not sure other options are really out there save medication or steroid injections, both of which are bad ideas.
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Old 12-01-12, 11:59 AM   #10
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can you tell me more about why steroid injection is a bad idea?
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Old 12-01-12, 12:00 PM   #11
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Never liked the gap idea.
Well, the cutout allows for each side to flex completely independently. This is more for people who have structural asymmetry. You can get the anatomica without the cutout, however.
Benefits over the Brooks includes the leather being waterproofed and no break-in time
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Old 12-01-12, 12:02 PM   #12
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can you tell me more about why steroid injection is a bad idea?
To my mind it doesn't correct the root of the problem, only the symptoms. Changing your fit or your saddle to change the pressure points will address the root cause. If you did go down the injection route, I would do it only if I had addressed the root issue and was just looking for relief while you wait for the bursa to heal.
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Old 12-01-12, 12:02 PM   #13
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Waterproofing is a non issue as is break in time. I was immediately relieved of the pain on the very first mile with the brooks. Never have waterproofed it and I ride in all weather.
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Old 12-01-12, 12:27 PM   #14
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To my mind it doesn't correct the root of the problem, only the symptoms. Changing your fit or your saddle to change the pressure points will address the root cause. If you did go down the injection route, I would do it only if I had addressed the root issue and was just looking for relief while you wait for the bursa to heal.
That is my thinking exactly...once I get the root imbalance causing it fixed, if the bursa is still unhappy, I think a cortisone injection would help it calm down. it won't fix the problem by itself, but could help the symptom.
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Old 12-01-12, 04:17 PM   #15
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To my mind it doesn't correct the root of the problem, only the symptoms. Changing your fit or your saddle to change the pressure points will address the root cause. If you did go down the injection route, I would do it only if I had addressed the root issue and was just looking for relief while you wait for the bursa to heal.
We have a winner. Excessive sit bone pain is generally due to improper fit on the bike.
You can perform an experiment easily. Ride bolt upright and put your finger under your sit bone during the pedal stroke. You will be astounded by the contact to the seat through your finger. Now go into the drops and do the same thing. Rotating your pelvis forward will dramatically reduce pressure on your sit bones.
Go have a look at some Cobb videos on bike fit on youtube. You likely need a more aggressive bar position...either more forward, lower or both and work on your posture. A bar more forward will generally promote a straigher back and rotating your pelvis more forward. Many that ride hunch backed with too much weight on their sit bones...Brooks lovers...sorry....is due to the handlebar being too close to the rider. Btw, I am not a proponent of a lot of drop for a non racer. Nomially a good road bike cyclist will want to have a back angle of almost 45 degrees to vertical with arms comfortably draped on the hoods with well rotated pelvis...incidentally promoted by proper saddle setback to center rider weight. Also a saddle tipped too far down in front will pressurize sit bones more....rear of the saddle should be level and nose in the air.
Good luck.

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Old 12-01-12, 04:30 PM   #16
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i was actually checking out the steve cobb videos yesterday, and plan to make some similar changes (though not as drastic as his examples - since I have more of a race-fit with some drop to start with).
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Old 12-01-12, 05:05 PM   #17
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I appreciate the suggestions, and am continuing to explore saddle possibilities, but don't want this to turn into just another saddle thread...anyone with experience in non-saddle treatments for this?
Were you seen by a competent doctor? I had a similar pain last year, and it turned out to be the attachment point of the hamstring to the sit bone and not the sit bone itself. Rigorous work on releasing tension on the hamstring helped cure this for me. Rollers, stretching and pelvic flexibility exercises.
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Old 12-01-12, 05:27 PM   #18
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the doc was was my pain specialist, who is amazing, but perhaps not the final authority on all things like this. it was clear in that visit that the bursa was the location of the pain (and that the left ischial bursa was inflamed, while the right was not), but there was no determination of the original cause. i am seeing a specialist in a week who should be able to shed some more light on the cause.
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Old 12-01-12, 05:58 PM   #19
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can you tell me more about why steroid injection is a bad idea?
Steroids have the nasty tendency to cause changes in tissue strength, furthermore they relieve pain not by solving the problem but in reducing the inflammatory response. The pain you have is a signal that damage is being done, to hide that means the problem is perpetuated when what needs to be done is to solve the problem be it by fitting or saddle changes.
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Old 12-01-12, 10:03 PM   #20
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so it seems my approach seems to be pretty much in line with everyone's suggestions...thanks for all your input and advice. i'll post back with the resolution (hopefully soon!)
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Old 12-01-12, 10:24 PM   #21
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By the way, if icing is recommended, ice cups work wonders.
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Old 12-02-12, 08:02 AM   #22
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ice cup means something like this?
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Old 12-02-12, 08:41 AM   #23
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ice cup means something like this?
Exactly. These are much better since you get to control where the ice goes and give yourself a massage at the same time.

Best of luck at the dr next week.
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Old 12-04-12, 10:29 PM   #24
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I'll ask the OP a few questions:

1. What tyre width and pressure do you run?

2. How far below your saddle are your handlebars?

3. Just how long have you spent off the bike to try to recover?

I got a case of ischael bursitis last year, touring in Canada, on a new Brooks saddle on a new Ti bike, with tyre pressures somewhat higher than I normally run. It's take 12 months to subside enough to do rides over 50km, although I did do rides up to 300km in that year, and centuries a month up to April.

I've been resting a lot while in the US for the past month (driving instead of a lot of riding), and that appears to have helped heal the bursitis, although not entirely.

I am paying a lot more attention right now to rear tyre pressure after finding over the past couple of rides that lower is better -- I normally run my 25C tyres at 80psi, but have been up to 100psi on occasion, and that was what caused the problem in the first place.
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Old 12-05-12, 09:05 AM   #25
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Thanks for the info and ideas!

1. I run 23c tires, but have been interested in trying 25c (at least on the back). I am 150lbs and run 90/100psi front/rear

2. I have about a 7cm seat to bar drop at the moment but am going to drop the bars a bit more and do some fit checks to see about my seat setback, ability to balance with hands off bars (per John Cobb and Steve Hogg strategies).

3. I have taken a few single weeks off at a time during the season, but now am in the middle of a two week hiatus that includes a lot of not sitting in an office chair and a lot of icing of the ischia when sitting. Once I get back from this business trip, I may ride one day this weekend for 30-40 miles, but will wait on any more riding till I see the body muscle dynamics expert this coming monday.

I think going to a 25c rear tire is probably a good idea.
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