Saddle sores, if you are lucky you've never had to deal with one, but when you get them it's hard to focus on anything else. We asked EF Education-EasyPost medical director Dr. Kevin Sprouse for his advise on dealing with saddle sores, especially on multi-day races.
Our riders certainly deal with saddle sores from time to time throughout the year, and more often than not, during something like a Grand Tour.
Susceptibility can be a bit individual. Some guys are a little more prone to them than others, and often it's due to a change in equipment. That could be a new chamois provider or a new saddle or a change in bike position.
It can also be environmental, so if it's been really wet outside or really hot or something is irritating or causes increased abrasion at the saddle area, that can trigger something.
Saddle sores often just happen randomly too, there's not always a definable reason.
But they do come up.
Fortunately, we've got very good clothing and saddle providers for the team and that goes a long way toward minimising these things, so I'd say that we deal with a minimal number of these, but it's impossible to avoid them entirely.
In regard to tips or tricks for treating them in the midst of the Tour, first and foremost, the goal is to prevent them.
Prevention
So, in addition to having good equipment, prevention is making sure that when they finish a ride or a stage the riders are immediately getting out of their chamois, they're getting in the shower. They don't sit around in a wet dirty chamois for hours after the ride, they're quickly out of it, cleaned up and into some loose-fitting clothing that allows just kind of some aeration and drying out.
The other thing to consider is the use of chamois cream, a lot of the guys will use chamois cream, and a lot of the creams have antimicrobial components to them, even if that's something natural like a tea tree oil, that can then help prevent saddle sores as well.
But if a rider does happen to get a saddle sore, we try to get on top of it pretty quickly.
Treatment
If it is not what we call fluctuant, in other words, if it's not full of pus, then then what we'll typically do is put a little bit of steroid cream on there, something like a hydrocortisone cream, and allow that inflamed and irritated tissue to settle down between rides.
If the area looks like it's pretty infected, though, you don't want to use hydrocortisone cream because it can make the infection worse. So, if there is pus or spreading of the redness, well beyond the area that is raised and hard and the sore itself, then we really want to consider probably more of an antibiotic treatment, whether that's topical or even oral antibiotics.
Occasionally there’s need to even open and drain the sore. That doesn't happen often, I think I've probably done 15 plus grand Tours, maybe, maybe more than that, and I can think of two times where I've had to do that, so it's not a common thing, but it does occasionally happen that we have to open up a saddle sore and let it drain. And of those two, only one of the riders continued. It can be, as you can imagine, very difficult to race with a with a severe saddle sore and especially once it's been incised and drained, it's pretty tender.
Riding with saddle sores
Most of these things you can ride through and if you are doing a multi-day race you may have to.
If it is a small sore that we get on top of early, maybe treating with a little hydrocortisone cream a couple times a day, we sometimes also use a benzocaine cream which is a numbing and anaesthetic ointment that can be put on just before the stage and oftentimes that can help a rider tolerate at least the first few hours of the stage. It'll probably wear off during the stage, but it's helpful at least.
There is one long term complication that can creep up. If somebody has a saddle sore that just persists for weeks and weeks, it can become cystic and require surgery to be removed and so it's one of the reasons why if a saddle sore is persistent, we try not to have an athlete push through it.
You need to take time off the saddle because ultimately that's what it takes to heal. That's not always a luxury that we have in a Grand Tour, but for a recreational person who's training often taking a couple days off the bike, it goes a long way toward healing it up.
And you don't want to get to a point where you need surgery for this, because then the recovery is a lot more extended so.
So that's how we how we approach saddle sores, which are certainly common thing that come up in cycling so prevention is key. If you do start to get a saddle sore, you want to get on top of it early.
Hope that covers it. It's not a pleasant topic by any means, and I hope that's not more information than you wanted!