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. The secondary symptom was that it also hurt when she sat for long periods, especially in the car. I saw her just a couple of weeks ago and she still had the same pain.
Although 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 that 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 actually stretching 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 th0se same tissues? The answer is no, it wouldn’t. Could this cause more sit bone pain? Yes.
What should you do about sit bone pain?
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.
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 I 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.
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 learning 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.
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.
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!
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.
As I was ready the solution for the pain in my sit bone, I lifted up my legs and I felt immediate RELIEF. Thanks.
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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.
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 🙂
pardon…”fan” of the ilium
not ischium-momentairy lapse in wording
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.
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!!! 🙂
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
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!
Is supta padmasana detrimental to hamstring re-attachment surgery?
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!
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)
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!
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!
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.
Enjoying the articles and maybe catch u next yr at Chi & Co 🙂
Many Blessings 2u