Cycling Sit-bone Injury Assessment & Treatment
This season, I have been struggling with a sit-bone injury that had me side-lined for weeks and then in significant discomfort during rides. Fortunately, my sit-bone is feeling better. A combination of rest, stretching and physiotherapy have really helped.
Physiotherapy
In an earlier post, I mentioned that I was going to see a doctor for this. But, I decided it would be better to go straight to a physiotherapist. It looks like this was a good call as my physiotherapist has worked with me steadily over the past few weeks to help my sit-bone injury get better with a focus on getting me riding — it definitely helps that she’s a cyclist! As well, my impression of my current physician is that he would simply tell me to stop riding — I gotta find a physician who enjoys working with athletes and is knowledgable about sports injuries (it seems that they are few and far between).
Injury Description
The oddness of the injury is that it’s one-sided - that is, affecting only my left sit-bone. It’s not uncommon for cyclists to suffer severe bruising of their sit-bones — resulting in scar tissue and swelling, as well as pain/discomfort during rides. The scar tissue can be substantial — think pea sized lump pushing into a tender bruised bone (very localized - ouch!). But, typically, this occurs on both sit-bones simultaneously — for example, resulting from too many hours in the saddle over harsh terrain. But the one-sided nature of my injury indicated that something more is likely going on!
Injury Assessment
The physiotherapy assessment determined that my left sit-bone is sitting notably lower than my right sit-bone. So, this could certainly explain why the left, and not the right, sit-bone got injured. We can’t ascertain how long this has been the case — recent, progressive, forever. But, this is the first time in over 10 years of cycling that I have encountered a lop-sided sit-bone injury.
Historical physiotherapy determined that I have a significant leg length discrepancy with a shorter left leg that can result in lower-back pain and hamstring tightness on the left-side. This has already been compensated for with orthotics for walking and running, and via cycling cleat adjustment. However, with the recent assessment, it was determined that a plausible contributor to my injury was a left hamstring that was simply remaining too tight. It’s very possible that the tightness of the hamstring has pulled down my left sit-bone. I was stretching pretty regularly — but not enough (it’s gotta be a daily routine)!
The more routine stretching is certainly helping. Best case scenario, increased flexibility will allow my sit-bone to float back in alignment with the other sit-bone. Worst case scenario, it will never float back - but eh, maybe it’s always been misaligned. Or, it will float back somewhat. It seems like it has floated back a bit since my first physiotherapy appointment.
And the discomfort during riding — well, that’s something I will have to deal with this season. It’s gonna take quite a while for the scar tissue and the bruised bone to heal. Thank goodness it’s feeling better!
Injury Treatment
The treatment that has been prescribed to me includes:
- Routine stretching of the hamstring
- Icing sit-bone area after rides to control inflammation
- Massaging sit-bone area to break-down scar tissue followed by icing
- Ultrasound to reduce inflammation and break-down scar tissue
- Exercises to strengthen the pelvic area on the side with shorter leg
- Having at least one off-the-bike day in between rides to aid healing
Injury Prevention
- Routine stretching of the hamstring (and legs, psoas, and glutes in general)
- Use of heel lift in shoe on shorter leg when walking and running
- Cleat adjustment to accommodate for shorter leg*
- Saddle that adequately supports the sit-bones
- Cycling shorts with added padding specifically in the sit-bone area
*A heal lift will not help in cycling shoes — it’s not the heel that pushes on the pedal. A cleat adjustment is needed to compensate for a leg length discrepancy. Two types of cleat adjustments can be done: (1) moving the cleat back or forth on the shoe; (2) adding shims to the cleat. Cleat adjustment is dictated by whether the leg length discrepancy is in the tibia and/or femur - this will determine whether the corrective measure is moving the cleat back or forth, adding shims to the cleat, or both.