Got Sit Bone Pain? – What To Do With That Hamstring © 2010

David Keil Anatomy, Lower Limb, Yoga Injuries 43 Comments

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Dealing With Sit Bone Pain

I was in the DC area this month and saw a student that I knew from a previous workshop. At that time Patricia had recently “pulled a hamstring”. Her major symptom was sit bone pain (sit bone = ischial tuberosity) when folding forward. Secondary was that it would also hurt when sitting for long periods, especially in the car. I saw her just a couple of weeks ago and she still had the same pain.

The HamstringsAlthough not my regular advice, the most common way people are told to deal with sit bone pain in yoga is to bend their knees in their forward bends. The idea is that by bending your knees you shorten the hamstrings. By shortening the hamstrings you reduce the amount of pull or tension placed on them. It sounds good in theory.

Here’s the problem with this theory. I refer to the hamstrings as two joint muscles. What this means is that changing the position at one of the two joints (hip or knee), changes the end of the muscles that will receive more force from the actual stretching of the muscle.

When you bend your knees and bend forward, more of the pressure created by the “stretch” to the hamstrings goes into the opposite end. In other words, if you bend your knees in a forward bend, you add more force to the sit bone end of the hamstrings.

Assuming that you’ve actually torn your hamstrings (of course a minor tear usually), and that you’ve torn the end of your hamstrings closest to your sit bones, do you think it would be wise to put more pressure on these same tissues? The answer is no, it wouldn’t. Could this cause more sit bone pain? Yes.

The next question is; Well, what should we do then?

Although I can’t say that this will work in every situation for every individual, this has proven to work for a number of people in this situation. There are always exceptions.

If you want to learn a process for working with injuries you should definitely check out the online injury workshop. It teaches you a process of how to assess, modify, and work with injuries.

Now, during this most recent interaction with Patricia, I took a moment to give a gentle squeeze to the area of her hamstrings just above the knee joint. (The opposite end from where she was feeling discomfort.) I could see in her face that these tissues were particularly tender and sore. That, along with the symptom that she would actually get pain in her sit bone when she would sit in the car, clued me in that this technique would probably work for her. The significance of the sit bone pain while sitting in the car is that the part of the hamstrings that gets the most pressure in a car seat is the bottom (distal) end of the hamstrings closest to the knee.

The technique I apply is extremely simple, and as I told this student, worth trying for two or three weeks to see what happens. Ah yeah, the technique… you’re waiting for it aren’t you? The answer is… Keep your knees straight. That’s it. When you forward bend, either standing or in seated postures, keep the leg extremely straight and don’t go as deeply into the forward bend as you normally do.

By keeping the knee straight, with quadriceps engaged, you keep the stretch in the hamstrings equal between both ends. In the situation mentioned above, the hamstrings had gotten to a place where their distal end near the knee got too tight. The tension in this end seemed to lead to consistent tension in the hamstrings as a whole and particularly near the sit bones. That needed to be taken out by keeping the knee straight.

Patricia came to three days of practice with me in a row. She kept her knees extremely straight and guess what? Sit bone pain was reduced after just these few days.

Conclusion

I emailed her just before this past weekend to check-in and here’s what she had to say:

David, Significant improvement indeed! I am not bending the knees on the standing or seated poses (like you instructed me) and now I can bend forward with my torso a lot more without any pain in the moment or afterwards. I am now doing kurmasana and supta k (almost fully) without sit bone pain and on my own!! It is definitely healing, recovering the flexibility. I am really happy about this!!! Looking back, I think that I may have been stuck on a phase of “pain-avoidance” without doing anything to heal the hamstring for good, addressing the problem. Thank you so much for your help with my trouble-making hamstring. Look forward to keep leaning from you (and of course to my entry to the hall-of-fame through the newsletter).

***please note that this does not account for all sit bone pain, nor does it mean that there are not times when it is appropriate to bend the knees. This advice was specific for this yoga student at this time.

Follow up article here.

