It sure is a touchy subject ( so to speak) but ladies we really need to talk about saddle soreness and specifically what’s normal and what’s not. Research through the years has mainly focused on male cyclists with only a few studies on women. But saddle soreness for women can lead to all sorts of troubles with pain and discomfort in the genital region.

​Being uncomfortable on the saddle could also be the underlying cause of a cascade of other cycling problems from lower back pain, poor pedalling efficiency , hand numbness, foot numbness, shoulder pain  and an overall desire to stop riding because it just hurts too much!!
 
So I thought I would do a quick post and answer the 4 most common questions I get asked about having a saddle soreness for women after riding from a sports medicine point of view.  Language warning people …. we are going to be talking about "girly bits" And before you start laughing too much guys - next week it’s your turn when we talk about “nuggets of truth” for men and their saddle issues!

Isn’t it normal to have saddle soreness and  numbness after riding?
Whilst it is common (studies suggest that between 62 and 80% of women cyclist have saddle numbness) it certainly is not good and is not acceptable.  Numbness occurs due to compression of the “nervus dorsalis clitoridis” on the saddle: Latin for nerve getting squished resulting in decreased clitoris sensation and genital numbness. 

You should be able to ride without saddle numbness and you should never have trouble urinating after riding, regardless of distance, speed or time on the bike.  No exceptions.  EVER!

And if you can’t then there is something wrong with you bike set up.

But it doesn’t stay numb very long after I stop riding – so that’s ok isn’t it?

Well that depends on your definition of “long”. Chronic traumatisms, calcification of the clitoris and degeneration of clitorial structure have been noted in women who have been riding for more than 2 years.  Truth is a once off “numbness episode”   is probably not a problem. BUT if you continually squish your clitoris’s nerve on the saddle – and it is constantly going numb - over time you can end up with a condition called “Anorgasmia”.  “An” from the Greek meaning without and “orgasmia” – well you can probably work out what that means ; )

Ok, ok – so I admit there is a problem. My friend has bought a “ ( insert name of saddle here)”  saddle that has worked for her, should I just go buy that one?
There are so many different saddle choices nowadays - it is not unusual for me to see someone who has tried 10 or more different saddles to try and to find the perfect fit and yet still have a genital numbness. And every woman is built differently down there – some peoples labia minora are more major than minor if you know what I mean….so don’t assume your friend is the same as you!

Contrary to popular opinion,  scientific studies have  shown that cut out saddles are great for men with bike related erectile dysfunction  issues  on a road bike, terrible for blokes on a mountain bike and can actually increase pressure on a woman’s labia and clitoris leading to sexual dysfunction for the woman!

Wider saddles may not be the answer for every woman with  one study has suggesting that wider saddles can be a cause of dysuria and stranguria (pain and trouble urinating) in women and another study has suggested that cut out saddles cause swelling of the vulva when compared with traditional saddles for women.

So what should I do then?
Pressure mapping of the saddle can help work out where and what saddle you should be riding.  It is a fool proof way of deciding what is good and what is not so good. If you don’t have access to that then opt for a safe bet and at least a "ladies" saddle

Changing handlebar height might offer the most immediate source of relief.  Handlebars placed above the lowers saddle pressure and protects against reduced genital sensation as compared with riding with hands in a low position.  Because women have a lower centre of gravity than men it means we can’t transfer our weight onto our hands as effectively. This equals more pressure on our girly bits than our hands. The way to circumvent this is to get your handlebars up!

Unfortunately, riding in a more upright position does mean you won't be quite as aerodynamic but when choosing between aerodynamics and comfort I know which one I would go for!
 
Happy riding!
Daina 

​Iliotibial band syndrome (ITBS) is the most common injury of the outside of the knee in runners and it is also the major cause of lateral knee pain in bike riders. In the good old days, the way we treated it was to jump on a foam roller and inflict as much pain as possible to ourselves as we tried to “stretch” the ITB and roll out the ‘adhesions’ in the tissue. The thing is that as you self-inflicted some major pain with the roller; your knee pain often didn’t get any better.
 
Here are some common questions about the ITB
 
Can you stretch your ITB?
The simple answer is no! The ITB is an incredibly dense fibrous band of tissue and has a firm attachment to the entire length of the femur which means any potential lengthening is physiologically impossible. Research has shown that in fact it can only change length by about 2mm or less than 0.2% of it's overall length. No amount of stretching will change it's length.
 
Should I roll my ITB?
Probably not. The last thing we want to do to a tissue that is painful because of a compression issue is to compress it further by rolling on it with our body weight.
Early research into ITBS suggested that it was a frictional condition that caused inflammation where the ITB attaches to the lateral femoral condyle (think outside bone of the knee) but recently this theory has been challenged with suggestion that ITBS is more likely caused by excessive compression of the layer of fat between the ITB and the bone.

So if the ITB can't stretch and hates compression, best to avoid the foam roller

What about taking anti-inflammatories?
As we said - new research challenges whether inflammation of the ITB is actually occurring when it's sore. So anti-inflammatories are probably not going to be the answer.
 
What about using a foam roller on other muscles?
There is good evidence that foam rolling
1. Helps mobility by improving the range of motion of the joints
2. Makes us feel good by reducing fatigue after exercise 
3. But it probably doesn't increase power or strength of muscles.

What should I do then if my ITB is sore?
Best bet is to focus your attention on the muscles at your hip - Gluteus Maximus and the Tensor Fascia Lata (TFL) which may be the cause of your pain. The TFL inserts directly into the ITB with the ITB behaving as an elongated tendon of the TFL. Also, a substantial portion of the Gluteus Maximus inserts onto the ITB too. Addressing any tightness or weakness in these muscles could have more of an effect on your knee pain than anything else. Soft tissue therapy, massage or dry needling the myofascial trigger points of these two muscles are good options. Seek out your allied health professional to expertly diagnose and treat the issue and save yourself the pain of the roll.