A Do-It-Yourself Perineum Relief Saddle: The TLRCP/PRS MkIV “Panzer”

About a year ago, The Logging Road Cyclist sustained serious damage to what he thinks is his pudendal nerve. While months of visits to various specialists failed to produce any definitive diagnosis, the fact of pain in the perineum, or colloquially the “taint”, remained. The damage happened while climbing up the steep Skillings side of McCulloch Peak, a road TLRC had ridden dozens of times before. Same ride, same bike, same seat. He had slid forward on the seat to keep the front wheel weighted as he had many times before.  This time, however, at the top, he felt an odd pair of filament-like things down there, like tendons or something, and that was all she wrote.

Three months later, he was able to walk without causing pain in the affected area. Another month or so and after lot of seat modifications he could paddle his kayak and ride his recumbent a bit. TLRC had pretty much given up on ever riding his upright bikes again.

By the Fall, TLRC was experimenting with taking his Gold Rush recumbent out  on the logging roads. With touring tires and fenders, he rode up McCulloch a couple of times. It took a lot of effort. He rode up Old Peak Road to the parking area at the North Ridge Trail and down Woods Cr. Rd. This was all encouraging, so he tried Prairie Mtn. This was not. About 5 miles up, a shooting pain in his right knee convinced TLRC that perhaps this superbly designed road machine was less than optimal for really steep logging roads and another debilitating injury lay ready to pounce should he persist.

Pudendal nerve injuries are a nightmare for the devoted cyclist. They are long-lasting, potentially career ending, and difficult to treat. As the Gnat put it, one of those things that might be the one that stops you. Based on TLRC’s experience, one must learn patience, Grasshopper, and try not to give up hope, find ways to adapt. Perhaps it is better not to identify one’s self totally with one’s pastime, e.g. not naming one’s self after it. On the other hand, since age will take it all away eventually, one might view it as a required “life experience”…

After this year of stoic suffering off of his bikes, TLRC felt healed enough to dip his toe into the water and try out some saddles designed to prevent or alleviate injuries like his.

That pudenal or perineal injuries are not uncommon is borne out by the number of bicycle saddles that purport to alleviate or prevent them.  There seem to be three main types:

Relief Channels. Typified by the Selle Italia Max Flow the large family of Selle SMP saddles, and any number of offerings from other manufacturers, these use a cutout or trench running for some length along the saddle or its nose to relieve pressure. TLRC tried a number of these, and while they might have helped prevent his problem, he is damaged enough that they didn’t feel safe for him.

“Noseless” Saddles. Adamo makes an array of saddles considered noseless, but they do not seem noseless to TLRC. A lot of people seem to like these saddles, especially the tri community, but TLRC could never figure out how to hang himself on one of these. Bi-Saddle makes an intriguing product that is not quite noseless, but is highly adjustable and has potential. The only truly noseless saddle that TLRC spent any time on is the Spongy Wonder. This saddle truly has no pressure in the perineum, is built to be used seriously (unlike some of the other “bench” type saddles that are meant for comfort or city bikes), and in spite of the whining one will encounter on various forums about how one can’t control a bike without a nose on the saddle, it is quite possible to ride the Spongy Wonder over pretty rough terrain. TLRC thought he had found his solution, but he was unable to get the Spongy Wonder adjusted so that it did not impinge on his sciatic nerve, which was quickly leading to additional problems he didn’t want.

“Rear Lift” Saddles. Versions made by Rido and SQ-Lab reduce perineal pressure by raising the rear part of the saddle where the sitbones go so that the nose of the saddle doesn’t press into the soft parts so much. These are a great idea, and the SQ-Lab saddle that TLRC tried was especially comfortable, but none of them quite did it for TLRC. To much padding on the nose, an arch in the forward part of the nose and not enough padding at the rear made them just not quite work.

Finally, TLRC just decided that his One Goal for the summer would be to make a saddle that he could ride. All the commercial options above were close, so he figured he could make something work.

What he came up with is a combination of all three types:

 

TLRC began with the shell of a Bontrager Yatra saddle. He chose this mainly because it provides a good, flat surface to glue foam to. Once the cover is pulled off the little channel that edges the shell needs to be cut off and the nose trimmed. Finding suitable foam was difficult. Most closed cell foam is too soft, and will remain compressed past a certain point (thanks to The Foam Man for pointing this out!). TLRC got an extra hard yoga block to use. This has a couple of drawbacks but has worked well so far. Because of the curvature of the saddle, the foam needs to be cut into roughly 1/4″ slabs (TLRC made a miter box to guide the cuts and uses a Japanese pull saw). The foam is applied in three layers with a very generous 1″ wide relief channel, then trimmed to follow the edge of the shell. One of the tricks is to extend the foam forward far enough for one’s pubic ramii to rest on them when tucked forward, yet not so far as to extend into the groin and perineum. The other trick is to sand the foam so that it is the full 3/4″ thickness in the front, but only 1/4″ thick at the rear. For this TLRC used a sandpaper rasp: a piece of 1×4 with 60 grit paper glued to one side and 36 grit on the other). This allows the saddle to be mounted in a strongly nose-down position while maintaining a flat seat. Thus the nose is pretty much out of the way of one’s delicates. Some custom sanding of a dip so that the saddle has a curved surface helps with comfort (TLRC used a piece of 60-grit disk sandpaper to a 2-gallon bucket to get the curvature). Finally, because the nose is wicked sharp, TLRC fashioned a foam cover for it.