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Comments 43

  1. Dear David,

    I am so grateful for your website ‘yoganatomy’. This is the second article that I have read that explains a problem I’ve been experiencing in my practice (I also heard pop in Kurmasana). You’re explanations are clear and empowering. Thank you so much! I’m so excited to try this straight-leg solution for my hamstring tear/pull! I’ll keep you posted.

  2. Hi,
    As a yoga teacher, I have a persistant pain in my hamstring. And as a teacher, it doesn’t get much rest!

    Recently, I went to an Iyengar class and the instructor had me put a strap around the top of my thigh and pull just to tension. It supported my hamstring and the results were almost immediate. My hamstring felt better very quickly.

    Why and how did this work? I have since used it with one of my advanced students who also noticed a difference.

    Thanks for all the info, it’s great to have!

    Melissa

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      I can’t say I know exactly why… but I have a guess. It’s possible that the tension from the strap redistributed the tension in the hamstring. Perhaps the location of pressure acted like a new attachment place of sorts (not exactly). Did it fix the hamstring pain, or did it just alleviate it while in the posture? Either way… I’m for whatever works. I’ll have to play with it with some students and make some more observations.

      1. Hi,
        I have been using the strap on and off and it has not cured the pain. I have very open hamstrings and I am flexible but my guess is that once they are warmed up, the pain subsides. Driving long distances in a car becomes very painful.

        I guess the only way to really heal this is rest? Not sure if that’s possible!

        Melissa

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          Melissa,

          Interesting… might I suggest that you may have a trigger point that gets activated. Is it possible for you to have someone check your gluteus minimus for TP’s?

          http://www.triggerpoints.net/triggerpoints/glut-min.htm

          I have had a few students who complained of sit bone pain… assuming it was hamstring attachment who had this. I checked personally and when pressing into the gluteus minimus on the side of the hip their pain was elicited. All of them found that it activated when sitting for long periods. For some of them the whole thing did begin with a hamstring “event”

          You can also check yourself with a tennis ball, but better to be assessed by a neuromuscular therapist or good massage therapist.

          Let us know what you find

          1. Thank you so much. I will definitely keep you posted. Just sitting here in my chair and pushing on my hip alleviates most of the tension. I will definitely see if I can find a good therapist in my area.

            Thanks again,
            Melissa

        2. Hi melissa, I know this is an old post but if I could offer some understanding of this possible pain it would my pleasure. My name is Nick Cress and i am a manual therapist, functional trainer, and yoga teacher. You mentioned your open hamstrings and it is so common for this high hamstring pain. 1st did the pain start by hearing a pop? If so there is some scarring in the area and the more you stretch and forward bend you pull from the attachment sites where you have pain. Also if your ilium is fixated, means stuck, and usually right side when you drive, will pull from the attachment. David is right about possible trigger point therapy and may I also recommend you need to create strength to your open hamstrings. A yoga pose to help is bridge pose, but with repetition. I recommend doing around 10-30 hip lifts, from starting point to end point of the pose. The more blood you bring to the tissue and energy to the muscle, will lessen the pain and help align healthy connective tissue. I could offer more details but I don’t want to write a book on davids comment sheet. Anything I can do to offer info or help please don’t hesitate to email me at mogatherapeut

          1. I would recommend a orthopedic massage therapist, with the initials COMT. They will give you a great understanding and address the scar tissue. Also a chiropractor can help with the ilium problem. Sorry for the long message but it is a common injury I see and treat all day long. Patients is key and can take up to 8 weeks to mend . Keep up the good work David with your yoga workshops and teaching anatomy. We both know the more knowledge we have the better we can help the yoga community. Namaste

          2. Hi Nick,
            Thanks for your response. I have actually done most of the recommendations you all have made. I do long holds in bridge and went to a chiropractor who did make an adjustment. The other thing I did that really helped was add chelated zinc to my vitamin regimen. Haven’t had a problem since. I’m amazed and dumbfounded.

            Thanks for all the help, I really appreciate it!

