How Do I Remedy Sit Bone Saddle Sores?

Questions: I have been suffering from what I call saddle sores or pressure “lumps.” I have changed saddles 3 times this season and just changed to some new shorts. I have also used a whole slew of chamois creams. In addition, I’ve had my fit checked, which was OK. While I have seen some improvement, beyond a few hours in the saddle I get pain in my sit bone area with associated redness and swelling that often keeps me off the bike for days. I really don’t know where to turn at this point. — Rob P.

On a recent century ride (very hilly plus some short 20% & 25% inclines) I ended up with two blisters on my backside. They were where my sit bones met the saddle. They eventually burst on the ride and caused some painful discomfort. I finished the ride but had to take a day off from riding, and the next time I rode (perhaps too soon) it was eye-wateringly painful. My questions are: A) Which is the best way to prevent saddle blisters?, and B) Once you have them, how are they best treated? — Mark N.

Coach John Hughes Replies: Rob and Mark, it seems that you’re both asking how to prevent pressure sores on the buttocks where the ischial tuberosities, or sitz bones, rest on the saddle, and how to deal with them if they develop. Because your questions were so similar, we thought We’d double up on the answer.

According to Patrick Kortebein, M.D., from the Mayo Clinic, in one study over 70% of saddle discomfort was associated with pain at the sitz bones. This is very similar to bed sores. The principle cause is pressure, which significantly reduces blood flow, depriving the skin of oxygen and nutrients.

The result is pain. Heat exacerbates the problem, because when the body heats up — both from exercise and ambient temperature — skin metabolism increases, requiring even more oxygen and nutrients.

Since the problem is pressure, lubricants won’t solve it. Save your money, and focus on the various ways to relieve pressure:

Get a saddle that fits. The width between sitz bones varies from individual to individual. According to Andy Pruitt and the experts at the Boulder Center for Sports Medicine, the most important factor is selecting a saddle of the right width for your butt. Many shops have a special device you sit on to measure this distance. Another great resource for understanding saddle  anatomy and how to find a saddle that works for you is Joshua Cohen‘s RBR eBook Finding the Perfect Bicycle Seat.

Check your seat height. If your hips are rocking at all as you pedal, your saddle is too high and you’re putting pressure on your sitz bones (and increasing chafing). Pull your jersey up and have someone watch you from the rear to see if the line at the top of your shorts is stable.

Stand frequently. Stand for 30 to 60 seconds every 10-15 minutes to get the blood flowing. This benefits your legs as well as your saddle pressure points.

Use padding appropriately. Too much padding will restrict ease of movement and may lead to chafing problems; however, one study showed that pressure was distributed more evenly with seats that had fluid-filled (LiquiCell) or gel filled (Spenco) surfaces.

If you develop pressure sores, taking time off the bike to let them heal is the best approach. Effective training includes both overload and recovery, and taking time to heal and recover physically and mentally could do you a lot of good. You don’t have to sit still — go for hikes, play catch with the kids, walk the dog, swim, etc.

If you don’t want to stop riding or are in an important event, try wearing two pair of shorts, with the inner pair turned inside out so the lycra is against your skin. This will provide more padding, and because the shorts are chamois-to-chamois they’ll move as one unit. You can also get a bunion pad with a hole cut out for the bunion and place that so the hole surrounds the pressure sore.

If the sore becomes an open wound, then stop riding and see your doctor. You don’t want to get it infected!