Bicycle Seat Neuropathy 

  • Author: John M Martinez, MD; Chief Editor: Sherwin SW Ho, MD   more...
 
Updated: Apr 23, 2012
 

Background

Bicycle seat neuropathy is one of the more common injuries reported by cyclists.[1, 2, 3, 4, 5] The injuries and symptoms are due to the cyclist supporting his or her body weight on a narrow seat, and they are believed to be related to either vascular or neurologic injury to the pudendal nerve.[2, 5, 6, 7, 8, 9, 10]

For excellent patient education resources, visit eMedicine's Erectile Dysfunction Center and Sports Injury Center. Also, see eMedicine's patient education articles, Impotence/Erectile Dysfunction, Erectile Dysfunction FAQs, and Bicycle Safety.

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Epidemiology

Frequency

United States

A wide frequency range has been reported for bicycle seat neuropathy, but it is believed to be underreported. The medical literature contains several case reports of reversible neuropathy[5, 9] and several retrospective studies surveying participants in long-distance cycling races and tours.[8, 11, 12]

Andersen and Bovim surveyed 260 cyclists participating in a long-distance bike tour that was 335.54 miles (540 km) in length.[8] Of responding males, 35 (22%) reported symptoms of either numbness or pain in the pudendal area. Thirty-three (21%) males reported penile numbness, with 10 (6%) male cyclists reporting symptoms that lasted longer than 1 week. In addition, 21 males (13%) reported symptoms of impotence, 11 of whom experienced symptoms for longer than 1 week, and 3 of whom reported impotence lasting longer than 1 month.[8]

Kuland and Brubaker reported that during the 1976 Bikecentennial tour, there was a 7% incidence of pudendal and/or penile numbness, but this study only surveyed 89 of 1200 participating cyclists.[11]

Weiss studied symptoms of cyclists participating in a 500-mile (804.97 km) bicycle tour.[12] Of the participating cyclists, 45% reported at least mild and transient perineal numbness; 10% reported the symptoms as severe, and 2% of the cyclists had to temporarily stop riding. Perineal numbness has also been documented in women cyclists. LaSalle et al surveyed 282 female members of a Dallas cycling club.[13] In this group, 34% of the women reported perineal numbness.

Potter et al assessed the differences between men and women with regard to bicycle saddle pressure distribution during seated cycling.[14] The authors noted that there were significant differences between the sexes in saddle loading, and these differences were especially relevant with regard to the position of the bicycle handlebar positions. In particular, the drops hand position shifted the rider's weight, such that more weight was supported on the anterior pelvic structures.[14]

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Sport-Specific Biomechanics

The cause of bicycle seat neuropathy has been attributed to several different ischemic events. Amarenco et al and Oberpenning et al hypothesized that compression of the pudendal nerve as it passes through the Alcock canal causes the condition.[9, 15] The Alcock canal is enclosed laterally by the ischial bone and medially by the fascial layer of the obturator internus muscle. The pudendal nerve exits the canal ventrally, below the symphysis pubis, and innervates the genital and perineal regions.

Oberpenning et al postulated that long-distance cycling results in the indirect transmission of pressure onto the perineal nerve within the Alcock canal.[9] Weiss and Bond separately proposed that bicycle seat neuropathy is due to temporary and transient ischemic injury to the dorsal branch of the pudendal nerve secondary to compression of the nerve between the bicycle seat and the symphysis pubis.[12, 16] Weiss also theorized that the genital branch of the genital-femoral nerve could be involved in cases in which scrotal paresthesia is reported.[12]

Bicycle seat design (eg, shape) may be the major extrinsic factor for the development of bicycle seat neuropathy.[1, 4, 6, 17, 18, 19, 20, 21] Results of computer modeling reported by Spears et al showed that wider bicycle seats that support the ischial tuberosities decrease pressure on the perineal area.[19] Other studies have also demonstrated the effect bicycle seat design has on penile blood flow[20] and penile oxygen pressure.[21]

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Contributor Information and Disclosures
Author

John M Martinez, MD  Medical Director, Primary Care Sports Medicine, Coastal Sports and Wellness Medical Center

John M Martinez, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, and American Medical Society for Sports Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Kenneth Honsik, MD  Consulting Staff, Department of Primary Care Sports Medicine, Kaiser Permanente

Disclosure: Nothing to disclose.

