Finding the Right Bike Saddle for Pelvic Comfort

By Morgan Connor, DPT, PHRC Los Gatos

Since I am sure you haven’t memorized the PHRC staff bios, I’ll give you a little background on myself: Last year I got into triathlons and now spend a lot of time riding my bike. This past spring I finally bit the bullet and decided to get a bike for myself. After riding two different borrowed bikes, I decided it was time but I was worried about getting the right bike. I was recommended by a neighbor to go to a small local bike shop called Véloro Bicycles and that the owner, Gebhard Ebenhoech, was great. True to her recommendation, Gebhard spent the time to help me figure out the right bike and after a fitting, I settled on the Intenso Dama Bianca. After it arrived and I took it out for a short test ride, it was a dream compared to the bike I was on before that was too small; it felt great… except for the saddle. Oh my goodness, the factory saddle was not going to fly, it felt like razors were trying to spread my sitz bones apart. Ok maybe a little exaggeration, but still a problem. Discomfort and pain from bike saddles are a very real problem and can cause all sorts of pelvic floor issues. Kim’s blog post on bicycle saddles gives a great overview about some of the reasons bike saddles can cause pelvic floor pain.

Morgan’s Bike. Intenso Dama Bianca

Let’s get this out of the way: Finding the right bike saddle is a challenge. That might be why you are here at this blog post, because you can’t find the right saddle. Maybe you’ve read a bunch of articles about how to find the right saddle and are still confused. This is not one of those articles as I do not have an encyclopedic knowledge of bike saddles and I am still learning about all the different elements of bike saddles. However, I personally know how frustrating it is to try to figure out the right saddle and my goal of this post is to give you some tools that I found helpful and to give you hope. I found the right saddle and you can too!

I went through four different saddles until I found the right saddle. The first saddle I tried after the factory saddle was the “611 Active saddle with TITube” by SQ labs. Unlike the curved factory saddle, it is flat and firm with an indented cutout. Gebhard explained that a curved saddle is preferred by high level racers with aggressive racing positions who want to be able to easily move around in their saddles and are not putting a lot of weight on the saddle, but probably not good for someone like me, ie not a high level racer (I probably ride about 50-100 miles a week on average).

This saddle felt better and I was able to do a longer ride (~25 miles) with no sit bone wedge torture. However, I still was not very comfortable as my sit bones felt very uncomfortable with how hard the saddle was and I was also starting to get some discomfort, pain and occasional numbness more anteriorly into the soft tissues. Check out this blog post and webinar about the anatomy of the pelvis and pelvic floor . Additionally, because I was now changing my riding position my hands were also getting numb. So it was a no go for me on saddle number two.

For saddle number three, Gebhard suggested the “Selle Italia Lady Gel Flow.” (This saddle has a narrow cutout which we hoped would help with the compression on the anterior soft tissues. This saddle also has softer padding so hopefully some relief of the sit bone pain. I was hopeful but apprehensive because with a softer saddle you sink into the cushion and as the pressure gets distributed you may actually have more pressure somewhere that is not able to handle that pressure ie soft tissue vs sit bones. “If you are a little sore in the sit bones after your ride” explains Gebhard, “that’s what you want. If you were to sit on a park bench and be uncomfortable in your sit bones only, that’s good.” Knowing this I decided to again do a longer ride to make sure that the relief I was feeling on the test ride for the Gel Flow would last. Long story short, it did not! While the soft tissue pain as well as the sharp pain in my sit bones had lessened, it was still there and I had a new problem: pinching in the gluteal fold (this is the place where cheeks meet legs and cause a crease.) So again, not my perfect saddle.

