gluteus minimus yoga anatomy

Sit Bone Pain – Revisited

David Keil Anatomy, Lower Limb, Yoga Injuries 44 Comments

Sit Bone Pain – Take Two

There have been a couple of overlapping additions to the original article on Sit Bone Pain. It just shows that whatever the issue, problem, or pain is… it can be coming from a number of different places. Figuring it out isn’t always so easy. We also naturally try to come to some conclusion about what is going on and sometimes wrongly assume that all, in this case, sit bone pain is created equally. What I’d like to do is offer a couple of other scenarios that are somewhat common. They would also change the way in which you work with sit bone pain. In the original article, I’m specifically talking about dealing with sit bone pain as a result of a hamstring tear or irritation.

First we have the Trigger Point. There is a trigger point in the gluteus minimus or sometimes the gluteus medius which can create pain around the sit bone. One of the most common complaints that goes along with one of these two being the culprit in sit bone pain is this: “The pain tends to increase when I’ve been sitting for a long period of time, in a car or in a seat”. Yes, this could be the sign of other things as well, including everyone’s favorite… piriformis.

What I can tell you is this, on at least 4 occasions I’ve met yoga students with sit bone pain who have mentioned that the pain comes on during the day while they’re sitting. I check their gluteus minimus on the side of their hip and when I press it reproduces their sensation. I realize this may be beyond your skill set to palpate, so have them check themselves with a tennis ball, something similar, or send them to a Neuromuscular Therapist.

Second, we have the Adductor magnus as the real culprit. Differentiating between the hamstrings and this adductor is relatively simple. If the sit bone hurts when doing a wide leg forward bend but not while doing a forward bend when the legs are together, it’s more likely to be Adductor magnus, which has an attachment on the sit bone as well. In this case, the pain is not because of a trigger point, but instead is likely due to an injury, usually during a wide leg forward bend! I would suggest that the same posture will be the one to stretch that scar tissue and alleviate the problem.

As always, proceed slowly and be willing to change course based on the feedback of the person you’re working with.

Gluteus Minimus trigger points from triggerpoints.net


Gluteus Minimus Trigger Points

Many of the concepts in this article are discussed in:
Functional Anatomy of Yoga

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Comments 44

  1. Hi David, I will share my sit bone pain and how I am progressing if it may help someone else and add to this helpful discussion and advice of yours here. You identified my tight gluteus medius on my right side when I saw you in Cornwall! well a few weeks later sit bone pain became unbeareable mostly in forward bends, wide leg forward bends also and sitting and driving. When practise came to a virtual stand still I sought help to understand it from Denise’s muscular/skeletal body worker;
    It was ligament damage; Sacrotuberal to the posterior, subsequent tear to adductor brevis and trauma to pectineus (all on the right side). Hip flexors tightened to compensate….I shan’t list all the muscles that tightened whilst ‘rallying round’ to help, but yes wide leg stretching for the scar tissue, piriformis and gluteus stretches, plus some adductor strengthening have helped me find a new normal will full practise….and of course with a little help from my teacher; as I said to John, Form doesn’t just follow Function with me,….Form follows Function of the Mind….without a doubt some citta vrttis were certainly getting in the way, and I wanted to add this important realisation to the mix. Few months on, pain free, forward bends are just a little less open than before, but lateral hip rotation thus lotus and supta kurmasana are slightly more open….. Think I had been overworking Prassaritas… Lots of love and thanks to you…Sandra x

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  2. Hi David,
    I too have been working on what I thought was a hamstring issue. I took your advice and had a massage. It was not specifically trigger point but I mentioned my right hamstring problem. I was at the Omega Institute and was referred to this therapist.
    Ironically, when he started on my left hip, I almost jumped off the table in pain. I think it was my gluteus medius, but I’m not sure. He could not get me to a point of pain on my right side; very odd.
    I just did a wide angle forward fold and it felt really good but when I got up, I can now feel slight pressure in the spot. Very interesting.
    My point of pain has been much better. I have laid off the intense hamstring stretches for a few weeks and accomplished two 4.5 hour drives this weekend with no sit bone pain.

    Thank you for your continued help and keep it up! It is greatly appreciated. Would love for you to come to the Philly area for a workshop!

