Here is an article on saddle sores.
Of course if you were using our padding you would not need to read this...
Saddle Sores...The What and Why, as well as Tips on Prevention and Treatment.
Patrick Kortebein, MD, Mayo Clinic, Rochester, MN
Remember when you first started riding seriously? And remember that pain in
your backside a few weeks later? None too pleasant a thought, right? Well, if
you're like most cyclists, it happens more frequently than you care to remember.
In one study of amateur long distance cyclists, over 60% reported buttock
discomfort and approximately 50% of these cyclists had to alter their riding style,
or temporarily discontinue cycling, due to the discomfort. If you're getting ready
to get back on your bike this spring, or you're new to cycling, there are several
things you can do to decrease your chances of developing saddle sores. But
What are "saddle sores"?
The term "saddle sores" should only be used to describe skin-related disorders of
the area of the body in contact with the bicycle seat. Anatomically, this area
includes the perineum (the skin between the base of the thighs) and the lower
buttocks. The resulting skin disorders can be further categorized into four
distinct clinical syndromes; ischial tuberosity, pain, chafing, folliculitis or
furuncles, and skin ulceration. Although these disorders can develop
independently, it is not uncommon for more than one to occur at the same time.
There are other bicycle seat related problems, such as pudendal nerve
neuropathy and impotence (see August 1997 issue of Bicycling), however as these
are not skin-related disorders they should not be termed saddle sores.
1. Ischial tuberosity pain: The ischial tuberosities are your "sit bones", the 2 bony
2. Chafing: Chafing results from the constant rubbing of the inner thighs and
3. Folliculitis and Furuncles: A folliculitis is an infection of the base of a hair
4. Skin ulceration: This small, crater-like lesion has been reported to occur in up
Why do saddle sores occur?
Imagine, if you will, that you're sitting on a hardwood straight back chair. As
previously noted, the bones in contact with the seat of the chair are your ischial
tuberosities (or "sit bones"). Now imagine sitting bolt upright on that hardwood
chair for an hour straight, no shifting your weight from side to side, no
slouching, no crossing your legs, sounds painful, doesn't it? Well, you're doing
essentially the same thing when you ride a bike for an hour. With one major
difference: while you're cycling most of your body weight is concentrated on the
tiny surface area of the bicycle seat, rather than spread out over the relatively
broad expanse of a chair. With that thought in mind, let's consider the factors
that contribute to the development of saddle sores. While, the causative
mechanism for the development of saddle sores has not specifically been studied,
there is a substantial amount of research examining the etiology of a related
phenomenon, namely pressure ulcers, or "bed sores". Since the same factors
implicated in the development of pressure ulcers are also present when a cyclist
is sitting on a bicycle seat, the results of pressure ulcer research can help us to
understand why saddle sores occur, and how to reduce the chances of
developing them. The most significant factors implicated include pressure, shear
moisture, and temperature. And the primary difference between developing a
pressure ulcer and a saddle sore appears to be exposure time; saddle sores
develop as a result of brief, repetitive exposures to these factors, while pressure
ulcers develop due to prolonged, persistent exposure.
1. Pressure: Considering the above scenario, it is readily apparent that the most
2. Shear: The next most significant factor in the development of saddle sores is
3. Moisture. Small amounts of moisture on the skin, like that from light to
4. Temperature: The effect of temperature on tissue metabolism is the final
Consequently, during seated cycling, the combined effect of these four factors
results in a marked reduction in blood flow to the tissues of the perineum, at the
same time that there is an increased demand. The end result is tissue ischemia,
which occurs when the blood vessels to a tissue are blocked or occluded, thereby
depriving the tissue of vital oxygen and other important cellular nutrients. For
instance, ischemia of the heart muscle typically causes chest pain, or angina.
Prolonged ischemia of the skin and underlying tissues also causes pain, as well
as tissue breakdown and ulceration. In addition, ischemic tissues are more
susceptible to infection, and can't repair themselves as well as normal tissue
Thus, the repetitive transient episodes of ischemia, of the skin of the perineum
and buttocks during cycling are the inciting event in the development of saddle
sores. Saddle sores (with the exception of chafing) probably become manifest as
different clinical syndromes because of variations in the degree, and the location,
of the ischemic tissue injury. For instance, ischial tuberosity pain may occur due
to mild ischemic injury of the skin and soft tissues over this bone, while a skin
ulcer may result from a more significant (more prolonged or repetitive) ischemic
In a more general context, saddle sores probably represent an early stage in a
continuum of ischemic tissue injury; at one end of this continuum there is seatrelated
discomfort, and saddle sores, while at the other extreme there are
pressure ulcers. Supportive evidence for this ischemic phenomenon is seen in
professional cyclists, where actual necrosis or death, of the connective tissue
beneath the skin of the perineum occurs due to the effects of the above factors,
especially excessive pressure, and shear.
In summary, the major difference, between the saddle related discomfort and
saddle sores resulting from cycling, and the development of a pressure ulcer
would appear to be the duration of time the tissues are subjected to excessive
pressure, shear, moisture, and temperature.
How does the body respond to these factors?
