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Bicycle Seat Neuropathy Treatment & Management

  • Author: John M Martinez, MD; Chief Editor: Craig C Young, MD  more...
Updated: Apr 21, 2016

Acute Phase

Rehabilitation Program

Recreational Therapy

Recreational therapy should include evaluation of the rider's position on the bicycle and could include changing the seat height and tilt position.

Medical Issues/Complications

Medical issues and complications include continued injury or insult to the area, resulting in continuation of the neuropathy and long-term sequelae such as impotence. Reevaluate the patient after making changes to the bicycle or riding style or after decreasing the training volume to ensure that improvement in symptoms is occurring. Continued symptoms despite changes in the bicycle seat position and training volume may indicate a different source of the symptoms and should warrant reevaluation by the physician.


Possible consultations include specialists in urology and neurology, based upon the patient's clinical presentation.

Other Treatment

The mainstay of treatment of bicycle seat neuropathy is the adjustment of the bike seat and bike position, such as tilting the nose of the seat down or lowering the seat height to relieve pressure off the perineum. Other recommendations include having the rider change the style of riding (eg, change positions more frequently or stop riding more frequently).

Newer bicycle seats with a split nose or a center cutout may also help to reduce the prevalence of neuropathy by limiting compression on the perineal area (see below). A study by Lowe et al compared pressure measurements in the perineal area of cyclists on these different bicycle seats and found that some of the newer seats reduced perineal pressure by approximately 50%.[17]

Another study by Parthiban et al used Doppler ultrasound to identify perineal artery occlusion forces and to facilitate force sensor placement in order to measure the occlusive force exerted over the perineal arteries in a variety of bicycle seat designs. The study found that that the “no-nose” bicycle seat design is associated with significantly less instances of perineal arterial occlusive pressure during bicycling. However, the study also added that all seats that were studied achieved occlusive pressures for a minimum 41% of riding time.[26]

Example of a bicycle seat with a cut-away middle. Example of a bicycle seat with a cut-away middle.
Contributor Information and Disclosures

John M Martinez, MD Staff Physician, Kaiser Permanente

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

Disclosure: Nothing to disclose.

Specialty Editor Board

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

Disclosure: Received salary from Medscape for employment. for: Medscape.

Russell D White, MD Clinical Professor of Medicine, Clinical Professor of Orthopedic Surgery, 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, American Medical Society for Sports Medicine

Disclosure: Nothing to disclose.

Chief Editor

Craig C Young, MD Professor, Departments of Orthopedic Surgery and Community and Family Medicine, Medical Director of Sports Medicine, Medical College of Wisconsin

Craig C Young, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Medical Society for Sports Medicine, Phi Beta Kappa

Disclosure: Nothing to disclose.

Additional Contributors

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, American Medical Society for Sports Medicine

Disclosure: Nothing to disclose.


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

Disclosure: Nothing to disclose.

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