    Melissa

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  3. Hi David,
    This is a very helpful article. Since your original article and your response to my questions, I have been working with my Ashtanga teacher on modifying through the primary series. It is working quite well (movement without pain) though I was tentative at first. My injured adductor magnus seems to require a very bent knee in quite a few of the forward bends (almost 90 deg in Prasarita) but it is lengthening.
    Thank you for the initial crack diagnosis! Hope you bring your workshops to Vancouver sometime…your knee/lotus videos were also quite illuminating…

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      1. Hi David
        I have an update and a question. I am still struggling with this adductor magnus therapy and am now working with a chiropracter and massage therapist to address other muscular imbalances leading to this injury. I am doing the slow static stretch at night in Prasarita to stretch out that muscle. I am combining this with daily heat/ice, glucosamine/msm and bending my knees in my ashtanga practice so i don’t feel any pain/sensation.

        I have a question about manipulation of scar tissue. I understand that it is good to break apart (cross-fiber friction, etc) scar tissue so it will be laid down in a more linear and lengthened way. You can do this with a ball or your fingers or by a massage therapist.

        Is it OK to feel pain when the scar tissue is specifically being manipulated by a therapist (with their hands, not a tool)? Is it OK to feel pain for up to 24 hours following the treatment? Is it possible to break apart the scar tissue without feeling pain? Or does pain simply mean that it will become re-inflamed and more scar tissue be laid down?

        Thanks for any insight

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          Hi Vandana,

          With this going on so long, is it possible that you’re not on the right track? Adductor magnus and bending knees don’t necessarily go together. The original post was about straightening the knees during forward bending if you’ve been struggling with sit bone pain and believe it to be a hamstring. Are you sure it’s adductor magnus? Do you feel no pain if your feet are only hip distance apart and you forward bend? If you don’t feel anything at that moment, then I agree it’s more likely Add. Mag.

          Regarding scar tissue… You’re going to feel pain when its being manipulated as well as after. The connective tissue doesn’t live in a vacuum. Your therapist is trying to focus on it, but it doesn’t mean that it’s the only thing affected by their treatment.

          Your general aversion to pain is a good thing. There are however pain that is long-term good for us and short-term uncomfortable. There is also pain that feels good. I’m feeling like you might be lumping all pain into one neat and tidy category and that’s not how it is…. Keeping in mind that we’re talking about connective tissue here, right?

          Confirm the legs together legs apart, pain, no pain.

          1. Hi David,

            Basically it went like this: initially, pain only in wide leg forward bends, not straight legs. Kept knees bent in standing and seated forward bends, and braced feet against the wall in seated forward bends. Visited my physiotherapist who told me to strengthen my gluteus medius(?). Pain eventually went away. THEN I probably got back to full expression of the poses too soon, and re-injured the area. Never did any scar tissue manipulation during this initial phase.

            It is worse now, as it also hurts in standing and seated forward bends whether legs together or apart. It was also hurting sometimes just sitting down (pressure). I tried a few different things but was not sure how to fix it on my own.

            Then I went to my chiropracter who did some cracking and some manipulation of the scar tissue. That felt great. I started slow stretching in Prasarita for about 2 minutes twice a day (with straight legs, mula bandha, gathered hips, microbent knees, weight in the heels, only as far as I can go with no pain). Daily Traumeel and ice.

            The scar tissue pain I asked about seemed over and above, as the area felt swollen and very tender and painful after. But I have since noticed that I have more mobility in the area than I have in a while. I am now keeping bent knees in standing fwd bends, but am doing straight legged seated forward bends with feet against the wall, only going as far as I can with no pain. The braced straight leg stretches feel really good and much more stable than bent knees. So I will continue with this regime (weekly chiro or massage for scar tissue, daily Prasarita stretches, ice and Traumeel). I think this will finally do it!!

            Thanks for your help.

          2. Oh yeah we have isolated the initial pain/inflammation to the inside of the left sitbone. (inside of the ischial tuberosity)

          3. AND I bought your DVDs today. Found the short lotus video so helpful so looking forward to learning a lot more!

  4. Hi David

    These articles are so helpful. Thanks for sharing. Quick question, I have a student with tp pain at the gluteus minimus, is my understanding correct from your previous sit bone article that I should encourage straight legs while forward bending?

