Photo Credit: Erin Meadows
Meet Dan
Fully Recovered
Riding Normally
Gravel, Road & MTB
Riding Type
Endurance, bikepacking
Riding Speciality
Sit bone and groin pain with urinary symptoms
Primary Symptoms
Bike fit, training load, and stress
Likely Cause of PN
How it Started
In retrospect, the humorous nature of how this all started is a big part of the reason it took so long to get properly diagnosed. It was late October 2025, the race season was over, and I was going on a few of my favorite rides for fun. One such ride was a fast, flat route down to Arapaho Bend and back. I did not notice anything out of the ordinary on my ride. When I returned, I hopped off of my bike, and as I was walking away I noticed a thread from my bibs to my seat post. I looked at my pants and couldn’t believe it - a thread had caught on one of my seat post bolts and I had inadvertently pedaled the threading out of my chamois pad. On my right side, my pad was all bunched up by my right sit bone.
Initially I was a little bummed that I’d have to have it repaired, but that was soon supplanted by an increasingly uncomfortable sensation coming from my right sit bone. It felt as though my sit bone had a golf ball stuck underneath of it. I wasn’t sure what was going on, so I took a week off of riding my bike, and the pain subsided. When I went for another ride, the pain returned, so I took a month off to play it safe. It was January 2026 at this point, and I felt better, so I went on another, longer ride. Again, I didn’t notice anything strange until I was off of my bike, but this time the pain was different.
Symptoms
What was initially one uncomfortable sensation on my right sit bone ballooned into something more complex. Both of my hips felt extremely tight, my groin burned constantly, and I felt regular numbness and burning in my feet. It grew unbearable when I was seated, and it felt like the pain moved around when I bent over. It seemed as though someone had put a vice grip around my hips, cutting off the blood supply to my lower half.
The days turned into weeks, and it kept getting worse. I talked to my PCP, along with my physician brother-in-law, who both seemed perplexed. I was able to schedule an appointment with an orthopedic physician, but there was a month wait. In the meantime, Dr. Google wasn’t particularly helpful, although it did lead me to read a little about something called “Pudendal Neuralgia.” Cyclists syndrome was its colloquial name, and I was advised to try a few nerve flossing exercises that did not help. I read about surgical options for “pudendal nerve entrapment,” which were described as “poorly tolerated” and “unhelpful.” After experiencing altered bladder emptying, my PCP had me go to urgent care, and the PA I saw was similarly confused. I was prescribed gabapentin, and was lucky enough to get my orthopedic appointment moved up. It was now February, and I had been in ceaseless pain for about a month.
Causes
While my previous appointments with my PCP and urgent care left me feeling more confused than when I had walked in, it was at this orthopedic appointment that everything seemed to click. My doctor was a cyclist himself, had dealt with similar issues, and had even helped a few riders recover from this condition. After a normal x-ray, he confirmed that what I was experiencing was likely Pudendal Neuralgia. He explained surgical options were generally unnecessary except in certain cases where this develops after childbirth, and explained that physical therapy and time would be what heals this.
After a little exam, he guessed that I wasn’t engaging my glutes correctly, and asked about my bike fit. Chances are, he explained, that something about my bike fit was probably off, and my improper glute engagement had, over time, put too much pressure on my ischial tuberosity, or sit bone. He also guessed that because I was a little taller than most, there was also likely something about my anatomy contributing to this hip tightness and sciatic-like pain. After an MRI to rule out any spinal issues, I started physical therapy.
Between my two physical therapists, my pelvic floor therapist, and Zack over at Bike Sports, I finally had the full story. Although I considered my chamois incident to be the start of this, I had been building towards this injury for months. I put a new groupset on my bike in April of 2025, did not adjust my fit, and trained too hard for the FoCo Fondo in July of 2025. My bike seat was much too high, and with each pedal stroke I was putting too much pressure on my sit bones. My pedal strokes were also consequently inefficient, which meant not only was I hurting myself on the bike, but I was pedaling harder without much of an increase in power. My improper glute engagement over time led to some awkward muscle compensation, including my piriformis, which had entrapped my sciatic nerve, explaining the leg and foot pain. Lastly, I had a pretty significant imbalance in the external rotation of my right leg, which explained why this was predominantly happening on my right side. By the end of my six weeks, and after my bike fit, I felt about 90% better. I still had lingering pelvic pain and burning, which I figured time would heal. I had a follow up with my pelvic floor therapist, who asked me about stress, which was the final piece to this puzzle.
What Helped
I met with my physical therapy team twice a week, for six weeks, and I did approximately 2 hours of exercises a day. The gabapentin helped take the edge off, and about halfway through this process I started noticing improvement. When my PT was complete, I scheduled a new bike fit with Zack Allison over at the Bike Sports Fit Studio, which was recommended by my orthopedic doctor.
