Yet Another Cycling Forum

General Category => The Knowledge => Health & Fitness => Topic started by: TomP on February 17, 2019, 08:46:02 pm

Title: Bottom woes - any suggestions?
Post by: TomP on February 17, 2019, 08:46:02 pm
My first post and it's about my bum - sorry!
I've been into various types of cycling for ages - then got into riding 200ks approx 2 or 3 years ago. Up to that point I'd never had any issues with saddle/bum issues. Last August I did my first hilly 300k on a very warm day. I enjoyed it immensely but unfortunately got a really sore backside and am still suffering the consequences in Feb.
A week post ride I saw my GP who gave me some canesten HC which helped clear up an obvious sweat rash. I rode a 200k several weeks later which ended in me being in severe discomfort and I've been struggling with bum issues and limited distance ever since.

Basically what I have is mostly focused on the area underneath my left sitbone, it ACHES all the time, I can't really feel any lumps or anything. I have a red patch around that area but the skin is completely intact - it feels internal.
I rode approx 30-40miles on saturday and my bum cheek was bright red, stung and really ached, the area under the sitbone was an even darker red and didn't look good at all. It usually doesn't look too bad day to day and when I've visited the GP - but cycling really sets it off. I don't know exactly what it it is I've done - the GPs don't seem to either - ?some type of pressure sore, aggravated scar tissue, muscle damage, infection - not sure.

Here's a list of things I've tried and am implementing:
- Seen two different GPs (both cyclists) who've recommended stretching, time off the bike (I did 6 weeks at least - didn't help as I still have the problem), Canesten HC (helped the immediate skin issue after the ride) , Antibiotic cream (didn't help).
- I'm implementing vigorous hygiene; always showering pre ride, airing my bum when possible on toilet stops, getting out of shorts asap post ride, babywipes after every sit down toilet, showering asap post ride.
- I've trialled several saddles including an SMP composit which i think would be the saddle for me - if I didn't have this issue already.
 I'm planning on trying to lose weight - I have approx 1 to possibly 2kg I could lose.
- I'm doing stretches and core strength exercises.
- getting out of the saddle regularly.
- Have tried several different chamois creams: bum butter, chapeau, conotrane, sudocrem, and tried also nothing at all.
- My diet is pretty good.
- I've had a bike fit and am experimenting with saddle height.
- I'm swimming and running more to compensate for the lack of cycling
- I've invested in better bibs too.

I go out with a race club and do short fast club runs - but my passion is fast touring and audax and its so frustrating to not be able to get out there.

I'd greatly appreciate it if anyone has any ideas/thoughts/suggestions as it's making me miserable and it feels like its not ever going to go away!  :(





Title: Re: Bottom woes - any suggestions?
Post by: mrcharly-YHT on February 17, 2019, 09:41:23 pm
If you found that Canesten cleared up some soreness, then I suggest applying that again (or any other treatment for athlete's foot). Once you have had a fungal infection on your skin, it is highly unlikely you have totally eliminated it, the canesten just drives it away for a bit. Been there, done that.

However, a fungal infection wouldn't create an ache. That is more likely to be a bruised bursa or poorly fitting saddle applying pressure to sit bones. Have you measured your sit-bone width?
Title: Re: Bottom woes - any suggestions?
Post by: Kim on February 17, 2019, 09:46:38 pm
My first post and it's about my bum - sorry!

You're in good company.  (My first post wasn't about saddles, it seems I waited until my fourth.)

The ultimate solution is to go darkside (recumbent cycles) - the only thing that really worked for me on long rides.  Might be worth considering, if only as an interim option to allow things to heal properly.
Title: Re: Bottom woes - any suggestions?
Post by: Phil W on February 17, 2019, 09:48:41 pm
On long rides I make sure I get out the saddle regularly.  I find this gives the shorts a chance to dry, plus the fabric stuck to your rear moves around a bit and unsticks.  Conotrane (for babies bottoms) can be bought from chemists for about £1-70 and acts as a good barrier cream.