            Melissa

  3. Hi there
    This is a very interesting way to address pain at the sitbone. I have the same pain too, though it is not tender above the back of my knee. An interesting thing is when I go into Trikonasana and try to grab my toe (Ashtanga style) I have to bend my knee and my hips are not stacked — this causes bad hamstring pain at my sitbone. However when I let go of my toe and move into proper Trikonasana alignment with my hips stacked, and I get that noticeable “crack” in my hip joint that most students get going into Trikonasana, this seems to immediately release a lot (though not all) of the pain at my sitbone.
    Should I also be straightening my legs? Or just focussing like crazy on engaging my quadricep? By the middle-end of my Mysore-style practice, my hamstrings are not hurting much anymore in the forward bends (maybe because they are warmed up, or some tension was released)?
    Thanks for your advice!

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      Author

      I have to admit… this technique will not work in every situation. Yours might be one of them. It is of course difficult for me to assess you from where I am… meaning, not in front of you.

      Your mentioning of changing trikonasana is interesting to me. It makes me think that it is possible that you have actually aggravated your Adductor Magnus. Do you feel any sensation there when in a wide leg forward bend?

      If the answer is yes, more likely it’s your adductor magnus in which case, straightening your knee will not change it.

      Yes… in general when you warm your tissues it’s likely that tension is less in your muscles so you don’t feel the same discomfort. This is almost always an indication that the problem is muscular.

      Let us know

  4. Hmm, yes I definitely feel pain in wide-legged (standing) forward bends, that and going into Trikonasana with a bent knee are the most painful poses. Seated forward bends are much easier and less painful, though I may still feel the pain on occasion.
    Adductor magnus — I will look at my Bandha Yoga books to figure out where that muscle is and see if it may be causing my problem.
    If the problem is muscular, that may be a good thing? Better than connective tissue/tendons. I may try the seated massage with a sensei ball or something.
    Thank you! Great and very detailed blog (I have a biology background so I enjoy it coupled with the yoga)

  5. In fact I isometrically contracted those muscles (standing, squeezed inner thighs together) and felt pain upon contraction at the top insertion point by the sitbone but in towards the groin a bit.
    Will try massage.
    Thank you for the help!

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      I honestly don’t know. It shouldn’t be any worse than say, forward bend… just proceed slowly unless your surgeon told you that some movements or positions were completely not allowed.

  6. I have sit bone pain too – have seen a PT and various yoga instructors, but with no resolution. I have only minor discomfort in a forward bend, and none at all in Malasana(garland) or Mandukasana(frog). Wide angle forward bends (especially seated) and half-moon are where I really feel pain; the rest of the time it seems to be a dull ache. It seems my problem is somewhere in between hamstrings and adductors, and started about 10 weeks ago. I practice 5-7 days a week at home, with 2-3 times/week in a studio. I will be attending teacher training in less than a month.
    Does anyone have any ideas on 1. What the issue might be 2. How I can re-hab it
    ANY ideas are warmly welcomed!

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      1. I consulted a massage therapist and a yoga therapist and though neither of them were sure, both suggested the back portion of the adductor or one of the obturators. Neither one had any suggestions of what to do to resolve it either!! I read the other post and comments, and have been practicing your suggestions – I use a foam roller to target trigger points in the outer hip and also the inner/posterior thigh muscles. I also stopped bending my knees in forward bends. I had only begun to place a small bend in my knees in the few months before the injury. I am happy to report that the issue is 90% resolved. I still have some soreness, but nothing compared to before. THANK YOU so much for sharing your knowledge here!

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          Thanks for keeping us posted on this thread. Very happy to hear that you’re 90% better already. That’s a good thing. You might also consider getting more specific than a foam roller now that things have changed. A tennis ball will do, or you might consider trying the Yamuna Body Rolling balls. I recommend the calf balls as a good size.
          Good Luck,
          David