To recap so far: none of the saddles provided complete relief of sit bone or anterior pain and one saddle also caused pinching! When I went back to the shop yet again, the next saddle we tried was the “Selle Italia SLR Lady flow.” This saddle was similar in shape to Gel Flow but with less padding and larger cutout. I had thought that the pinching in the gluteal fold was from the shape of the saddle, Gebhard thought it was more likely from the softer cushion. I was sinking into it as predicted and the result was pinching. If that was indeed the case then the firm cushion should help. To my surprise, it did! While the saddle was less comfortable in the first two to three miles of a ride, it actually started to get more comfortable the longer the ride. Although I still have some pain in the sit bones with this final saddle, I got a new pair of cycling shorts with a thicker chamois that improved the sit bone pain.

Morgan’s Bike

Success!

Finding the right saddle is a process. There are no universally perfect saddles that will work for everyone, but you can find the right one. Here are my three pieces of advice:

1) Have patience: As much as I wanted to right saddle quickly, I took my time to test each one, trying it out on a couple longer rides to pinpoint the exact problems with each saddle so that it could be remedied with the next one.

2) Find a local bike shop that will work with you: Having someone who I could talk to was so helpful. Even as a pelvic floor physical therapist who knows more than the average person about the pelvic floor, I would not have guessed that a harder saddle would have felt better in the end. Additionally, being able to get help from someone who knows what saddles are available and how different saddle features can help remedy different complaints was essential for me in finding the right saddle. Also, I’m a giant nerd and I loved asking a million questions about various saddles like is there a huge difference between men’s and women’s saddles?? (There is but that doesn’t always mean that the right saddle will match what you have between your legs)

3) Don’t be afraid to talk about the problematic location: I cannot stress enough the importance of correctly identifying where the problem is located. Most bike shops and many other cyclists have probably heard about or experienced some sort of saddle related pain. If you don’t feel comfortable using the anatomical names (clitoris, labia, vaginal introitus, penis, scrotum, perineum, ischial tuberosities, gluteal fold, etc) at least identify if it’s boney or soft tissue and whether it’s in the front or back. Being able to communicate where the problem is will help the person assisting you to make a good suggestion.

Lastly, while the Selle Italia SLR Lady Flow works for me, it might not be the perfect saddle for you and just because the other three saddles didn’t work for me, don’t let that scare you from trying them, they might work for you and be the saddle of your dreams! Your bike, riding position and style, pelvic anatomy and clothing are all going to affect which saddle is right for you. Good luck and see you out on the road!

Morgan on her first long ride with the winning saddle!

Thank you to Gebhard Ebenhoech for helping me out. If you would like to check out his shop you can find Véloro Bicycles on the web, on Facebook. or Instagram. Or go if you’re local, you check the shop out at their address below:

910 Main St,

Redwood City, CA 94063

I would love to hear your saddle stories in the comments. Everyone’s experience is a little different and I think we can all learn from each other.

FAQ

What are pelvic floor muscles?

The pelvic floor muscles are a group of muscles that run from the coccyx to the pubic bone. They are part of the core, helping to support our entire body as well as providing support for the bowel, bladder and uterus. These muscles help us maintain bowel and bladder control and are involved in sexual pleasure and orgasm. The technical name of the pelvic floor muscles is the Levator Ani muscle group. The pudendal nerve, the levator ani nerve, and branches from the S2 – S4 nerve roots innervate the pelvic floor muscles. They are under voluntary and autonomic control, which is a unique feature only they possess compared to other muscle groups.

What is pelvic floor physical therapy?

Pelvic floor physical therapy is a specialized area of physical therapy. Currently, physical therapists need advanced post-graduate education to be able to help people with pelvic floor dysfunction because pelvic floor disorders are not yet being taught in standard physical therapy curricula. The Pelvic Health and Rehabilitation Center provides extensive training for our staff because we recognize the limitations of physical therapy education in this unique area.

What happens at pelvic floor therapy?

