Peudendal Neuralgia: A Pain in the Saddle

Peudendal Neuralgia: A Pain in the Saddle

“Snakes in the pelvis,” “burning in the undercarriage,” “fiery pain in sitting.” These are all descriptors that signal a condition called pudendal neuralgia, which results when compression or trauma arises within the pudendal nerve. The pudendal nerve is an important nerve that courses through the pelvis to supply a vast distribution of sensation and motor function to the perineum and pelvic floor muscles. As is the case for most conditions, pudendal neuralgia can arise due to a variety of reasons, but one that is important to highlight in today’s society is compression on the nerve due to prolonged sitting, particularly on a bike seat.

Cycling in many forms is gaining increasing popularity across the US, whether it be spin classes, road cycling, mountain biking, or commuting to work via commuter bike. Bike seats aren’t usually the most comfortable things to sit on at first, but there is a right fit and a wrong fit to a bike seat and the overall bike itself. Ultimately, an ill-fitted bike seat paired with prolonged bike rides can lead to increased compression on the pudendal nerve, causing unpleasant symptoms such as burning, tingling, or the feeling of pins and needles near the sit bones and/or within the entire perineum (ie, the undercarriage). Often, this pain goes away at night when the body is at rest and nerve is not being compressed but starts back up again upon getting up for the day (and especially upon sitting). For most people with pudendal neuralgia caused by cycling, symptoms appear after prolonged biking, sometimes months or years later. In other words, by the time you realize there is a problem, the repeated trauma has already caused some undesirable chronic tissue responses. In other words, the pelvic floor muscles and supporting connective tissues are tight and painful and the nerve is beyond irritated.

When pudendal neuralgia arises in response to sitting on certain types of bicycle seats, it is also termed “cyclist syndrome.” In order to treat and/or prevent pudendal neuralgia, cycling professionals and physical therapists advocate for different bike seats and overall improved bike fits to avoid nerve compression in the saddle region. Lauren Esmailka, PT, bike fit specialist at Elizabeth Rogers Pilates & Physical Therapy, says, “Trying out a new bike seat and/or having a bike fit can often improve the overall efficiency on a bike as well as reduce repetitive strain on certain body parts. A bike fit with a physical therapist can also help you determine if prolonged sitting on the bike seat is the causative.” You may be able to avoid pudendal neuralgia by taking regular rest breaks during periods of cycling, or by taking time off between races or training periods to “rest” the pelvic nerves and musculature.

If you are starting to develop pelvic pain symptoms, take a rest and schedule with Kelsea Cannon, PT, our pelvic health physical therapist or Lauren Esmailka, PT, our bike fit specialist as soon as you can. At Elizabeth Rogers Pilates & Physical Therapy, these two professionals will work together to address the cause of your pelvic pain. The way to treat this unpleasant pain is to catch it early and work preventatively as soon as you can.

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Covid-19 Notice

3/27/2020 Covid-19 Notice:

On March 19th, we made the difficult, yet important decision to close both clinics, in order to do our part to flatten the curve. We will reopen the clinics part time on Monday, April 6th, with an emphasis on telemedicine. This will allow us to comply as much as possible with the governor's Stay Home Stay Healthy order if it is extended, while also meeting our obligation as essential infrastructure workers. According to Dr. Matos, an expert in biological surety and the management of select agent programs at federal facilities: "Physical therapists are essential in flattening the curve of the Covid-19 pandemic. They play a key role in keeping people they can help out of doctors' offices and ER's. This will not only free up the medical teams to treat those impacted by Covid-19, but also limit the exposure of those seeking the care of the physical therapist." To that end, we will focus on telemedicine, but also allow for select, necessary in-office treatments for low risk, healthy individuals. This will be a joint determination between you and your PT. Many, if not all of our patients, have come to appreciate the effectiveness and efficiency of the hands-on manual therapy techniques our physical therapists use to help relieve pain and improve function. So, we recognize that a telemedicine visit may not seem as appealing. At this time, telemedicine is the appropriate and safe way to continue your care without further interruption and your physical therapists are prepared to alter their approach in order to still provide effective care.

During our temporary closure, your physical therapists have been on unemployment and not able to contribute to our communities financially as they normally would like to. Getting back to work, providing your care will allow us to resume caring for you and our community. For every telemedicine visit we provide in April, the clinic will donate $5 to the following organizations:

Kelsea Cannon, PT- Westside Baby
Lauren Esmailka, PT- Treehouse
Elizabeth Rogers, PT- Rainier Valley Food Bank

We remain passionate about helping you improve and maintain the function of your movement system so that you can do the activities you love. I remain available for urgent (i.e. post-op care, acute injury, treatment needed to decrease/avoid use of NSAIDs and Opiods) in-clinic treatment and telemedicine treatment from now until April 6th. We invite you to follow/Like our  Facebook page, where I am offering complimentary weekly Pilates mat class on Wednesdays at 7am and foam roller class on Fridays at 7am. All are welcome to participate in these classes or view them anytime on our Facebook page.

Please contact me directly with any questions or concerns. If you are a current patient, you should have received an email from me with scheduling/rescheduling info. Be in touch with your PT to schedule your telemedicine visit. I am available via clinic phone (206-535-7356) and email ( We will update you here and our Facebook page as things change.

We are counting the days until we get to resume our work together both virtually and in the clinic! Thank you for your support of this small, locally-owned physical therapy private practice!

Elizabeth Rogers, PT

Owner, Elizabeth Rogers Pilates & Physical Therapy, PLLC

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