    Ta

    Jo

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      Jo,

      Straight legs in the posture… yes. Transitions can bend to distribute weight. if it’s glute minimus then have them roll on a tennis ball or something similar. Larger and softer may be better at first.

  5. Hi, reading the article on sit bone pain. I have issues for many years. I used to run at a resonable level, stopped had kids tried to start up again, pain in hip, stopped started kayaking, pain in sit bones, then legs going numb with pins and needles. I cycle now and it plays up now and then. I know I have tight hamstrings, I did do some yoga for about 6 months @ 10 mins a day, it did help but then I stopped. I bike/race at mtb fairly ok but would like to loosen up more and improve and maybe if I could improve a lot I could run again. I never used to stretch it was uncomfortable, so maybe I have had tight hamstrings for years, . From 4 years old I danced ballroom etc, so maybe it stems from that-I don’t know. I can’t afford lots of theraphy so need to help myself. Stretching what types and how often, knees bent on forwards or not. I live in a fairly small town not much goes on with regards yoga etc. Any ideas etc really welcome. Thank you Nicky

  6. Ps: I borrowed another mtb bike the other week and the pain was horrendous. My bike is very comfortable. More of a forwards position as opposed to sat upright. I also know I stand with my knees bent to.
    Thanks

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  7. Thank you David for this article!

    I have suffered with sit bone pain for over 2 years now. My doctor is clueless and after 4 MRI’s still didn’t know what was causing this pain and sent me to an Ortho doc who just shot me in the bum with a very long needle. I had relief for about 2 hours and then it was back again.

    Your article mentioned the Adductor Magnus and your simple test confirmed that it is most likely my issue – straight leg forward bend no pain – wide leg forward bend triggered the pain immediately.

    Can you suggest what my next step might be? My GP doesn’t hear me when I say “pain in my sit bone” all she hears is “hip pain”.

    I also find the tip of my tail bone is occasionaly very sensitive…as if I fell on it and it is bruised….tender to the touch….any idea if this is related?

    Thank you for any guidance you can provide and thank you so much for your article!

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      Hi Barb,

      Sorry to hear about your 2 year old sit bone pain. My suggestion would be to find a really good manual therapist. Someone who deals with chronic pain and who works with trigger points and generally does problem solving. That sounds easier than it is. Start asking around where you live. It will most likely be a massage therapist but one who has done extra training in pain relief therapies.

      I would guess that the fall to your tail bone is related somehow, or at least overlapping. When you think you found the person… you’ll know if you’re on the right track if they do a thorough assessment and evaluation.

      I hope that helps,
      David

  8. I have had infrequent sit bone pain at night – so bad that it wakes me up and I haev to get up and walk around before it will go away. It appears to be both sides and deep into the bone. I don’t think i ahve injured my hamstring and it’s doesn’t recurr with enough frequency to tie it to any particular activity – do you have any suggestions?

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  9. This was a very enlightening series of posts for me! I had an injured adductor Magnus that caused me trouble for a long time …. years. I had a lot of conflicting advice from doctors and physios, none of which really helped. In fact the only thing that helped it in the long run was practicing extra prasarita paddottanasanas.
    While the muscle was injured I had to be very cautious with this pose during regular practice and keep my legs bent, as when the body is warm it’s easy to over stretch and be back at square one. So I also started to practice these poses on their own, outside my yoga practice, as follows. I take a minimum of five breaths to move very slowly into each pose, not reaching maximum extension, but just taking it to a point where I can comfortably hold the pose for 10-15 slow breaths, without rushing or forcing. Then I take another 5 breaths to come out again (and so for each of the four prasaritas). Usually I do this right before bedtime, which allows for a reeeally loooong savasana afterwards 🙂
    To begin with I had very little flexibility in the pose, but after only a couple of weeks of doing this I already saw a great improvement and now (after about 18 months) I can do the full pose safely and without pain as part of my regular practice (taking the standard 5 breaths). And my head now gets to the floor between my feet.
    It’s no exaggeration to say that prasarita paddottanasana is a therapy pose for me. I’m still doing the slow version of it daily in addition to my regular ashtanga practice.
    I don’t have it front of me at the moment, but somewhere in In yoga mala Guruji says poses can be held for many breaths (i think he says up to 50) if you are doing them therapeutically.