Specialty Editor Board

David T Bernhardt, MD  Director of Adolescent and Sports Medicine Fellowship, Associate Professor, Department of Pediatrics/Ortho and Rehab, Division of Sports Medicine, University of Wisconsin School of Medicine and Public Health

David T Bernhardt, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Sports Medicine, and American Medical Society for Sports Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Russell D White, MD  Professor of Medicine, Professor of Orthopedic Surgery, Director of Sports Medicine Fellowship Program, Medical Director, Sports Medicine Center, Head Team Physician, University of Missouri-Kansas City Intercollegiate Athletic Program, Department of Community and Family Medicine, University of Missouri-Kansas City School of Medicine, Truman Medical Center-Lakewood

Russell D White, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Family Physicians, American Association of Clinical Endocrinologists, American College of Sports Medicine, American Diabetes Association, and American Medical Society for Sports Medicine

Disclosure: Nothing to disclose.

Jon B Whitehurst, MD  Clinical Instructor of Surgery, University of Illinois College of Medicine; Partner, Rockford Orthopedic Associates; Orthopedic Chairman, Rockford Memorial Hospital

Jon B Whitehurst, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America

Disclosure: Nothing to disclose.

Chief Editor

Sherwin SW Ho, MD  Associate Professor, Department of Surgery, Section of Orthopedic Surgery and Rehabilitation Medicine, University of Chicago Division of the Biological Sciences, The Pritzker School of Medicine

Sherwin SW Ho, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, Arthroscopy Association of North America, and Herodicus Society

Disclosure: Breg, Inc. Consulting fee Consulting; Biomet, Inc. Consulting fee Consulting; GMV, Inc. Arthroscopy Simulator Evaluation and teaching; Smith and Nephew Grant/research funds Fellowship funding; DJ Ortho Grant/research funds Course funding; Athletico Physical Therapy Grant/research funds Course, research funding

References

  1. Schrader SM, Breitenstein MJ, Lowe BD. Cutting off the nose to save the penis. J Sex Med. May 7 2008;epub ahead of print. [Medline].

  2. Kennedy J. Neurologic injuries in cycling and bike riding. Neurol Clin. Feb 2008;26(1):271-9; xi-xii. [Medline].

  3. Asplund C, Barkdull T, Weiss BD. Genitourinary problems in bicyclists. Curr Sports Med Rep. Oct 2007;6(5):333-9. [Medline].

  4. Weiss BD. Clinical syndromes associated with bicycle seats. Clin Sports Med. Jan 1994;13(1):175-86. [Medline].

  5. Silbert PL, Dunne JW, Edis RH, Stewart-Wynne EG. Bicycling induced pudendal nerve pressure neuropathy. Clin Exp Neurol. 1991;28:191-6. [Medline].

  6. Gemery JM, Nangia AK, Mamourian AC, Reid SK. Digital three-dimensional modelling of the male pelvis and bicycle seats: impact of rider position and seat design on potential penile hypoxia and erectile dysfunction. BJU Int. Jan 2007;99(1):135-40. [Medline].

  7. Leibovitch I, Mor Y. The vicious cycling: bicycling related urogenital disorders. Eur Urol. Mar 2005;47(3):277-86; discussion 286-7. [Medline].

  8. Andersen KV, Bovim G. Impotence and nerve entrapment in long distance amateur cyclists. Acta Neurol Scand. Apr 1997;95(4):233-40. [Medline].