  7. I am suffering similar type of problem but don’t know what it is…pls help me..i m 27 yrs….young strong guy…5’9″. I don’t know has happened to by back now…if i sit for long
    I cannot get up now…it pains so much…o god…but as soon as i get up..after 1 min…i feel comfortable as earlier…Its just that one min of getting up kills me…I am selected for bank officer post…and i soon i will be giving my medicals….do u think it is something that will get caught in medical…can they reject me for that…..I NEVER HAD THIS PROBLEM ALL MI LIFE….IT STARTED 8 MONTHS AGO… i took medicine also…with medicine this pain goes away…..but after sometime it reoccurs…Kindly someone help me…PLS PLS PLS…..AMIT

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      Amit,
      More details would be required and of course it’s very difficult to help you via posts. Did you also see this post as it may offer you something different. it’s hard to understand but it sounds like your back is hurting after some time. You might also check your iliacus and psoas muscles. Although not exactly describing your situation watch the video on this post to see how tender it is.
      Good Luck,
      David

      1. i m stating my problem in details here:
        I have never had any pain like this before ever in mi entire life.I have no pain while walking ,running,lifting weights,but when I sit down on anything even for 10 mins and then try to get up…i feel immense pain at the end of mi vertebrae exactly at the point when mi vertebrae ends…the pain is just and just only at the end point of vertebrae.when i touch it or press it…i have no pain.Just that 5 second pain when i get up from a sitting position that kills me. I took some pain killers as suggested by a doc ,when it take it the pain goes away but then after a week it starts again.whether it is sofa or bed or table or train seat or anything..the pain is just the same with all .The pain is so much that I fear sitting anywhere.While standing I have no pain whatsoever.
        Pls help me.Reading ur articles i came to know that it could be a term called Sitting Bone.I did not even knew that.Kindly help me.I cannot bear this pain anymore.Recently I was in a bank officers Interview and how I got up from that Interview chair only I know.I m avoiding sitting.standing or lying down is not a problem,but i cannot get up from a sitting position.What has happened to me.My mom ,dad,grandfather,grandmother,paternal and maternal nobody has this problem ever.
        I use to life weights 2.5 kg like any normal guy of this age..while excercising.I have left all that.help me out…..

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          Amit,
          Again, it’s very difficult to correctly tell you what is going on for you. The fact that the pain is not there all the time says to me that it is unlikely to be structural in the sense that you have a skeletal problem, or a problem with vertebrae or something like that. Because it happens in just one situation… sitting for a long period of time and then trying to stand up, it may simply be a muscular dysfunction. The hard part is that none of this can be confirmed, because of the distance. You’ll have to check some of these things for yourself. Sometimes hernias can cause pain upon standing and there are many possibilities here and I am not a doctor nor can I diagnose you. What I can offer you is to possibly check some muscles that could be causing this problem. That’s all I can do from here. Take a look at this website… Triggerpoints.net I’ve set the link to go to the Lower Torso section. Since you’re complaining about pain being at the very bottom of your vertebrae (coccyx I assume) I would look at the section titled ILIOSACRAL PAIN, last section. See if any of the images resonate with you. Often times after sitting for long periods The gluteus Medius gets activated and can cause pain where you’re describing. It may be a combination of a number of these… there is no way for me to know. If you want to know if one of these is your problem… you’ll have to place pressure and hold roughly where the X is on the illustration. If you wait about 20 -30 seconds and you feel pain in the area that you describe, that might be your problem. Or if you find that any of these muscles is extremely tender, they might be your problem. This is the only direction I can think to send you in. Try to find someone qualified who can help you. Perhaps a Physical Therapist?
          Good Luck,
          David

  8. Hi,

    I too have had sit bone pain on and off for the past few years. I just started my first 200 hour teacher training and now this pain is “on” again. It starts in my sits bones and travels down my hamstrings. I’ve been told by teachers to bend my knees, but after reading this blog post and paying careful attention to the effects of bending my knees, especially in certain poses, I’ve begun to rethink this method.