Have you got a plastic or leather saddle? Leather saddles breath and might relive a bit of the moisture build up.
Title: Re: Bottom woes - any suggestions?
Post by: Phil W on February 17, 2019, 09:50:14 pm
Oh and when riding my recumbent on audaxes none of the above apply and I do not wear anything padded.
Title: Re: Bottom woes - any suggestions?
Post by: Kim on February 17, 2019, 09:53:35 pm
Oh and when riding my recumbent on audaxes none of the above apply and I do not wear anything padded.

Padded shorts can work on recumbents (eg. if you don't want to have to own two sets of cycling kit), but the pad design needs to be one that doesn't rub on the inside of your thigh.

+1 for Conotrane.
Title: Re: Bottom woes - any suggestions?
Post by: hellymedic on February 17, 2019, 09:55:42 pm
Canesten HC contains an antifungal and a steroid, which suppresses inflammation and can weaken fibrous tissue.

This is OK for short-term skin issues but your description sounds more 'deep-seated' than this.

I don't know what's going on here, though I suspect there might be a bursa, with or without bursitis ('weaver's bottom').

Strikes me you've been doing the right things but need an expert's eye and hand, as well, possibly, as some advanced imaging.

I see no alternative to your returning to your GP.
Title: Re: Bottom woes - any suggestions?
Post by: TomP on February 17, 2019, 10:21:12 pm
Thanks all. Not measured sitbones exactly - but know I'm narrowish; 143mm romin evo and SMP composit are the best saddles I've tried. Not got on with leather saddles as I seem to wear in to them quite rapidly with my sitbones creating a rise in the middle of the saddle that isn't - ahem comfortable!

I think you're right hellymedic - I'm going to have to get back to the GP. It feels more deep than anything.

I will consider the darkside eventually - but would like to get back on the bikes I have if I can.

I've used conotrane a fair bit - but think there may be something in it that I don't get on with.

Out of interest - if it is bursa related - are there any treatment options?

I'm sure there's bucketloads of Buddhist wisdom that can be pulled out of having to come to terms that you have to moderatea passion - but I love cycling a long way on hilly, narrow, tussocked lanes whilst stopping at cafes and pubs (my alcohol intake is minimal btw!) I'd dearly like to get back to it.
Title: Re: Bottom woes - any suggestions?
Post by: hellymedic on February 17, 2019, 10:26:12 pm
I'm no expert!

AIUI a bursa can be aspirated, injected with steroids or surgically removed.

Any surgery will leave a scar and I personally would not want scarring here!

Infection can be treated with antibiotics and inflammation with anti-inflammatories.
Title: Re: Bottom woes - any suggestions?
Post by: Phil W on February 17, 2019, 10:29:42 pm
Oh and when riding my recumbent on audaxes none of the above apply and I do not wear anything padded.

Padded shorts can work on recumbents (eg. if you don't want to have to own two sets of cycling kit), but the pad design needs to be one that doesn't rub on the inside of your thigh.

+1 for Conotrane.

I just wear normal shorts on recumbent or running tights in winter.
Title: Re: Bottom woes - any suggestions?
Post by: TomP on February 17, 2019, 10:40:24 pm
Thanks v much all - I'll be making another GP appt in the morning and doing a bit more research.
Title: Re: Bottom woes - any suggestions?
Post by: Klar on February 18, 2019, 08:30:16 am
I'm not sure where you are based but do consider seeing a cycling specific sports therapist or osteo. There are great people based in AthleteLab in London. It might be something to do with obturator internus and would need some specific exercises of strengthen and stretch that area (it is a really difficult area to get to). You could give them a call before you book up to see if it is something they could help with. It will cost money but getting to the root of the problem will get you back on the bike.

Hope that helps.

Title: Re: Bottom woes - any suggestions?
Post by: TomP on February 18, 2019, 08:06:48 pm
Thanks.  I've a gp appt booked for Friday. Have done a bit of research, and weaver's bottom seems to match my symptoms pretty well indeed.
I'll talk to the gp about physio as they're a pretty good bunch where I'm based.
I've been riding fixed a fair bit which could well have exacerbated things even more when spinning like a loon down the hills. I'm also trying to mentally prepare for the possibility of taking a few months off cycling completely if needed.

