Written by: Michelle Boileau, RPT
Date published: December 18, 2024
Cycling has grown in popularity over the years as a form of transportation and exercise. It improves your fitness and decreases your risk of cardiovascular disease, cancer, obesity and all-cause mortality. Despite these positives, cycling may have a significant impact on your pelvic health whether you’re a seasoned cyclist or a casual rider, no matter what gender. Want understand the relationship between cycling and the pelvic floor? This can help make your ride more comfortable and protect your body in the long run!
What is the pelvic floor?
The pelvic floor consists of three layers of muscle that form the floor of your core. It is responsible for supporting organs, maintaining bowel and bladder control, sexual function and providing stability to your lower back and hips. Common symptoms of pelvic floor dysfunction include urinary incontinence, lower back pain and prolapse in addition to many other symptoms.
Click here to learn more about how a pelvic health physiotherapist can help you cycle better! Click here to learn more about pelvic floor physiotherapy at Tru Physiotherapy.
How cycling affects pelvic health
Most riders have likely experienced some degree of discomfort on the perineum (the area between the genitals and anus). I know I certainly have. In fact, the most common cycling related problem affecting the urinary and genital organs is nerve entrapment. This presents as genitalia numbness and/or pain, affecting up to 54% of male cyclists and 58% of female cyclists. Nerve entrapment syndromes occur because of sustained pressure on the perineum. The pressure compresses the sensitive neurovascular structures in the region, thereby decreasing blood flow and nerve conduction. Ultimately, this impairs the pelvic floor muscles’ ability to effectively contract and relax. This can lead to symptoms such as:
Urinary incontinence (leaking with sneezing, coughing, jumping etc.)
Urinary frequency and urgency (sudden urges to urinate; urinating every < 2 hours)
Sexual dysfunction (painful intercourse)
Perineal numbness
Lower back, pelvic and / or hip pain
Pelvic floor overactivity
Cycling also impacts the health of your skin. Excessive friction between your skin and the saddle, combined with increased sweating is a recipe for irritation and chaffing. This can lead to symptoms such as:
Saddle sores (painful skin lesions), rashes
Cracked and broken skin, swelling, bleeding
Skin hyper-sensitivity and pain
Skin infection
While these symptoms are quite common among cyclists, there are several ways to protect your pelvic health while riding:
Optimizing bike set up and position
Bike fitting is known to help optimize performance and comfort while decreasing pain when riding. However, there is conflicting evidence regarding whether bike fitting decreases your risk of injury.
A professional bike fit will help you determine your optimal measurements related to your saddle and handlebar. The saddle should be bearing ~ 60% of your body weight. If your seat height is too high or too low, the saddle pressure will be much higher leading to increased discomfort when riding.
It’s important to note, even with the “perfect” bike fit, there are still several other factors to consider that contribute to pressure distribution (e.g., riding position and pedaling technique. For example, riding in the drops (the curly bit of the handlebar) puts more pressure on the front of your perineum vs. riding upright will place more pressure onto your sit bones (which tends to be more comfortable).
This is where a pelvic floor physiotherapist can come in and assist you in understanding how to optimize your bike fit and positioning to be specific to you as an individual. Making sure you are on top of your pelvic health and able to achieve your cycling goals!
Saddle selection
There is a wide range of saddles of different shapes and sizes; some have cut-outs and others don’t, some are short, some are long. So, which is the best in the context of pelvic health? Well, it depends.
Studies that mapped saddle pressure distribution found that each rider on the same saddle demonstrated an individual pressure pattern. What does this mean?
Saddle shape and design is a matter of personal preference and cannot be simply determined by measurement or algorithm. Preference will depend on the type of riding you are doing and your own anatomy.
Ideally, pressure should be distributed posteriorly towards your sit bones, away from sensitive structures in the front of the perineum. Measuring your sit bone width is a helpful place to start when searching for a saddle.
On average, sit bone width for men is 60-160 mm and 90-170 mm for women. Add 20-25 mm to this measurement to determine saddle size. Sounds simple enough right? In some instances, riders may find a wider or narrower saddle more comfortable and less painful. Therefore, the best way to find the saddle that works for you is to try as many saddles as you can and see which one works best!
I’ve tried a few saddles over the years and have personally found my stock saddle to be the most comfortable (so far). I tried the Power Mimic saddle by Specialized, which was initially designed for women, but is now marketed as unisex. It features an indent in the center intended to alleviate pressure. I read many positive reviews on the saddle and so I figured I would give it a try! After several weeks, I unfortunately found it too uncomfortable. Despite this saddle working for many riders, it’s not going to be suitable for everyone. This further highlighted how saddle selection is an individualized choice and not a one size fits all. If only it were that easy!
Maintaining efficient posture and technique when riding
How a rider interacts with their bike is equally as important as the bike fit itself. A proper bike fit is what optimizes your ability to interact with your bike.
In terms of position, we want to keep the body loose and relaxed, with a slight bend in the elbows. Tension in the neck and shoulders can lead to unnecessary energy expenditure. We also want to make sure we’re not excessively rounding the shoulders and upper back. This will compromise our ability to breathe deeply.
A proper gear ratio for optimal cadence of 60-90 rotations per minute (rpm) is also important. If your rpm is either too high or too low, pressure increases on the perineum. An rpm of this range is also generally more efficient as it reduces muscular fatigue.
