Question: My wife (age 75) is just starting to ride. She has a new hybrid bike, with a comfort bike-type seat. We want to ride the Katy Trail (250 miles) this October, about 40 miles per day. We have started a training program. She complains of “tail-bone” pain after about 5-6 miles. She thinks she needs more seat padding or a gel-seat cover. Suggestions, please. — Bruce R.
Joshua Cohen PT, MS, Replies: The Katy Trail looks like it would be a spectacular place for a long ride in autumn. You certainly want your wife to be comfortable on the ride.
Discomfort in the region of the tail-bone (coccyx) could be due to a number of factors. Here are some areas to consider:
Saddle cushioning: If her current saddle is too cushioned, it could actually cause discomfort by displacing padding into more sensitive regions of the perineum and cause nerve compression and vascular restriction. The saddle should provide moderate cushioning without the displacement that occurs with heavily padded gel seats. Ideally, the saddle should have a relatively flat rear section to support the sit bones without pressing up into the central perineum.
It is also important that she is able to pedal while remaining comfortably over the widest rear section of the saddle. Otherwise, the nose will press squarely into the perineum and tail-bone region. This would not be comfortable at all. Cushioned bicycle shorts may be helpful to reduce sit-bone pressure if she feels the saddle is too firm. Anticipate that it may take longer for her to adapt to the bicycle saddle, given age-related changes in the skin’s collagen and sub-dermal tissues that reduce the body’s ability to distribute pressure.
Saddle contours: The presence of a long, centralized depression from the very rear of the saddle to the nose will help to reduce pressure on the tail-bone and perineal regions. Try to find one without a hole in it, as this tends to increase pressure surrounding the cut out. Also, the edges of the depressed channel should have a smooth radius, to avoid spikes in pressure along the depression.
Pelvic rotation: Many hybrid bicycles for beginners are set up with a very upright riding position. By sitting upright, weight is shifted from the handle bars to the saddle, which increases the saddle/rider interface pressure. This position also rotates the pelvis posteriorly and makes it more likely for the tail-bone region to receive pressure from the saddle. If she feels comfortable with her bicycle handling skills, she could try a more forward riding posture, which will rotate her pelvis forward and shift weight off of the tail-bone region.
Prior injury / flexibility: This same forward rotation of the pelvis can be accomplished by working on lumbar spine and hip flexibility. Since her posture and flexibility are unknown, she may want to consider going to a physical therapist for a thorough evaluation. If she has ever had an injury to that region, such as a broken tail-bone, or lower back injury, that could also cause tissue adhesions that result in limited flexibility and discomfort. Given her age, it is also possible that there is some vertebral/disc degenerative changes that could relate to this issue. If the problem persists, an evaluation by a physician and physical therapist may help her to find other solutions so that she can enjoy the beautiful changing colors of the trees on the Katy Trail without pain!
Joshua Cohen PT, MS, is the designer of the Kontact anatomical bike saddle and is the author of the RBR eBooks Finding the Perfect Bicycle Seat and The Illustrated Guide to Bicycle Seats. 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. You can view his videos on saddle comfort in the Health section of the site.