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Are there seat types or seat features that are ergonomically better for certain kinds of ailments such as lower back pain, knee pain, etc.?

For example, perhaps cushioned seats might be better for absorbing shocks from the bike or firmer saddles could be better for stability.

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Anecdata: when I've had knee or other joint trouble exacerbated by cycling, it was saddle placement rather than saddle type. I did just change saddles, but that had to do with pain in the unmentionables, not joint pain. –  dsalo Jul 1 '13 at 23:15
    
FWIW, a big part of actual seat comfort relates to friction. You want a seat that provides "good friction" to keep you from sliding forward, but doesn't cause too much "bad friction" that contributes to "butt burn" (though "butt burn" is also a factor of butt hair, believe it or not). –  Daniel R Hicks Jul 2 '13 at 18:33

2 Answers 2

Yeah, seat height and fore/aft position (and handlebar position) are more important than design.

Seat height is especially important for knee pain -- having the seat too low is quite hard on the knees (as is pedaling in too difficult a gear).

For the back, seat position fore/aft and handlebar position (both up/down and fore/aft) determine how much the back is stressed. Generally a more upright position (seat and handlebar closer together and handlebar higher) is easier on the back, but seat and handlebar too close together can "scrunch up" a tall person and cause problems. (And if you have an excess of avoirdupois having the handlebar too low can make it hard to breathe well.)

The main thing that seat design can do for you is relieve (or not) pressure on sensitive areas, indirectly relieving the back since you don't contort yourself so much to take pressure off the sensitive areas. But it often turns out that super-padded seats and (especially) seats that are extra wide are less comfortable than their more Spartan cousins.

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Of course any seat needs to be adjusted to the proper height, fore and aft position, saddle tilt, and in conjunction with your foot/peddle positioning. More "cushioning" isn't always the answer. I used to have the soft seat and then add a gel cushion to that. This made the seat wider, but it still became uncomfortable after about 30 to 40 miles. It was just too wide. I switched to a Brooks leather saddle, the B-17 model, and after treating the saddle with their Proofhide, and a break in period of about 750 miles or so, the saddle seemed to be more comfortable than a "softer" saddle, mostly because of the width being a bit narrower. I found that adding a pair of Zoic padded shorts or wearing padded touring shorts in good weather, was the perfect combination for me. I'm 5' 11" and weigh about 200 pounds. Sometimes it's just necessary to try different combinations of soft/firm and regular, wide or narrow widths of saddle to get the combination that works for you. This also includes saddles that have the "cutout" area in the seat for your Perineum area.

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