    Yesterday in a class I did some experimenting in pasarita padottanasana as wide legged forward bends give me more pain in this area. I couldn’t believe how much worse it felt when my knees were bent! It makes so much sense to me after reading this post that as the hamstrings extend between the sits bones and the knees, reducing pressure at the knees increases it at the sits bones. I’m going to keep experimenting, and hopefully this method will help me to heal. Thanks David!!! 🙂

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  9. I have found that most students (i teach) I’ve seen complain of this issue have an anterior tilt to their pelvis, elongating the hamstrings pre-fwd fold. It is often most visible in warrior 2, as the “fan” of the ischium pinches into the femur (coupled often with “butt out knee in”. This is all in the lead leg. By engaging the inner back thigh muscles to the outer thigh, thus grounding the back outer heal, one can press into the front heal (assuming proper alignment is established in the heal over the knee), stabilize the sits bones even with the earth. All of this balances the hamstrings, obdurators, and qluteals in a different shape.
    Once there’s less of an anterior pull in the pelvis, fwd folds begin to take shape in a more balanced way as well, the necessary action of toes pointing up (when seated) comes from the freedom of at the hip. Avoiding folds for a short pd of time may free up the brain too, allowing new habits to reform in the same target tissues. Lastly, given that the add.mang. is attached to the lower femur, and then facially to the muscle (it escapes me currently the name) to the outer knee, using a foam roller (first, during initial stages) on the outer lower thigh, just above the knee-incase thats in tension, as well as the inner-upper (at first avoiding the attachment) through hamstring belly would be a good release.

  10. Thank you so much for the great article! I had the same issue with the deep pain near my sit bone on the left side and unfortunately, I thought bending my knees would help! We, I tried a few yoga exercises I found on line for “hamstring tendonopathy” which helped me heal, but the thing that helped me avoid continuous reinjury was keeping my quad flexed and my leg straight! The pain immediately started getting better although it took a good year before it felt almost normal. Now I’ve been negligent and injured it again (I felt it coming on, but I just took it easy on my left side, whereas I should have been keeping my leg straight!). No one seemed to be able to give me this advice, so I’m so grateful for your article!!! Namaste 🙂

  11. Pingback: Gluteal and Psoas Relationship and it's Problems for Yogis | Yoganatomy

  12. My experience is that tight hamstrings are a symptom of a disfunction else where. I spent years trying to relieve my injured hamstring and it was not until I took the focus off the hamstrings and began looking at and lengthening the hip flexors did I find relief. I have written a bit about the hamstrings in a sports magazine and have published some on my blog. I no longer stretch my hamstrings and they are no longer a problem. For mor info on my experience http://yogabeyondtheasanas.com/category/blog/hamstrings/
    I also am exploring the idea that perhaps it is also feeling tight because of tight calves. Teaching anatomy with clay, with a strong emphasis on back health I have a whole new perception on my practice.

  13. Hi David,

    I just come across your website via Stu Girlings. Recently been struck with this injury after hearing a loud ‘pop’ going into Hanumanasana, I am now struggling to get into any stretch, split legs being the most painful (prasarita’s, upavishta Konasana etc) interestingly i went to the osteo and they diagnosed it at Bursitis of the sit bone, which i didn’t quite agree with as i can really feel it in my hamstrings. I am trying work on strengthening my glutes now and hamstrings also. but it is making any practice at all quiet difficult at the moment as it leaves my right leg feeling sore and tender afterwards.

    Interesting to read everybodies helpful comments on what worked for them.

    Hayley

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      Hi Hayley,

      It sounds like it is most likely your adductor magnus. This is often true if the pain is more intense when doing any type of wide leg forward bend. Although this doesn’t solve your problem, it may help your focus.

      David

  14. I heard a pop when mindlessly transitioning from Upavishta Konasana A to B about 6 weeks ago. I have been very careful with my practice, being more mindful, also noticing that straightening the legs in forward fold seemed to aggravate it less than bending the knees. Driving back & forth to your workshop in Columbus this past weekend seemed to really re-aggravate it (1.5hr drive each way). It is still really painful to attempt the Prasarita Padottanasana series so I have mostly skipped these asansa in my practice or just lengthen the spine forward without folding. Looking through articles of yours I thought it may be a hamstring issue & possibly the adductor magnus you mentioned in the comment above. I have run several marathons & practice Ashtanga. My tight hamstrings brought me to yoga. I will follow your advice above but any further advice or insight would be greatly appreciated. BTW, your workshop was amazing! Your passion & expertise make anatomy much more attainable for people like me, thank you!

