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

11/15/2020 Covid-19 Notice:

For the past 5+ months we have safely operated under our Covid-19 Exposure Control, Mitigation and Recovery Plan. This has allowed us to continue caring for our community and helping our clients return to the activities they love! As King County and all of Washington State are facing the third wave of Covid-19 cases, we remain open and committed to keeping you moving while also lessening the load on our primary care offices, urgent care clinics and emergency rooms. Our PT team is available for both in-clinic and virtual physical therapy visits and Pilates sessions. This allows us to comply with Governor Jay Inslee's Covid-19 Guidance on 11/15/2020, while also meeting our obligation as essential infrastructure workers. For in-clinic treatment/Pilates sessions, the PT will wear a mask and the client needs to wear a mask of their own. Social distancing is observed throughout the clinic and rigorous cleaning guidelines are followed. At times during your PT treatment, it may not be possible for your PT to observe social distancing, such as during certain manual therapy techniques. The need for in-clinic treatment vs. virtual or telehealth treatment will be a joint determination between you and your PT. You may review our Covid-19 Exposure Control, Mitigation and Recovery Plan for the details of how we provide safe, in-person care.

If you are seeing your extended family indoors or traveling via plane during the Thanksgiving holiday, we ask that you inform your PT so that we may switch your visits to telehealth for 14 days after these holiday exposures. Thank you for understanding that this policy is in place to allow us to meet our responsibility to all clients, which is to do no harm.

We remain passionate about helping you improve and maintain the function of your movement system so that you can do the activities you love. We invite you to follow/Like our Facebook page, where I am offering complimentary weekly Pilates mat class on Wednesdays 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. I am available via clinic phone (206-535-7356) and email ( We will update you here and our Facebook page as things change.

Thank you for your support of this small, locally-owned physical therapy private practice!

Elizabeth Rogers, PT

Owner, Elizabeth Rogers Pilates & Physical Therapy, PLLC