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The Unspoken Secret
There is a little unspoken secret about bicycles that not many people like to mention -- the majority of bicycle seats are really uncomfortable! Most of us have experienced some discomfort in the perineal area or at the ischial tuberosities (the sit bones), especially after long rides. Some of us develop saddle sores that are highly uncomfortable. Unfortunately, some people suffer from genital numbness due to cycling. This numbness can interfere with our sexual functioning and can indicate more serious medical problems, genital pain, urinary tract dlsorders, erectile dysfunction (ED) and localized atherosclerosis.(2)
Why can cycling cause damage to the genital area? When you sit on a firm surface, like a chair, your ischial tuberosities (located at the bottom of your pelvis) bear most of your weight. This part of your body is uniquely designed for sitting and supporting your weight. There are no organs attached to your sit bones, and they are padded by muscle and fat. There is plenty of blood flow through this area, so you can sit comfortably for long periods of time.(3)
Now, think about the size and shape of a bike seat. Most of them are not wide enough to support us directly under our sit bones, especially for women, whose pelvic girdles are wider than men's. As a result, most bike seats make us sit on our perineums, resting on the ischiopubis rami (the connector bones of the anterior pelvis) and the internal part of the genitals. This area of the body was not designed to be weight-bearing.
The ischiopubis rami are surrounded by nerves and arteries and, in men, erectile tissue and the urethra as well. The male genital actually attaches far back in for erectile functioning. The Alcock canal, which contains nerves and arteries that enter the penis, runs through this area. Similarly in women, the clitoris attaches far back in the pelvis, and the Alcock canal supplies blood and sensation to the genital and urinary tract regions. Sitting on a bicycle seat compresses this sensitive area, cutting off both blood supply and nerve sensation to the genitalia. The normal, narrow, unpadded bicycle seats significantly reduce blood flow through the Alcock canal, and even padded seats are still restrictive. (4)
A recent case study by Irwin Goldstein M.D., a well-respected urologist at the Boston University School of Medicine, shows an association between ED and extended athletic cycling. Goldstein's research demonstrates that cyclists are four more times likely to experience ED than track athletes. (5) In a 2002 study of bicycle policemen in Long Beach, California, 91 percent of participants reported genital numbness, and experiments revealed that they had a significantly lower rate of normal erectile events during sleep than non-cyclists did. (6) Results from the major Massachusetts Male Aging Study show that men who cycle more than three hours per week are at risk to develop artery blockage and long-term damage in the perineal region. (3) In terms of women's health risks, research at Boston University documents urinary tract problems and sexual dysfunction in women cyclists as well, including both road bikers and racers.(7)
Without preventive care, many cycling injuries occur.
Depending upon the cyclist's riding position, biking can either enhance health or contribute to injury.
The good news is that, if we make certain changes, most people do not have to give up cycling. But you may have to give up the seat that came with your bike! A recent comparison trial showed that the use of an experimental bike seat reduced perineal numbness and posited that proper seat design could prevent cycling -associated impotence.(8)
New bike seat designs include seats with split saddles that can be adjusted to the width of your sit bones, saddles without noses, saddles with holes in the middle of them and saddles with extra padding. I have researched five innovative dual platform models and one with a short front piece, which many people find very comfortable. These include the BiSaddle, the Hobson Bike Seat, the Spongy Wonder Bike Seat, DDwings Ergonomic Bike Saddle and The Seat. There are new seats being developed, as well.
The stated aim of all these seats is to reduce or eliminate the damaging pressure and irritation on the entire perineum and genital region, including the coccyx, prostate, dorsal artery, vein and nerves. Recent research by Goldstein also found that only the dual platform seats, with two separate pads and no nose in the front, were effective in taking pressure off the perineurn and ensuring genital circulation. In his research, Goldstein continues to test different models that claim to achieve the same goals.
Unfortunately, these seats are not readily available in most bicycle stores and are usually purchased through the Internet. The seats, available in stores with a depression in the center or a space toward the back, still substantially cut off the circulation to the genital region.
If the person does not choose to use a dual platform seat, it is recommended to limit cycling to three hours per week, take frequent breaks, or regularly stand up when peddling. Additionally, as experienced bikers know, it is important to remember that the seat must be adjusted to the proper height. This means the knee can be fully extended with the heel on the pedal.
The good news is that, if we make certain changes, most people do not have to give up cycling. But you may have to give up the seat that came with your bike!
As a practitioner concerned with the whole health of your client, it is good to encourage your client to exercise. However, be sure to inform your clients about the health risks associated with cycling on the standard bike seat, and let them know about the new dual platform seat alternatives for making their cycling habit a safer one.
Ben E. Benjamin, with a Ph.D. in sports medicine and education, is the founder and president of the Muscular Therapy Institute in Cambridge, Massachusetts. He maintains a private practice in Cambridge, and has been in practice for more than 35 years. He can be contacted at: 175 Richdale Ave., #106, Cambridge, MA 02140, or via E-mail at: BB@mtti.com.
Do not look where you fell, but where you slipped.
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