This thing actually works! It took a couple of months to finally settle on this design, but TLRC has done 2 unshuttled Alpine Trail rides, the Middle Willamette Trail and a bazillion local rides with no ill affect. It takes a lot of fiddling and sanding while out on rides to get it dialed in (one can expect, for example, that the two sides of the saddle will not be of exactly equal height). The foam TLRC used is pretty hard, but not a lot more unyeilding than a lot of high-end saddles. It is pretty funky, but it works:

The Logging Road Cyclist’s Perineam/Pudendal Relief Saddle, MkIV “Panzer”

TLRC is riding again!

Rollerblade

The Logging Road Cyclist has had a couple of high-stress years. This included the inability to ride at all for nearly a year. TLRC aficionados will realize what this means. Another pair of external stressors that were right up there in the all-lifetime stress levels coupled with no riding brought back some nasty remnants from the past. TLRC is amazed at how similarly he responds now. It is, to loosely quote William Gibson, describing something else, “rather like having a Nazi tank buried in your back yard, grown over with grass and dandelions, but then you notice its engine is still idling.” Following is an example of one of the old events. TLRC is riding again (see other posts), and promises to pretty much drop the TLRC history lessons (especially the first person ones) and get back to the business of the site, which is after all, LRC, and happier.

The pager went of with its usual shriek and called us up to the old town of Placitas for a pedestrian hit by a car. It turned out to be a stupid guy rollerblading in the 50mph two-lane blacktop that ran through there. It was late at night, and given the lack of lighting, it would have been nearly impossible for the driver to have seen him before he dodged out into her path, got crumpled up over the front of her car and hammered face first through her windshield.

When we got onto the scene in our personal vehicle, the driver, an Hispanic woman of about 40, was still in the driver’s seat in hysterics. The windshield where his face had gone through was shattered in a circle a couple of feet across right in front of her. He was crawling around on the highway, on all fours, screaming like an animal. There was nothing human about it.

Our rescue rig arrived with some gear so that we could start doing some good, and soon after a county sheriff unit arrived and started to take control of the traffic. Everything was still out in the middle of the road and cars were stacking up in both directions. We got a backboard out of the rescue and took hold of the guy. This was a bit tricky. Given the mechanism of injury, i.e. face first through a high-speed windshield, we were by protocol required to immobilize him in case of spinal injury. On the other hand, he was combative and bloody, so we had to manhandle him onto the board without exacerbating his injuries and, at the same time maintain his airway with all that blood.

We got him down and rolled him over. His face was nightmarish. It looked like someone had spent 10 minutes slashing at him with a box cutter and every time he screamed, which was with each breath, the cuts lifted and moved around and bled. It was like some abstract rendition of a human face come to life through LSD. He screamed and fought us and bled and screamed some more. Finally there were four of us on him, one at the head, me at the right arm, one at the feet, another with the left arm. He pretty clearly wasn’t having any airway problems.

I held hard while my wife, an EMT-I, started a line in him. I am simply unable to watch IVs or blood draws, or even have my own blood drawn without getting the heebie-jeebies or fainting, but this time it didn’t bother me at all. I just watched all her prep and, pinning his arm against all of his contortions, closely watched her slide the catheter home.

By this time the Albuquerque Ambulance medics had arrived, so legally it was their scene, as we were all EMTs and outranked. One of them moved to the IV point with my wife, so I took over the feet from one of us who was having trouble dealing with this horror show. The medic in charge said he was calling medical control to get an order to paralyze the skater with versed, an anesthetic with amnesia-inducing properties, probably a good thing for him, and probably something we all could have used. He went back into the ambulance to make the call.

About this time the Sandoval County Sheriff deputy came up and looked to us to get the attention of someone. Since I was only holding feet and everyone else was either busy or in shock, he caught my eye and asked if he could take our rescue unit. He needed a second vehicle with emergency lights besides his own so that he could block off a section of the highway to make a landing zone for the helicopter that had been called. I looked around. It was Albuquerque’s scene; their ambulance had everything they needed and our rescue was pretty much just sitting there adding to the diesel atmosphere. I nodded and he gave a quick thanks and took off.