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      Jennifer,

      Most likely adductor magnus. Why? Because it happened in a wide leg forward bend. If you feel the pain less when legs are together then it is almost definitely adductor. Either way, don’t avoid, just keep light and steady pressure on it when you feel it in those postures. When we sit for long periods, the muscles cool off and well, tighten up a bit. It could be as simple as that. You should have asked me to look at it during the workshop!

      Keep us posted about what you do for your sit bone pain and if it works or doesn’t work.

  15. Thank you for all the advice. I have been forced to focus & be aware because of the injury. I love how the practice teaches us in so many different ways. I am finding my way back into the wide legged forward bends & Kurmasana by following your advice from the workshop & in this post. Slowly, slowly the discomfort is lessening with each passing day. After long periods of sitting I have been using a tennis ball to help loosen up the tightness of the muscle. I sit on the tennis ball, using my arms to support me as I roll the effected area over the tennis ball (sounds weird, but it helps). I stole the idea from my running friends who use a golf ball to massage the soles of their feet in a similar manner after long runs.

    Thank you again for your guidance & I look forward to attending another workshop of yours in the future. Hoping to attend the Ashtanga practices the next time you are in town too.
    Much appreciation,
    Jennifer

  16. Hi David: We met in DC and in Charlottesville, Va! I am here of course because I went from tightness around left sit bone (which i thought to just keep stretchin), to now, a tender spot at the attachment. I would say it’s all hamstring (definitely tender near knee end) but I do feel hesitation in some of the wide leg forward folds, and even felt a slight baby tinge in extended side angle with left leg forward and bent. I wonder if maybe I have irritation of both the hamstring and the adductor? I am not sure what feels best, bent knees or straight, but for the most part I am putting weight into my hands in the sun salutations (for the fold) and otherwise keeping leg straight but not folding much. i’ve never had a hamstring issue so it’s quite an odd thing for me. I am most concerned about not making things worse, and wondering if that means, rest? Interestingly, krounchasana feels quite alright with the leg straight! i wonder if it is because the sit bone is grounded. I am just blabbing here, happy for any thoughts, and I do hope you are well. I keep looking at tour schedule hoping i can find a way to do mysore with you again. Many thanks for all you do, and for your book.~ jean marie

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      Hi Jean Marie,
      I remember you of course. It’s possible that you overstretched it and now it’s irritated. Maybe backing off forward bends will work.
      It is possible that its a mix of adductors and hamstrings, it all ties together on that sit bone. Based on the krounchasana part, it could be that because you’re sitting it’s not as bad. My guess is more to do with the pelvis typically being tucked under more in that posture, in other words, more of a posterior tilt. I would start with testing that aspect. Perhaps your pelvis has a stronger anterior tilt on that side and it’s part of the problem? Not sure. I doubt that it is just because it’s grounded. More likely the function and shape of the pose in other ways. Try tilting your pelvis in other postures and see if that changes the sensation at the sit bone.
      Best,
      David

      1. Hi David– thank you for writing! A bodyworker said it was my biceps femoris, not the attachment, which explains a lot. recently it has been bugging me a touch more after going away for a bit. the initial hurt period is behind me, happily! but I feel vulnerable in parasite more than anywhere else. Krounchasa,a no big deal! so i agree, I think it is places where I have more of anterior tilt. I feel it a bit in my forwards folds during the sun salutes, particularly when coming back up to stand, and I think that has to do with the title of the pelvis. your articles have been really helpful, as I have found that straight engaged legs, with less of a forward fold, or putting weight in my hands where I can in folds, has been really helpful. thanks for providing such great resources. I hope I get to practice with you again!

  17. Hi David,

    I annoyingly get pains around my sit bones area and believe it to be my adductor magnus or adductor longus. I feel it in wide forward bends, trikonasana and especially when in warrior II. What can I do to heal the muscle but also strengthen it for poses like warrior II

    Thank you 🙂

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