Although the human body does not have specific structures that are capable of
reducing pressure, there are structures, called bursae, which function to
minimize shear forces. Bursae look somewhat like a partially flattened water
balloon, except they have a thick fibrous wall, and are filled with synovial fluid
(see Figure 2). They are typically found interposed between the skin and a bony
prominence, or between a tendon and a bone, and are located adjacent to all the
major joints of the body. The synovial fluid is the same fluid found in our joints,
and acts like ultra fine motor oil, allowing the two opposing walls of the bursa to
slide past one another with essentially zero friction. Thus, with a bursa in
between reducing shear (and friction), the skin can move back and forth over a
bone without being damaged. During cycling, the ischial bursa, located between
the ischial tuberosity and the skin, helps reduce the shear force on the overlying
skin. While a normal bursae is unable to minimize pressure to any significant
extent adventitious (or extra) bursae may be able to reduce pressure, in addition
to shear, since they are filled with more fluid. These structures have been noted
to develop in unusual locations within the body, such as at the end of an
amputee's residual limb, in response to excessive shear and pressure. It is not
known if adventitious bursae develop in competitive or professional cyclists,
although a related phenomenon, discussed below, does occur. To better
understand the beneficial, effects of a bursa, try this: Rub you hands together
briskly for 10- 15 seconds. Then rub thorn together with a partially filled water
balloon between your hands. Notice a difference? There is no heat production
or friction with the balloon interposed between your hands.
Since the human body is unable to sufficiently reduce the effect of these factors,
especially excessive pressure, the body must rely on another system, the nervous
system, to avoid significant tissue injury. The discomfort and pain of the
perineum and buttocks that is felt when riding, is a signal that the skin and
underlying tissues of this region are ischemic. Since pain is a signal of ischemia,
and the potential resultant tissue damage, most people avoid repetitively painful
situations and allow their tissues to heal. For instance, most people who develop
saddle related discomfort temporarily discontinue cycling, or change their
position on the bike, or decrease the length of their rides in order to allow the
injured areas to heal, and to prevent further injury. However, a significant
number of cyclists tend to endure or suppress saddle discomfort. Novice cyclists
are probably especially prone to this behavior since they are enthusiastic to ride,
may mistakenly believe that pain is necessary to 'toughen up' their tissues, are
unfamiliar with an appropriate method of gradually increasing their mileage,
and may have unrealistic expectations of their ability to ride a specific distance or
for a certain amount of time (e.g., doing a 70 mile ride two weeks after beginning
a cycling program). These conditions may contribute to the development of
saddle sores, since they result in more prolonged repetitive, exposure to the four
physical factors mentioned than the individuals' tissues are ready to handle. The
analgesic effect of endorphins, the body's natural pain-killer released during
exercise, is probably another contributory factor. Since endorphins will
minimize some of the ischemic discomfort, an individual will likely remain
seated longer thus inflicting tissue damage. In addition, there is certainly some
individual propensity towards developing saddle sores, since some people tend
to get them regardless of how they limit their mileage, while others never
develop them. For instance, the cyclists competing in the Tour de France are
most certainly relatively resistant to developing saddle sores. Since the incidence
of saddle, related discomfort and saddle sores tends to decline with continued
cycling, some form of tissue adaptation most certainly occurs. However, since
this has not been studied, the specific changes that occur during this 'toughening
up' period are unknown. The thickness of the skin, or of the underlying
connective tissue, may increase. It is also conceivable that the ischial bursae may
become more like adventitious bursae; by accumulating more synovial fluid over
time, they may be better able to accommodate the extra pressure and shear forces
associated with cycling. Professional cyclists have been noted to develop fluidfilled
cysts of their perineum that may be a similar adaptation. Alternatively,
individuals prone to developing saddle sores may simply quit cycling.
It is probably not possible to completely avoid saddle sores, particularly ischial
tuberosity pain, if you plan to do any reasonable amount of cycling, however,
experts recommend the following to minimize your chances.
1. Decrease ischemia: Stand up, or ride out of the saddle, every 10-15 minutes
2. Check your positioning: Make sure your seat height, and seat tilt are adjusted
3. Gradually increase mileage: For most novice cyclists it is probably easier to
4. Proper attire: Clean, dry cycling shorts with a natural or synthetic chamois
5. Maintain good hygiene: You, and your cycling shorts should be washed or
6. Change seats: Despite numerous recent modifications in the composition and
Although saddle sores can be divided into four different clinical syndromes, the
treatment for each is quite similar; and all of them typically resolve
spontaneously, or with minor medical therapy performed at home.
1. Modify your cycling regimen: Complete avoidance of cycling until the lesions
2. Skin care: In general, keep the skin clean and dry. Moisturizing creams can
3. Medical attention: Seek medical attention for any lesions which are
1. Braddom, RL: Physical Medicine and Rehabilitation. Philadelphia. W.B.
Saunders Co., 1996: pages 634 - 635.
2. Carlson JM, Payette MJ, Vervena LP. Seating orthosis design for prevention of
decubitus ulcers. 1. Prosthetics & Orthotics 1995; 7: 51-60.
3. Weiss, BD. Clinical syndromes associated with bicycle seats. Clinics in Sports
Medicine 199403: 175-86.
4. Weiss BD. Nontraumatic injuries in amateur long distance bicyclists. Am J
Sports Med 13(3): 187-92,1985.
5. Kita J. Special report: Impotency and Cycling. Bicycling 38: 90-97, 1997.
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