All this time the patient was screaming and kicking and bleeding and his face was fracturing and bleeding and this was all to be seen in the flashing of the emergency lights and the odd bright white light of someone’s heavy-duty flashlight or the ambulance’s spots and the diesel stank and the radios crackled and we could still hear the hysterics of the poor driver that this idiot had catapulted into hell when he went into her windshield.

The head medic came back with a syringe and pumped the versed into the line. Almost instantly the skater slumped peacefully. The wounds on his face settled neatly into place like a jigsaw puzzle and he looked human again, but as if someone had taken a red Sharpie and drawn several feet of lines all over his sleeping face. This remains one of the most graphic and vivid images of my life, not the screaming and the horror, but the falling into place on a quiet face of all that wounding.

This done, we packaged him up and carried him to the LZ a short distance away. The Life Flight medic climbed out, talked to the Abq guys, we loaded the patient and backed off to let the Aerospatial haul this poor stupid kid off to be fixed. I later heard that he got two hundred-odd stitches in his face.

We picked up a bit and got into my Volvo to head back to the station to clean all the blood out of the rescue. I was trying to compose myself after all I had just seen; not an easy thing to do. It was hard not to just curl up into a small ball and cry, which was really my inclination. After a few minutes, my wife, who was clearly stewing about something popped up: “Don’t you ever, EVER give away my ambulance like that. EVER!” I, a mere EMT-B (basic) was outranked by her EMT-I (intermediate) and was legally subordinate to her on emergency scenes. I explained to her what the cop had asked for, that it was Abq’s scene at that point, that Abq had no need for the rescue, that the LZ was the priority at that point and that I wasn’t in the habit of denying reasonable, if any, requests from the police. She would have none of it and started to lay into me again. I said, look, think what you want, but if you put me in that same situation 100 more times, I’d do the same thing every time, so just drop it, but she didn’t. I didn’t need this at that particular moment.

While we were in the station bay cleaning the shocking amount of blood that had gotten transferred into the rescue, the Sandoval deputy came in, looking for me particularly. He thanked me, in front of my wife, for giving him the rescue and said that without it there was no way he could have gotten a safe LZ and hence no way we could have flown the skater. She just looked on. I looked at her and said nothing. In retrospect, this event was the second- or third-to-last nail in the coffin of our marriage, demonstrating to me a growing and fundamental lack of respect. The last nail was firmly driven home a few weeks later during a similar incident, and I left soon after.

I often look back on the time I spent running with that fire department 20 years ago and wonder how I did it. In a period of about 18 months I responded to more than 12 calls, maybe 14, that involved death. There was a drug overdose. There was a multiple death car wreck on I-25 and the blood from the victims ran in rivulets across the banked asphalt into the median before we zipped the bodies into the bags. A guy in a small pickup towing another truck rear-ended someone on that same road and burned to death while his foot was trapped beneath the brake pedal and we had to extricate him which meant working in close proximity for an hour. (We really dropped the ball on this one: instead of doing it the way we were trained to do we let the coroner direct us. We should have told him to take a hike.) I honestly can’t even remember most of them; I just remember that when I stopped I counted and the number is what I know now. There was a lot of other stuff that didn’t involve death, but was gruesome too, like extricating a comatose drunk from a blood-soaked Caddy after a high-speed head-on with another drunk, or the story I just told.

There was a lot of feel-good to it too. For extended periods, since I worked at home, if you called 911 in our area, you got me. Medical calls were challenging and made me feel like I was really helping the community and usually didn’t have the emotional impact of serious trauma calls. But what really got us rockin’ were the 10-45’s: car crash with injuries. Not to say that I enjoyed them, for that implies that I found gratification from someone else’s disasters and that isn’t true. What 10-45’s did was to seep into my being, into my very living bones and expose all the flaws and weaknesses in me. Each one was a test of whether or not I could stand to see and deal with the worst. Each time I passed, I knew something about myself that changed me. I learned to drop a cloak of calm over myself, to detach from what was in front of me and focus on the task at hand. While I can still do this, and it is indeed an asset, eventually I paid a price. The accrual of all that trauma damaged me in a long-lasting way.

What sticks in my head is the nighttime nightmare stuff. Lit by the emergency bars, diesel in the air, something bad out in front of you, hoping you can hold it together if it’s as bad as you fear, that you won’t break. I never did, but I did take some long walks out into the desert and cry by myself sometimes. I know myself better now than I did then, and knowing what I know now, I would never have subjected myself to that kind of emotional loading. I’m picky about what books or movies I absorb and have to recognize that I have my limits. Recent situations have stretched those for me, and I found with that the same feelings that the lights and diesel and blood elicited all those years ago arise in me with a surprising freshness.