Patient, a male in his early 40s, presented with numbness in the toes of the left foot, knotted muscles in the upper left quadrant of the back, and related stiffness in the neck. Patient also reported constant urge to push back on the bike saddle. He now questioned his entire position on his bike.
Since he showed an initial interest in a new saddle, we began there. I'd already asked whether he was aware of any alignment problems because of the way the symptoms built in the course of 20 to 30 miles. He said he did not feel any unbalanced tension. His symptoms said otherwise.
His old saddle, an old version of the Flite Trans Am, turned out to have a crack in the shell reinforcement in the back. The padding in the center was broken down, so he would tend to sag into that divide while riding. It looked level, but it would ride as if it were nose down. In addition, the edges of the cutout are narrow enough to increase pressure on the nerves down the inside of the leg instead of relieve it.
The new saddle has wider margins around the central cutout and firmer shell and padding. With the saddle placed in exactly the same position as the old one the rider reported significant improvement in all symptoms.
I'm joking around with the pseudo-medical lingo, but the problem and the solution are real. We're not finished yet, but the major issue seems to have been the saddle. Neck pain and foot numbness stemmed from the minor misalignment caused by the deficiencies of the old, worn-out seat.
Older riders will be more vulnerable to position problems a younger rider might not even notice. Look at the whole picture before zeroing in on specific changes directed at each affected area.