By conducting a comprehensive assessment a pelvic physiotherapist can help you work towards being more efficient, comfortable and powerful on your bike!
Pressure management strategies
Even with the perfect saddle selection and bike fit, the perineum is sustaining 60% of our body weight and is therefore still susceptible to pressure-related injuries. This is why off-loading the perineum is important (especially on longer rides and indoor training rides).
Standing up and changing your pelvic position and/or hand position every so often during a ride is a helpful way to temporarily relieve pressure on the perineum (thereby restoring blood flow). Riding in the drops puts more pressure on the anterior perineal region, so changing hand positions will directly impact saddle pressure distribution.
This may not be as relevant during the summer months, as we’re likely to be stopping at the occasional red light or stop sign. During indoor rides, we are riding for longer periods of time without getting off the bike, increasing the risk of discomfort.
Use chamois cream
Using an antibacterial chamois cream helps to decrease friction, which is especially helpful during warmer summer months when we sweat more.
There are specialized creams for women that are pH balanced. These do not disrupt the acidity within the vagina micro-biome and should not increase the risk of infection.
Most local bike shops carry chamois creams, and it is relatively inexpensive. I personally found a huge difference in comfort and skin irritability when I started to use chamois cream. I highly recommend it for cyclists who are riding for long periods of time.
Wear clean, appropriately fitted chamois shorts directly over the skin
Cycling shorts have a chamois (a thick pad that provides extra cushioning for the perineum). Different brands have different styles of chamois, some may provide more comfort than others. We all have our favourite pair of bib shorts!
Cycling shorts are designed to be worn without an extra layer of fabric. Wearing under-garments affects how well the chamois pad absorbs sweat and may increase the risk of a urinary tract infection.
Cycling shorts should fit snugly but not feel too tight. Shorts that are too loose may cause chaffing and shorts that are too tight may restrict your mobility.
Wearing different brands of chamois pads on back-to-back riding days is a helpful way to change the pressure distribution on the perineum.
Wearing a properly fitted pair of cycling shorts can really help maximize comfort on the saddle. Similarly to saddle selection, selecting a suitable chamois short is highly individualized and subject to personal preference.
Proper hygiene
After a ride (no matter how tired you may be), it’s good practice to change out of your sweaty cycling clothes to prevent skin irritation.
Use a mild, unscented, and hypoallergenic soap when showering. Focus on areas that are prone to chafing such as the inner thighs and groin. Be gentle and avoid using loofahs or washcloths. This can irritate the skin. Gently pat or air dry afterwards.
Clip pubic hair (instead of fully shaving or waxing), as the hair in this region helps to provide an additional barrier between your pelvis and the saddle. The act of shaving may also damage or irritate the skin and hair follicles which will contribute to additional discomfort when riding.
Gradually increase riding time and emphasizing recovery
Even with a professional bike fit, we need to be mindful about gradually progressing training volume over time. Doing “too much too soon” is a significant risk factor for developing an overuse injury or a saddle sore. Gradually increasing riding time and intensity allows the body (including muscles, tendons, joints, skin etc.) time to adapt and recover.
Recovery is equally, if not more important, than the training itself. Taking rest days is crucial to allow time for the body (including the skin) to adapt to the training stimuli. So doing more is not always better. Prioritizing sleep, nutrition and stress management is key to maximize all the benefits of cycling! A pelvic floor physiotherapy can help you develop, manage and execute a program that is specific to you and your goals so that you can safely and efficiently progress your training.
How can a pelvic floor physiotherapist help you?
Pelvic floor dysfunction is common amongst cyclists and often riders present with an overactive pelvic floor and difficulty with relaxation. This can result in urinary urgency and frequency, incontinence, or pelvic, lower back and/or hip pain.
A pelvic floor physiotherapist will conduct a thorough examination of your pelvis, assessing for muscle tone, strength and coordination of your pelvic floor and the pelvis as a whole. This will help determine which types of pelvic health exercises are suitable for you. For example, if a rider has an overactive/overly tight pelvic floor, pelvic floor exercises can make their issues worse.
In addition to the pelvic floor, a pelvic floor physiotherapist will also assess the strength and mobility of your mid- and low back, hips, knees and ankles to address any mobility deficits and/or muscular imbalances present that might be affecting your riding. In the long run, this can improve both cycling efficiency and performance and decrease risk of injury.
Click here to book an appointment at Tru Physiotherapy for an assessment to see how your pelvic floor could be impacting your cycling, or vice versa! Click here to learn more about Michelle, our pelvic physiotherapist with cycling expertise at Tru Physiotherapy.
Conclusion
Cycling is a great way to improve your cardiovascular health and overall fitness. However, it may pose some risk to your pelvic health. By paying attention to your bike fit, saddle choice, cycling technique, and incorporating additional strengthening exercises that are catered to your needs, you can enjoy the benefits of cycling without undue compromise to your pelvic health. Always listen to your body and with the support of pelvic health physiotherapy, you can make the adjustments you need to ensure a safe and comfortable ride for years to come. With the right approach, cycling can become a lifelong, enjoyable activity that benefits both your physical fitness and your pelvic health.
Happy cycling! 🚴♂️🚴♀️
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