 
Title: Re: Bottom woes - any suggestions?
Post by: pdm on February 19, 2019, 08:38:04 am
Or you could go with a "minimal saddle" approach: https://infinitybikeseat.com/shop/

I have one and it produces no pressure on the sit bones at all....
They are expensive, thoughbutt...
Title: Re: Bottom woes - any suggestions?
Post by: TomP on February 19, 2019, 01:23:16 pm
Thanks for the suggestion.  I'd definitely need to trial one of those before buying! 
Title: Re: Bottom woes - any suggestions?
Post by: pdm on February 19, 2019, 02:02:14 pm
The UK importers are: http://www.ten-point.co.uk/infinity-saddles/

I loaned the saddle to a friend with prostate problems for a few rides last year - he bought one.
Title: Re: Bottom woes - any suggestions?
Post by: mattc on February 19, 2019, 02:13:21 pm
A wacky saddle is a much cheaper experiment than a recumbent - it's deffo what i would try first in this situation.

(It might be the start of something beautiful!)
Title: Re: Bottom woes - any suggestions?
Post by: Kim on February 19, 2019, 02:26:51 pm
A wacky saddle is a much cheaper experiment than a recumbent - it's deffo what i would try first in this situation.

That depends on how you look at it, the recumbent (assuming a previously-owned all-rounder) is likely to have less depreciation.  But saddles (even weird ones) have much less of a learning curve, and ideally you want to find a saddle that works for you anyway.

Anyway, the n+1 rule applies.  By riding recumbents on long rides, I can tolerate saddles for riding around town, off-roading, etc. where uprights are the best tool for the job.  It's all good, and much better than time off the bike while things heal.
Title: Re: Bottom woes - any suggestions?
Post by: McWheels on February 19, 2019, 08:28:05 pm
My first post and it's about my bum - sorry!
...

You have been more persistent in trying to solve it, and have described in much greater detail, why I crossed over.
Title: Re: Bottom woes - any suggestions?
Post by: TomP on February 19, 2019, 08:53:35 pm
I've been really impressed by and appreciate all the ideas and support,  what a great forum!
Money is a bit of an issue in regards to new equipment,  I break even (just) at the end of the month usually. So need to make the most of the stuff I accumulated when I was in better paid work.
From what I've read,  if it is indeed ischial bursitis; I think resting from cycling is the best option for a while.  I'll get stuck in to walking,  swimming and jogging for a while if I need time off.
I've started doing several exercises and gluteal stretches that are recommended as well as my usual stretches and planks.  Have also done a few self diagnostic tests to try and differentiate between high hamstring injury and ischial bursitis (I think it's likely the latter).
Gp Friday,  going to discuss if they think it could be ischial bursitis,  option of physio, and ask them to double check my skin for any signs of infection. 
Title: Re: Bottom woes - any suggestions?
Post by: TomP on February 23, 2019, 10:27:31 am
Updating this in case it's of any use to others.  Gp was very sympathetic given how long it's been going on, he agreed very likely bursa related. I'm being referred to a musculoskeletal clinic to clarify what it is and for potential corticosteroid injection.  I'm also being referred to physio. I'm going to take a month off cycling to help things  heal. Have already booked some swimming lessons (want to learn the front crawl!) and am going out with a rambling group Sunday - so hopefully that'll keep the non-cycling blues to a minimum.
If I end up suffering with these problems ongoing,  I think I may sell a few bikes and cross to the darkside in order to meet my distance needs :)
Title: Re: Bottom woes - any suggestions?
Post by: jiberjaber on February 23, 2019, 11:10:43 am
Thanks for the update Tom  :thumbsup:
Title: Re: Bottom woes - any suggestions?
Post by: TomP on May 05, 2019, 02:57:42 pm
Update: 2 months off cycling completely (swimming, running and walking instead).
Saw a specialist practitioner in the msk clinic who agreed that it was an aggravated bursa. He gave me a steroid injection (ouch!). I then had 10 days of no cycling, then a week of 2 mile each way commutes, I've since done x2 40 mile rides - with loads of freewheeling down hills and standing up. I was using a madison flux saddle for these which i found the comfiest in present circumstances.

