Friday, July 11, 2008

Buttock pain and the Tour de France

The Tour de France is a monument to human endurance. Cyclists cover over 2000 miles in just over 20 days, with some prodigious climbing through the Pyrenees mountains. Participants can consume 8000-9000 calories a day, with metabolic rates rising to 4-5 times normal. Cyclists are some tough hombres.

Endorphin highs are intoxicating, and even nonprofessional cyclists are willing to undergo a great deal of pain to keep doing their favorite activity. Many cyclists are addicted to their sport, and are out riding several days a week. Perched on top of a gangly two-wheeled contraption, unusual forces can be exerted on the human body.

Forty-five year-old avid biker with six weeks of bilateral buttock pain, left greater than right:

Coronal STIR and T1 images demonstrate subcutaneous edema and soft tissue thickening in the area (red arrows) where the biker sits on his bicyle seat.

Six weeks ago, he had adjusted the stem of his seat, and also changed his handlebar position. Riding position is a balance between comfort and power. This patient was getting older, and wanted a less aggressive riding position. He made the changes, and quickly experienced buttock pain. Interestingly, the skin overlying this area was completely normal, with no evidence of saddle sores. This edema is the result of abnormal, unrelenting pressure on the subcutaneous tissues of the buttocks. The cyclist will have to forego his endorphin high for a few weeks (as mentally painful as that might be), and alter his riding position.

One can speculate that similar changes could be seen in any riding sport. I have occasionally ridden horses, and can state unequivocally that this can be remarkably unpleasant. I did not realize just how much pain ischial tuberosities can cause until I rode a horse for a full day in Colorado, on a dude ranch last summer. I was hobbling around and sitting gingerly for a few days following that experience. I did not need an MRI to tell me that I was not cut out to be a cowboy....

Vic David MD

No comments: