Ischial bursitis

I’ve had a bit of an ordeal with a bike injury over the past year, and now that it’s on its way towards resolution, I thought I’d share the experience in case it can help anyone else.

A year ago, I noticed some discomfort around my right sit-bone, right where my butt contacts the saddle. At best, it felt like a slight protrusion with some slight tenderness. I had to scooch around to find a good position. At worst, I’d feel a muscle “click” every pedal stroke, which didn’t feel right at all. I’d describe the “protrusion” as feeling like there were cotton balls under my butt, leaving me unbalanced. Like half my chamois was thicker than the other.

It was always worse inside on a trainer than out on the road. It’s probably because I could compensate the angle of the bike on the road, as opposed to on the rigid trainer. (At one point it was so bad I tried running. Oof, running’s the worst.)

I think there are two possible causes. First, I had a crash, which is what the doctor and PT attribute it to. But the crash was on my left side, and though I lost a good bit of skin on the left side, it wasn’t a particularly hard impact. Maybe my butt was planted so well in the saddle that there was an impact there when I went down. But second, it was the end of a lockdown winter of LOTS of riding on the trainer. I would definitely believe I spent too much time on the trainer.

So I went to a physical therapist first. He wasn’t really able to identify exactly where the problem was (it really only was noticeable while on a saddle). But he did see that I was very inflexible (apparently epidemic among us cyclists) and had some particular issues on my right side. He gave me a stretching regime which I followed closely.

As spring turned to summer, and most of my riding was outside, the discomfort abated. Had a nice summer of good long rides. I thought it was done. I kept up the stretching. And the stretching worked, as far as increasing my flexibility; I was able to touch my toes for the first time in my life! I might go in for a bike fit at some point and lower my stem.

But as fall began and I started riding more inside, the issue crept back. Did more PT, didn’t really help. I kept training; I was told riding on it wouldn’t make it worse, but it didn’t feel great. At that point it was time to see a doctor.

The sports medicine doctor was satisfied that I’d done enough PT and said it was time to inject stuff into me (they won’t do any procedure until you’ve done enough PT first). First I’d get an MRI. I’m no radiologist, but even I could see the inflammation (sorry for the TMI view):

The diagnosis: Ischial bursitis. After that, the doctor injected a steroid into the area of the inflammation, guided by an ultrasound. Not the most comfortable injection, but it was quick.

And after two days, I got back on the trainer, and the difference was immediate. MUCH more comfortable. It was such a big difference that I got a little emotional on the trainer. And even more surprising, I had much more strength. After a week, my FTP was up at least 4%, and it’s still going up. Maybe it’s the steroids and I’m doping. But I think it’s a result of being more comfortable on the saddle.

There are still moments now and then of discomfort, usually after a high-torque pedal stroke, but I’m told if I keep up the PT exercises, that should go away. Also, I’m getting that new Tacx Neo Motion Plate which should make trainer riding less unnatural.

Sorry for such a long post, but I think the lesson is, if something really doesn’t seem right, see a doctor, they can help!

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I feel your pain. I had been going through this issue for years on and off. I FINALLY got to a permanent fix. I ended up having to get a saddle that is wider than my sit bone measurement suggests. I also found that I need a flat saddle with minimal padding. After a lot of experimentation, I landed on a fizik antares in a 155 mm width. The aggressive curve from the rear of the saddle to the front enabled me to get that proper support on the saddle but not have it chafe the inner thigh. On a more narrow saddle, I’d have these infrequent moments of irritation that would eventually lead to chronic inflammation. And I went through all of the same steps. Ortho, PT, injections, etc. That stuff helped to have the symptoms go away for a bit, but they’d always come back. Best of luck to you.

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This is both discouraging and encouraging. Discouraging to hear that the injections were only temporarily effective. Encouraging that you found a solution. My saddle is a Specialized Power Arc- narrow, very curved. I might have to try something different.

That would have been my approach, a long long way back in this scenario. I had major issues with the down under, saw the doctor, found out what it wasn’t (they weren’t all that certain of what it was), all kinds of tests, but I prefer to avoid cortisone and related types of injections in favor of actually resolving the problem, so I went through a series of different saddles, some with cut outs in the center in order to avoid contact with sensitive areas, some wider, shorter, softer, harder, and finally ended up with Brooks B-17 saddles (the Champion version) with my own version of the “Imperial” cutout, and no longer have any of the issues I once suffered from–I have them on all five of my bikes.

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Thanks for sharing. I’m glad you are still enjoying the bike!

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Really interesting and thanks for sharing. As a physio I love these sort of case studies. Wishing you all the best in finding a long term solution .

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