Cyclist syndrome? / Numbness

[cyclist2020]

Hello:

I'm a young male cyclist and started noticing persisting perineum numbness as well as reduced sensation on genitals through a season of races. I had about 4-5 different bike fits, tried over 20 seats, including what I believe to be every single one billed for saddle-related issues (ISM, Infinity, Specialized, SMP, BiSaddle, SQLab, Ergon, the list goes on). I've also had a little bit of tingling and slight reduced lower body sensations, but strength is completely normal.

I've been off the bike for over a year trying to take this seriously. Done long rounds of PT with pelvic floor and regular PT, including internal work. Was told that I have "increased pelvic tone" whatever that means. I have dramatically strengthened my quads, hip flexors. However, internal (anal) massage, either by therapy or self via a thera-wand, causes dramatic flare-ups of numbness that last for days or weeks. Cycling and internal work make it flare-up the worst, long car or plane rides irritate a little but not much.

I did sacral and lumbar MRIs and they came back normal, perhaps slight ambiguity if I had a small annular tear but my physical therapist and spine doc from a reputable research hospital don't see any major spine issues besides normal age-related wear. I saw one of the doctors visited by many folks on these forums, who suggested I don't have PN based on palpation (that I didn't cry in pain). Contrary to the advice from the spine doctor, he suggested it could have spinal causes. I've had no spinal issues or surgeries, and have had a minor bike accident before but all this stuff was starting well before that.

I'm still running, but it doesn't cause flare-ups, oddly (I see that for folks here).

My suspicion is that I've irritated the nerve through tight pelvic floor, ligaments. With poor form and lack of lateral movement/hip strengthening. My game plan is strengthening, maybe massage as much as I can tolerate, and continued time. Welcome thoughts of others. Thank you!

[Violet M]

Hi and welcome to the forum. If numbness rather than pain is your problem, then pressing on the nerve might not make you cry out, it seems to me. So maybe you don't have typical neuralgia with pain, but maybe you still have nerve involvement. I don't know for sure what might be causing it, whether it could be small nerve fibers (the endings of the nerve) or maybe even a different nerve. Not sure where the distribution area of your numbness is but if it's the genitals then you would certainly have to suspect something wrong with the pudendal, even if it's not a nerve entrapment. But the pudendal complaining doesn't mean it's the root cause of all of your problems. You could have some mechanical problems going on.

Increased pelvic tone means your pelvic floor muscles are a little tight due to being in spasm. This could be caused by a nerve being irritated whichi could be due to mechanical issues that don't show up on an MRI -- such as SI joint dysfunction or pelvic instability and hypermobility. But I'm assuming your PT must have checked for those. What does your PT think is the root cause?

Not sure what type of strengthening exercises you are doing but strengthening exercises are what caused my PNE. Due to chronically strained ligaments I eventually did some prolotherapy to strengthen the ligaments since they don't heal very well on their own. This helped stabilize the pelvis.

Just throwing out some ideas for you to consider with your PT.

Violet

[Ray P.]

My advice;
DO NOT EVER GET ON A BIKE AGAIN

I started riding in 95. I tried earlier years, but it always hurt. I decided to ignore the pain thinking it was just hemorrhoid pain.
I gave up riding in 2000 thinking the pain would go away. Boy, I was wrong. Still out of work and suffering to this day to make a long story short.

Ray

[marven121]

sorry for the late reply, check if ur coccyx it straight or deviated to right or left. if its deviated to left for instance, palpate the right sacrotubeuos ligament and put pressure for about a minute and repeat every 3-4 hours. dont forget pudendal nerve runs thro the ligament, what u r dong is relieving it. this was my case, never lose hope. u will cycle again.