Time off the bike, physical therapy, specifically glute and core stability exercises, and an improved bike fit all resolved my pudendal neuralgia. The core stability exercises in particular improved my sciatic nerve pain. But after all of this hard work, I still had lingering pain and discomfort. I was worried I would cause this again, which I explained to my pelvic floor therapist, and she gave me a little information about stress and pain. She had asked whether there was anything big going on in my life, and I explained that there was. I had recently become a first time father.
My wife gave birth to our daughter in May of 2025, right around when I was training very hard for the FoCo Fondo. I was doing a lot of baby carrying too, with hip straps that may have been contributing to my hip tightness. I was extremely busy, extremely tired, and moving more awkwardly thanks to the baby carrying than I had ever been in my entire life. The stress of new parenthood was something I had not considered as playing any sort of role in this condition, but here my therapist was explaining that stress made pain worse, and could make it linger. She hypothesized that my pelvic floor was tight, which she confirmed, and recommended some breathing exercises. It was at this point that I took seriously what I had read on this very website after my diagnosis and initially dismissed: the mind body connection.
Mind-Body Insights
I will be honest, I was a complete skeptic of the mind-body connection in chronic pain. I am in the genetics field, and am in disability advocacy circles, so I generally distrust the psychologization of physical symptoms. This “thing,” which I caused by moving my body the wrong way, could not be “in my head.” That sounded preposterous. But I could not explain why I still had lingering symptoms, and so I gave a little book called “The Way Out,” a shot. I was floored. While reading it, I was lucky enough to be one of those folks in Alan Gordon’s Boulder Back Pain Study who felt chronic pain relief just by hearing about chronic pain science. Suddenly, aspects of this experience that didn’t quite make sense, did; I felt significantly worse around the time when my daughter started crawling, mostly because I was crushed that this important moment in my life was marred with pain. At a certain point I had to stop baby carrying - the carrier hurt too much - and I was devastated. Strangely, it sometimes felt like not being able to use the baby carrier “hurt” more than actually using it. It started to become clear that some of this pain was actually “neuroplastic,” which meant the severity was modulated by my emotional state. There were even moments where it seemed like I hurt significantly worse while watching other cyclists, or seeing friends post new rides on Strava.
I discovered all of this while only dealing with pelvic burning, and as this component of my recovery came into focus, the pain abruptly subsided. Learning that some of the unexplained pain sensations I had were the product of a lot of “crossed-wires” in the parts of my brain that deal with my sense of self helped to re-contextualize other injuries I had in my life, where I dealt with lingering issues long after the tissue had healed.
Of everything I learned throughout my experience, this proved to be the most fascinating. If I had come to understand this earlier in my treatment, there is no doubt in my mind I would have had a much easier time throughout my recovery.
Current Status
It is now October of 2026, and I would consider myself fully recovered. I have been back to riding my usual distances (~50-75 miles) on the gravel roads north of Fort Collins since about June, and as time has gone on there have been less and less moments where I am briefly sore on the bike. There have been zero moments where I am sore afterwards. Every now and then when I sit on something like concrete, or I am stuck driving long distances in the same position, I feel a little sensitivity on my right sit bone. At first, I was startled by the sensation, but now it serves as a friendly reminder of what I went through. When I take a breath, it goes away, which serves as an even better reminder of what I need to keep doing.
This entire experience reshaped my relationship with cycling, and while I do still plan on training and racing, I am mostly just trying to have fun. I haven’t changed what I wear, nor have I changed the kinds of rides I do, but I have changed my priorities on the bike. A successful day on the bike is one where I have fun, regardless of what happens. It certainly helps that since I recovered, my wife and I got a Burley to cart our daughter June around in, something I worried I would never be able to do. She loves every second of it. June, who is 16 months now, just got her first Strider bike, and while she’s too young to use it yet, she can keep it upright and take a few steps. The shrieks she makes while on her bike mean she already knows, intrinsically, that this is all about having fun.
Personal Note
It wasn’t until about halfway through my tedious, time consuming physical therapy routine that it dawned on me: “I moved my way into this, and I can move my way out.” Repetitive motion injuries are challenging for myriad reasons, but what helped me keep going - before the gabapentin was helping, before I saw progress in physical therapy, and before I learned the role stress played in all of this - was knowing in my heart that “I can move my way out of this.” Stress played a significant role in my experience, and I implore anyone reading this story to channel their inner Thomas The Tank Engine during their recovery. It is important to “think you can.” This little bit of optimism I was channeling is an essential tool in the stress management tool kit. I would go on to channel it again after reading “The Way Out,” and it is what helped me finally give my story an ending.