Can I Ride with an Inflamed Bursa Sac near my Sit Bone?

Question:  I have an inflamed bursa sac near my sit bone. What seat would you recommend to me for long distance cycling? — Susan T.

Joshua Cohen PT, MS, Replies:

Susan, given the description of your symptoms, and my conservative physical therapy approach, I don’t think you’re going to love my answer. The short answer is that you should probably take some time off of the bicycle to allow your body to repair itself.

Here’s the longer answer:

1. Are you sure it is purely ischiogluteal bursitis? The hamstring muscles also attach to that area and it could be a combination of tendonitis and bursitis. It would be a good idea to have a physical therapist evaluate you to determine what other biomechanical issues might be causing your pain. Hamstring tightness, muscle strength imbalances, and bicycle fit may all be causative factors.
2. Almost every bicycle seat puts some pressure through the sit bones. If it didn’t, that would mean that all of your weight would be resting squarely on your perineal region, which is horrible for your blood supply and nerves.
3. One other option would be to move all the pressure to the front of the pelvis. I don’t endorse this approach, but if you absolutely had to ride like your life depends on it, this might take pressure off of your sit bones. There are saddles on the market that transfer the pressure to the frontal pubic rami region (if your pelvis lines up correctly) but they can also put weight on sensitive blood and nerve structures nearby, if everything doesn’t line up correctly. Plus, the small contact area may not be tolerable for long distances, especially if you’re not used to it.

My concern is that, if you keep riding on a very sore ischeal tuberosity, it will only get more inflamed. You may also start making alignment changes to reduce the pressure on that area, and those alignment changes could cause other muskuloskeletal issues and injuries. It’s a sort of domino effect waiting to happen.

I have heard of riders, desperate for relief due to pelvic alignment issues, who started cutting out padding from their seats. I don’t suggest that either.

I suggest that you let it heal, find a physical therapist to evaluate your injury, and have someone evaluate your bicycle fit.

Joshua Cohen PT, MS, is the designer of the Kontact anatomical bike saddle. He holds a Master’s degree in Human Movement Science with an emphasis in Sport Biomechanics and Product Design. His research on saddle design has been published in the Journal of Sports Medicine and Physical Fitness.