The pain and discomfort  is still there unfortunately - slightly less since the injection but still there. I know doing a 200k or banging 50 miles with the local race club would not be a good idea at all.

I bumped into a fellow CTC member last week - who had the same issue several years ago. He had 6 months off cycling completely. When he did get back on the bike - he used a saddle implementing a design from an american leather saddle manufacturer - but on a cambium to save a lot of money. The idea is that each side flexes slightly as you pedal. He's lent it to me for a while - it felt pretty good yesterday and I could feel each side flex approx 5mm on the alternate down pedal.

My plan is to continue doing the occasional conservative 40/50miles with bucket loads of standing up until an msk review at the end of June. Following this I'll either continue cycling a little bit - or actually stop completely until there's a really noticeable improvement - however long it takes. I realised the most I've had off is about 2 months in one go and I've spent a lot of that whining and pining for my bike - maybe I need to get my head round 3-6months.
Title: Re: Bottom woes - any suggestions?
Post by: TomP on May 05, 2019, 03:09:47 pm
I'd put a photo of the saddle up for info - but I can't work out how to?!  ::-)
Title: Re: Bottom woes - any suggestions?
Post by: jiberjaber on May 05, 2019, 03:36:43 pm
I'd put a photo of the saddle up for info - but I can't work out how to?!  ::-)

Head over to https://imgbox.com/ (https://imgbox.com/)

Drag photo in to where it says "Upload Images"
(https://images2.imgbox.com/f6/36/csxc0eJG_o.jpg) (http://imgbox.com/csxc0eJG)


Select options presented (image size, recommended as shown (1) and click Upload (2) )
 

(https://images2.imgbox.com/88/86/AmiScqdL_o.jpg) (http://imgbox.com/AmiScqdL)

Picture uploads
Set Option from Thumbnails to Full Size (1)
and then copy BB-Code and past in to message on YACF (2)

(https://images2.imgbox.com/ad/c2/oDd9aAnF_o.jpg) (http://imgbox.com/oDd9aAnF)


Use Preview of message on YACF to check you have right picture presented  :thumbsup:
Title: Re: Bottom woes - any suggestions?
Post by: T42 on May 05, 2019, 03:54:10 pm
I bumped into a fellow CTC member last week - who had the same issue several years ago. He had 6 months off cycling completely. When he did get back on the bike - he used a saddle implementing a design from an american leather saddle manufacturer - but on a cambium to save a lot of money. The idea is that each side flexes slightly as you pedal. He's lent it to me for a while - it felt pretty good yesterday and I could feel each side flex approx 5mm on the alternate down pedal.

Sounds familiar - the saddle that is.  Summat like this?

(https://pbase.com/johnewing/image/161210316.jpg)

Mine's possibly an older model - they look a bit snazzier these days.
Title: Re: Bottom woes - any suggestions?
Post by: TomP on May 05, 2019, 05:15:43 pm
(https://thumbs2.imgbox.com/c7/c9/XbiFesIl_t.jpg) (http://imgbox.com/XbiFesIl)
Title: Re: Bottom woes - any suggestions?
Post by: TomP on May 05, 2019, 05:20:59 pm
thanks Jiberjaber - you've just helped a luddite  ;D

T42 - most probably! I can't see the cutout on yours though. Looks comfy! Have you had similar issues with sit bone pain?
Title: Re: Bottom woes - any suggestions?
Post by: TomP on June 02, 2019, 04:22:47 pm
Another update: I managed to get a follow-up appt with the musculoskeletal clinic several weeks after the steroid injection as I realised things were no better after cycling a little bit again. I'm now waiting for an ultrasound scan in mid June to see exactly what's going on,  with a review of the scan with the practitioner mid July.  Possibly another injection needed with imaging.
I've stopped cycling completely until I know for sure things have improved.  Am coping okish with not cycling - apart from when I see someone enjoying themselves on their bike! 😀
Title: Re: Bottom woes - any suggestions?
Post by: LittleWheelsandBig on June 02, 2019, 04:57:48 pm
T42 - most probably! I can't see the cutout on yours though. Looks comfy! Have you had similar issues with sit bone pain?