  9. Oberpenning F, Roth S, Leusmann DB, van Ahlen H, Hertle L. The Alcock syndrome: temporary penile insensitivity due to compression of the pudendal nerve within the Alcock canal. J Urol. Feb 1994;151(2):423-5. [Medline].

  10. Goodson JD. Pudendal neuritis from biking. N Engl J Med. Feb 5 1981;304(6):365. [Medline].

  11. Kuland DN, Brubaker CE. Injuries in the Bikecentennial tour. Phys Sportsmed. 1978;6(6):74-8.

  12. Weiss BD. Nontraumatic injuries in amateur long distance bicyclists. Am J Sports Med. May-Jun 1985;13(3):187-92. [Medline].

  13. LaSalle MD, Salimpour P, Adelstein M, et al. Sexual and urinary tract dysfunction in female bicyclists. Presented at: 94th Annual Meeting of the American Urologic Association; May 4, 1997; Dallas, Tex.

  14. Potter JJ, Sauer JL, Weisshaar CL, Thelen DG, Ploeg HL. Gender differences in bicycle saddle pressure distribution during seated cycling. Med Sci Sports Exerc. Jun 2008;40(6):1126-34. [Medline].

  15. Amarenco G, Kerdraon J, Bouju P, et al. [Treatments of perineal neuralgia caused by involvement of the pudendal nerve] [French]. Rev Neurol (Paris). Jun 1997;153(5):331-4. [Medline].

  16. Bond RE. Distance bicycling may cause ischemic neuropathy of the penis. Phys Sportsmed. 1975;3(11):54-6.

  17. Lowe BD, Schrader SM, Breitenstein MJ. Effect of bicycle saddle designs on the pressure to the perineum of the bicyclist. Med Sci Sports Exerc. Jun 2004;36(6):1055-62. [Medline].

  18. Bressel E, Larson BJ. Bicycle seat designs and their effect on pelvic angle, trunk angle, and comfort. Med Sci Sports Exerc. Feb 2003;35(2):327-32. [Medline].

  19. Spears IR, Cummins NK, Brenchley Z, et al. The effect of saddle design on stresses in the perineum during cycling. Med Sci Sports Exerc. Sep 2003;35(9):1620-5. [Medline].

  20. Jeong SJ, Park K, Moon JD, Ryu SB. Bicycle saddle shape affects penile blood flow. Int J Impot Res. Dec 2002;14(6):513-7. [Medline]. [Full Text].

  21. Schwarzer U, Sommer F, Klotz T, Cremer C, Engelmann U. Cycling and penile oxygen pressure: the type of saddle matters. Eur Urol. Feb 2002;41(2):139-43. [Medline].

  22. Taylor JA 3rd, Kao TC, Albertsen PC, Shabsigh R. Bicycle riding and its relationship to the development of erectile dysfunction. J Urol. Sep 2004;172(3):1028-31. [Medline].

  23. Dettori JR, Koepsell TD, Cummings P, Corman JM. Erectile dysfunction after a long-distance cycling event: associations with bicycle characteristics. J Urol. Aug 2004;172(2):637-41. [Medline].

  24. Sommer F, König D, Graft C, et al. Impotence and genital numbness in cyclists. Int J Sports Med. Aug 2001;22(6):410-3. [Medline].

  25. Solomon S, Cappa KG. Impotence and bicycling. A seldom-reported connection. Postgrad Med. Jan 1987;81(1):99-100, 102. [Medline].

  26. Akuthota V, Plastaras C, Lindberg K, et al. The effect of long-distance bicycling on ulnar and median nerves: an electrophysiologic evaluation of cyclist palsy. Am J Sports Med. Aug 2005;33(8):1224-30. [Medline].

  27. Mellion MB. Common cycling injuries. Management and prevention. Sports Med. Jan 1991;11(1):52-70. [Medline].

 
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Example of a bicycle seat with a cut-away middle.
 
 
 
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