  10. Pingback: Yoga Anatomy Article - Got sit bone pain? What to do with that possibly torn hamstring when practicing yoga | Yoganatomy

  11. Thank you for this Article!

    I was a gymnast for a very long time and after a bad injury(I was told hamstring tear) I could hardly walk and any bigger movements were out of the question. Now, eleven years later I still can’t sit for very long without pain. I’ve seen many PT’s for this and we are running out of ideas. I can do any form of stretching or exercising without pain. Just sitting triggers it. We have looked at hamstrings, adductors, sacrum, and the pelvis and are making no progress. I’m still very flexible and strong so getting me to even feel a stretch can be challenging. The doctors I’ve seen don’t believe there is an issue, because I’m in my early 20’s and apparently don’t have an excuse to be in pain. So I haven’t been able to get an MRI. But, I’m getting really frustrated and don’t know what else could be causing this problem. Any suggestions?

    Thank you for posting this article. It has already been tremendously uplifting.

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      Christine,
      I’d bet that it’s a trigger point as shown in the diagrams above. Probably gluteus minimus. See if you can find a well trained neuromuscular therapist in your area who will be willing to treat the gluteals thoroughly and maybe you’ll find your problem. It sounds like you’ve checked everything else… why not these. Again, you’ll need someone who knows how to treat trigger points correctly and thoroughly.
      David

    2. wasn’t until i had an x-ray of lumbar by chiro doctor who gave diagnosis of spondylolisthesis. so my opinion is it’s most likely lumbar issue like spondylolisthesis, which causes pinch/pressure on sciatic nerve, tight glute & hamstring muscles…for which the pain is always present. i’ve tried A.R.T., regular chiro care, acupuncture, massage, R.E.S.T., anti-inflammatory meds, etc., all with some degree of relief, but by no means a “cure”. i regularly do yoga, biking, pilates, & strength training. I aslo swim, ski & hike. i’ve been an athlete all my life, did competitive gymnastics in middle & high school.
      my degeneration is L4/L5, which ortho doc wants to fuse. i’m opting for the epidural steroid injection, plus serrapeptase supplements for inflammation.
      that’s my 2 cents worth.

  12. I have been struggling with pain since Feb 2012. I came off a slide (long story) in a fun company, and landed on the hard floor, since then I have had pain in what feels like my sit bone on my left side. I do however feel extreme pain under my buttock where it meets the thigh in forward bends, in tortoise, and in Utthita hasta padangustasana. I too have been for Physio therapy and even reiki. It is really limiting for those above mentioned postures and even affects my walking sometimes. It is a pain I have come to live with and is a mystery to what it could be? Can anyone shed light on what I may have… Not usre it’s piriformis syndrome as I don’t have shooting pain down my entire leg…

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  13. Hi, i have had some pain in my bottom now for some time sitting on a hard chair makes it worse.i am a carer in a nursing home and bend incorrectly without bending my knees because of my weight.the pain is probably most like the trp1 picture sometimes with hip pain could this pain be from muscle damage,many thanks

  14. Ciao David! Ho da tempo tendinite bilaterale Achillea e tendinosi dei hamstrings sul tuber ischiadicum, sopratutto dei bicipiti femorali. Cosa mi consigli? Grazie! Meg

  15. Hello David! I have long bilateral tendinitis and tendinosis of Achillea, tendonosi of hamstrings on tuber ischiadicum, especially the m.biceps femoris. What do you recommend? Thank you! Meg

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  16. Hi David,
    Thank you for this article. I was wondering if you can help me out a little bit. I am living in Thailand and practice yoga regularly. I find that a few hours after practicing I am getting subtle pain on my lower left buttock right in the middle. There is no pain anywhere else. I work on a computer so I am sitting a lot and it tends to worsen the longer I sit. In seated forward folds, triangle pose, or revolved side angle pose I can feel it more. I am very flexible, but lack core strength. I am limited with physical therapists or medical professional so am resulting to the internet for now. I hope you can point me in the right direction.