https://selleanatomica.com shows the various options. I had to similarly lace a SH Titanico X saddle to stop it cutting into my thighs. I generally prefer a stiffer saddle with a cutout; the steel Rivet Pearl Pass suits me quite well.
Title: Re: Bottom woes - any suggestions?
Post by: TomP on July 11, 2019, 09:59:33 pm
Ultrasound done and reviewed - I have calcified hamstrings where they attach to the sitbones: likely causes: pressure, wear and tear, over-stretching, and muscle imbalances.
Previous steroid injection didn't help. I'm now being referred to the hip consultant at the local hospital for possibly another injection under ultrasound or x-ray.
I've also found a sports therapist who is really positive and optimistic for my recovery; the first professional to actually try and understand why the injury occurred; hypothesising that my back and hamstrings were over compensating for a weakness in certain parts of my glutes. He's given me strengthening exercises which i'm working away on.
No cycling or running at the moment, just swimming, walking and pilates.
Still hoping to get back to cycling - maybe next year?! :)
Title: Re: Bottom woes - any suggestions?
Post by: TomP on December 15, 2019, 03:20:35 pm
Putting this up in case anyone has the misfortune of getting this literal pain in the ass injury!

I'm STILL not cycling. I've had x2 steroid injections via the NHS, second one was guided via ultrasound. Not much improvement, not getting any more!
My chiropractor recently told me about shockwave therapy (which I'd never heard of) and I've started treatment in a local chiropractic college on reduced fee. 4th year interns provide the assessment and treatment under guidance of tutors. I also had another ultrasound via the college which was really helpful.

I basically have proximal hamstring tendinopathy, probably with initial bursitis and also calcific areas - causes: from riding too much, muscle weaknesses/imbalances, bad luck and over stretching. Because I didn't know what I'd done for a good few months - I continued to ride on it - making  it much worse. I then drifted into running instead of cycling which lifted me a bit psychologically but is really a bad idea if excessive for the injury.

https://www.running-physio.com/phtvids/

https://www.running-physio.com/new-research-in-proximal-hamstring-tendinopathy-goom-et-al-2016/

So shockwave therapy, rehab exercises, and minimal running at mo.

I've also now got a recumbent which I'm learning to ride over the winter and hope will enable me to ride bigger miles on in the long term as it off loads any compression on the sitbones.
Title: Re: Bottom woes - any suggestions?
Post by: chrisbainbridge on December 15, 2019, 07:49:14 pm
Ouch.  I hope you get well soon
Title: Re: Bottom woes - any suggestions?
Post by: bludger on December 15, 2019, 08:31:07 pm
I really hope the bent works for you. Lots of cyclists have had problems with upwrongs but have enjoyed decades of great riding on a bent.
Title: Re: Bottom woes - any suggestions?
Post by: TomP on December 15, 2019, 10:14:20 pm
Thanks  :thumbsup:Going to have to take it easy, working the hamstrings under too much load with the hip flexed can exacerbate things as well as compression from sitting.  Good job its shitty weather otherwise I'd be totally overdoing it on the recumbent!
Title: Re: Bottom woes - any suggestions?
Post by: chrisbainbridge on December 15, 2019, 10:34:18 pm
It may all be mumbojumbo but ask about PRP as well
Title: Re: Bottom woes - any suggestions?
Post by: TomP on December 16, 2019, 02:34:44 pm
Prepared to try anything if it helps and doesn't cost the earth!
Thanks,  will consider prp as an option if no success with shockwave and rehab.  :thumbsup:
Title: Re: Bottom woes - any suggestions?
Post by: tonyh on December 16, 2019, 06:52:38 pm
TomP, many thanks for posting. And, best wishes.
Title: Re: Bottom woes - any suggestions?
Post by: TomP on December 17, 2019, 12:31:40 pm
Cheers Tony  :thumbsup: