Pelvic floor dysfunction includes many signs and symptoms and its weakness (or spasm) comes with a wide range of presentations. When it comes to cycling, the actual sport and the level of difficulty play a role in the level of dysfunction that the individual may end up with. In this blog, we will discuss the following:

• What is pelvic floor dysfunction?
• What are the symptoms of pelvic floor dysfunction?
• How to adjust the cycling style to not have pelvic pain and
• How to prevent pelvic floor dysfunction and pain as a cyclist

What is Pelvic Floor Dysfunction?

The pelvic floor is like a bowl that is at the base of the spine where it is attached to the pelvis. In fact, the inner part of the pelvis where the lower intestine, bladder, uterus, and ovaries or prostate reside is the area of the pelvic floor.

Pelvic floor muscles on the outside surface include the area in and around the vagina or penis, the anus, and the tissue between. On the inside, there are muscles that line this ‘bowl’ including the muscles that are involved in hip stabilization.

As seen in the picture above, the pelvis is connected to the spine and the hips and itself consists of 2 bones called Ilium and another bone named sacrum. Just as a point of reference, the lower tip of the sacrum is where your tailbone or coccyx is located. This means that the alignment of the pelvis and the muscles of the pelvis are directly influenced by the alignment of its ilium and sacrum forming the sacroiliac joints as well as the lower back, lower mid-back, and the hip joints on each side; after all, the thigh bone is attached to the pelvic sockets forming the hip joints.

Anything that compromises the bones and the muscles in these areas leads to its dysfunction. This dysfunction can be in the form of weakness or spasm, it can cause issues with the function of the internal organs it holds or manifest itself as pain in the pelvis or the joints attached.

What Are Symptoms of Pelvic Floor Dysfunction?

I have written a detailed blog on this very subject given that some of the symptoms are well known while there are many subtle symptoms that I wished the health care professionals would look into when a patient presents themselves to the office. I strongly suggest reading my blog to be clear but here, I will mention the list of symptoms. As mentioned in my blog,

“The following symptoms are what most people either know or associate with pelvic floor disorder or pelvic floor dysfunction:

• Urinary incontinence
• Fecal incontinence or Bowel incontinence
• Prolapse of uterus
• Bladder prolapse
• Bladder pain syndrome or Interstitial Cystitis
• Hemorrhoid
• Feeling pain in the pelvic area with or without going to the bathroom”

While following are the subtle clues that get missed often!

• “Lower back pain
• Pain in the back joints of the pelvis (SI Joints)
• Pain in the front pubic area
• Arched lower back
• Slouched lower back
• Slouched mid-back or hunchback
• Military posture with the chest pushed out
• A V-stance where the torso is positioned behind the hip joints on the side view
• Chronic forward neck
• Inability to bend down below the knees
• Habitually standing on one leg with the other leg bent
• Chronic one-sided pain in the lower extremity
• Hip pain on one or both sides”

Can Cycling Cause Pelvic Pain?

The short answer is yes, but does that mean that everyone cycling will get pelvic floor pain and the answer is no! So what is the difference?

If you think about it, anything that leads to exerting force onto the pelvis while the muscle of the pelvic floor or muscles attached to the pelvis are contracting imposes the potential for a tweaking of the pelvis and its attached muscles. Misalignment of the pelvis (sacroiliac-iliac joints and pubic symphysis), lower back, lower mid-back, and hips all make you prone to pelvic floor dysfunction and its pain. 

Imagine being on your bike going uphill, getting off the saddle to pedal forward; unless your position of the feet on the pedal, knees stacked on top of the ankles and staying midline, hips being stacked midline with the knees and ankles, and pushing equally on both legs, your chances of pelvis misalignment leading to pelvic weakness, perhaps inner thigh and hip flexor activity is exponentially high. What if you are careful getting off the saddle to push through, going uphill but have had a history of lower back pain that is now gone so there is no pain but in reality, the tension on one side of the lower back is more than the other? Do you see how the tense side is the shorter side so getting off the bike with one side of the back shorter than the other leads to the imbalance?

The point here is that every time you increase your level of activity, the importance of having a balanced posture becomes even more important. After all, the more ‘miles’ you put on this machine we call our body, the more important it is to make sure it is tuned up and in shape!

The difference between those that cycle and have pelvic floor pain and dysfunction (no pain) and not, is that in one group the important points are touched and attended to, while the other group jumps on the bike and calls it it!

How to Adjust Your Bike for Healthier Cycling?

I found this Rei article to be quite informative and worth reading and my take on the bike seat is that if you are an avid rider, invest in getting a titanium seat as it is lighter and absorbs more impact if you ride a dirt bike. The center cut out on the bike is a matter of preference and should be adjusted based on your anatomy. I am a bike fan of this feature as it semi-protects the gonads when riding.

While it is advised to get a narrower seat for better efficiency in riding, once again, I suggest you try different seats for your anatomy. If you are not a heavy rider, you should consider a wider seat as it provides more cushion to the perineal area where you sit on.

When it comes to clip-in pedals and cleats, I have personally sustained good injuries as a result of wearing them but they are helpful with the speed and alignment of the feet over the pedal. I do suggest you pay close attention to your feet positioning and skip the clips and cleats if you can!

When getting off the bike seat to push on those crazy uphills, make sure you are even pedaling. Pay attention to your form and side to side push, as well as the positioning of your hands and feet over the handlebar and pedals.

I strongly recommend getting your bike adjusted every 6 months by professionals who are riders themselves. It is money well spent.

Prevent Pelvic Floor Dysfunction and Pain as a Cyclist

So you are a cyclist and into prevention, you want to know what to do to not end up with the pain and dysfunction that your hobby and sport of choice can cause. Following is the to-do list with references to look into further.

• Breathing

Not every breathing is the same and the right type of breathing is the one that all babies all over the world do without any coaching. To learn about this method of breathing which is what I teach all of my patients, I suggest you watch this video.

• Postural Neurology

There is a map of movement and sensation that you are born with which gets detailed specifically within the first 2-3 years of your life. This map called Homunculus gets modified based on your habits, injuries, and lifestyle and so the ‘blueprint’ of movement changes. When it comes to cycling, for example, we want to make sure that this map is not modified but is as close to the best fit for the design of your body as it once was. To learn what your ‘map’ is like, through a postural neurology exam, we can determine what areas of the brain with regards to movement needs attention and with simple, but strategic exercises, we address those weaker areas.

• Functional Movement

If all babies, regardless of the differences among all humans, move the same way then that must be the ‘software’ we are programmed to follow. If we can find out through postural neurology what the blueprint looks like, then why don’t we rehabilitate the areas of the body (that were used based on the modified map or not used at all, based on the modified map) by following the developmental movement patterns? Through Dynamic Neuromuscular Stabilization or DNS, this has become possible. This is another place where the rehab. health care providers fail in treating patients.

• Emsella Chair

While FDA-approved for incontinence, the Emsella chair provides 400 Kegel’s per minute to strengthen the inner pelvic floor muscles. We trust that people have the best intentions in doing their Kegel’s but let’s be real, no one does it religiously and certainly, no one does so many of them. In my blog on Kegel’s, I explain how Kegels are not the answer to all pelvic floor dysfunction and are not the best choice in certain cases. I suggest you take the time to read the blog to better understand how this amazing machine that thankfully we have available to our patients works.

• Chiropractic Adjustment

Not all chiropractic adjustments are the same and no one technique is the best fit for everyone. In my blog on the difference between chiropractic adjustment and mobilization, you see the difference between the two. Studies show that chiropractic adjustments stimulate the nervous system faster than mobilization, massage, or other soft tissue techniques, so in my practice, I use its unique impact to stimulate the nervous system, the problem-solving system, and follow it with the DNS and Postural Neurology exercises to lead the way toward correction.

• Visceral Manipulation

Just as we can manipulate the spine and soft tissue, we can manipulate the internal organs as well. This is something that some massage therapists, physical therapists, and chiropractors are trained to do and is certainly worth including in your overall quest for a healthier self.

• Massage

Not all massages are created equal so for all athletes and active individuals, I strongly recommend deep tissue massage in the forms of Active Release Technique (ART) which is explained in detail in my blog on ART.

This should give you a clear outline of what to look into. You can check out my two Youtube Channels for more information on the pelvic floor and DNS exercises and contact me if you need help solving your related issues.

Dr. Shakib