During an evaluation for pelvic floor dysfunction the physical therapist will take a detailed history. Following the history the physical therapist will leave the room to allow the patient to change and drape themselves. The physical therapist will return to the room and using gloved hands will perform an external and internal manual assessment of the pelvic floor and girdle muscles. The physical therapist will once again leave the room and allow the patient to dress. Following the manual examination there may also be an examination of strength, motor control, and overall biomechanics and neuromuscular control. The physical therapist will then communicate the findings to the patient and together with their patient they establish an assessment, short term and long term goals and a treatment plan. Typically people with pelvic floor dysfunction are seen one time per week for one hour for varying amounts of time based on the severity and chronicity of the disease. A home exercise program will be established and the physical therapist will help coordinate other providers on the treatment team. Typically patients are seen for 3 months to a year.

What is pudendal neuralgia and how is it treated?

Pudendal Neuralgia is a clinical diagnosis that means pain in the sensory distribution of the pudendal nerve. The pudendal nerve is a mixed nerve that exits the S2 – S4 sacral nerve roots, we have a right and left pudendal nerve and each side has three main trunks: the dorsal branch, the perineal branch, and the inferior rectal branch. The branches supply sensation to the clitoris/penis, labia/scrotum, perineum, anus, the distal ⅓ of the urethra and rectum, and the vulva and vestibule. The nerve branches also control the pelvic floor muscles. The pudendal nerve follows a tortuous path through the pelvic floor and girdle, leaving it vulnerable to compression and tension injuries at various points along its path.

Pudendal Neuralgia occurs when the nerve is unable to slide, glide and move normally and as a result, people experience pain in some or all of the above-mentioned areas. Pelvic floor physical therapy plays a crucial role in identifying the mechanical impairments that are affecting the nerve. The physical therapy treatment plan is designed to restore normal neural function. Patients with pudendal neuralgia require pelvic floor physical therapy and may also benefit from medical management that includes pharmaceuticals and procedures such as pudendal nerve blocks or botox injections.

What is interstitial cystitis and how is it treated?

Interstitial Cystitis is a clinical diagnosis characterized by irritative bladder symptoms such as urinary urgency, frequency, and hesitancy in the absence of infection. Research has shown the majority of patients who meet the clinical definition have pelvic floor dysfunction and myalgia. Therefore, the American Urologic Association recommends pelvic floor physical therapy as first-line treatment for Interstitial Cystitis. Patients will benefit from pelvic floor physical therapy and may also benefit from pharmacologic management or medical procedures such as bladder instillations.

Who is the Pelvic Health and Rehabilitation Team?

The Pelvic Health and Rehabilitation Center was founded by Elizabeth Akincilar and Stephanie Prendergast in 2006, they have been treating people with pelvic floor disorders since 2001. They were trained and mentored by a medical doctor and quickly became experts in treating pelvic floor disorders. They began creating courses and sharing their knowledge around the world. They expanded to 11 locations in the United States and developed a residency style training program for their employees with ongoing weekly mentoring. The physical therapists who work at PHRC have undergone more training than the majority of pelvic floor physical therapists and as a result offer efficient and high quality care.

How many years of experience do we have?

Stephanie and Liz have 24 years of experience and help each and every team member become an expert in the field through their training and mentoring program.

Why PHRC versus anyone else?

PHRC is unique because of the specific focus on pelvic floor disorders and the leadership at our company. We are constantly lecturing, teaching, and staying ahead of the curve with our connections to medical experts and emerging experts. As a result, we are able to efficiently and effectively help our patients restore their pelvic health.

Do we treat men for pelvic floor therapy?

The Pelvic Health and Rehabilitation Center is unique in that the Cofounders have always treated people of all genders and therefore have trained the team members and staff the same way. Many pelvic floor physical therapists focus solely on people with vulvas, this is not the case here.

Do I need pelvic floor therapy forever?

The majority of people with pelvic floor dysfunction will undergo pelvic floor physical therapy for a set amount of time based on their goals. Every 6 -8 weeks goals will be re-established based on the physical improvements and remaining physical impairments. Most patients will achieve their goals in 3 – 6 months. If there are complicating medical or untreated comorbidities some patients will be in therapy longer.