  17. I couldn’t fuly understand what you were talking g about but do u think that could be tube issue cause its hurts when I’m driving and I havey foot on the gas pedal to stretch it out like that I tend to find myself sitting way close so I don’t have to stretch it out like that I can go about 10 miles before the pain gets toe so bad I have to stop to pull over and stand up

  18. I have had left sit bone pain for approx 6 years, I have no idea if I injured myself or not, but I remember after doing some really long bike rides, for my ability at the time they seemed long, 30 miles. I started developing this irritation when sitting down, I sad for my work 8 hours a day, and after about two years of this irritation, it became almost impossible to sit for more than 5 mins. I was lucky enough to have my work purchase a stand up desk so I could do my job. I continue to stand, and this helps, but I still have lots of pain. I have tried PT, Chiropractic, Accupunture, Steriod injections, in piriformis, and ishial tuberosity (? SP, Have had MRIs, Bone Scan, Ultrasounds, and have identified my IT busitis. However, have not found much relief, as soon as I sit down, especially on a hard surface, it comes back. The only thing that helps is sleeping. But, I eventually have to get up and go to work. Since I stand all day at work, I need to sit down at home, catch 22.

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      Hi Carrie,
      As I also posted in another response… My guess is that you have an active trigger point in your gluteus minimus possibly Tensor fasciae late. That is, of course without seeing you. Check out the Sit Bone Pain Articles here and here and you should find some links to trigger point images. You’ll want to find a therapist who is familiar with treating them as the it’s probably not just trigger points but excess tension. You can also do some research at Triggerpoints.net Search for these muscles… gluteus minimus, gluteus medius, tensor fasciae latae, and maybe even iliacus.
      David

  19. obviously like your web-site but you need to take a
    look at the spelling on several of your posts. A number
    of them are rife with spelling issues and I find it very
    bothersome to inform the truth then again I will
    certainly come back again.

  20. Please can you help me, I have been in pain since December when I had a great yoga session and the next day took a long haul flight. I have had mri and bone scans and seen a physio for 3 months, all to no avail. They found nothing wrong so diagnosed me with Periformus Syndrome. A couple of sessions of dry needling into the periformus did bring some relief, but I kept pointing out the pain feels lower down, or at least is most significant there. I’m still doing regular yoga, but getting nowhere in terms of improvement on that right side. The position in which I can most feel the pain and it completely stops me in my tracks is Standing Separate Leg Head to Knee pose, with my right leg in front, (the painful side). From all the above could it actually be the Abductor Magnus? I am going to see a pain specialist on Tuesday and before I let them inject something in me, I want to go in as informed as possible!! Thank you so so much everyone for sharing, please let me know your thoughts.

  21. Just one more thought, I also bend my knees on the seated forward bends, and that goes right into the pain, but from your first article now I’m thinking I should be straightening them?

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    Hi Louise,
    It’s very hard to figure things out via comments or emails. You didn’t describe your pain or exactly where it is, which makes things that much harder. The best I get from your description is that it is below your piriformis and obviously you’re looking for info on sit bone pain.

    I’m sure you meant to write ADDuctor magnus. Although it could be, you would have to test for this.

    My guess is trigger points from gluteus minimus, anterior portion. Why? Long haul flight… this trigger point is often aggravated during prolonged sitting. Raising your leg holding it there would also activate this muscle. AGAIN, you would have to test for this in some way.

    Get a tennis ball. put it on the floor. Go completely sideway and lay on the floor with your right hip on the floor. Get the tennis below the top of your pelvis and behind the bump on the front. Move slowly through that area, essentially the side of your hip, but slightly more toward the front. If you find an area of pain (I’m pretty sure you will), stay there without moving for about 20 seconds and see if it brings about the pain you’re experiencing. If not, move on to a different spot.

    Good Luck,
    David

  23. Pingback: Sitz Bones & the Art of Sitting – Alligator Healing Arts Yoga

  24. I know this is years old, but how was your ligament damage found? I’ve had X-rays and mri’s that show nothing, prp and prolo injections, trigger point work, massage….. And still I have the sit bone, glute, and upper hamstring pain. The doc that did my injections found some inflammation in sacrotuberous ligament, but no diagnostic work was ever done and I don’t even know what type of tests to consider. Thanks!

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