More on sit bone pain
Let me guess, you’re here because you have sit bone pain. Whether you want to call them sit bones, sitting bones, or even sitz bones, (By the way, “sitz” comes from German verb “sitzen,” meaning “to sit.”) what we’re talking about are technically called the ischial tuberosities. Ischial refers to the name of the area of bone on your pelvis and a tuberosity is a large bump. Your sit bone pain is real and I’m sure you want to know what to do about it.
How best to manage sit bone pain depends on the cause of the pain. I’ve learned from working with many clients and students that what we think is the cause of sit bone pain and what the cause really is are often two different things.
In fact, figuring out the cause of sit bone pain can be the trickiest part of managing it! If you can’t figure out what caused it, then you might choose the wrong way of working with your sit bone pain, all the while wondering why it never gets any better. You can always check out my original article on sit bone pain here.
Sit bone pain can come from any of the following:
- Overdoing forward bends in yoga and creating general inflammation at the hamstring attachment.
- Over stretching (tearing) a hamstring which usually happens with an audible pop.
- Trigger points that are referring into the sit bone area.
- Adductor magnus strain.
- A running related strain or injury.
What Does it feel like?
There are some important questions you may want to ask to help identify the source of your sit bone pain.
Is the pain sharp and only when you forward bend?
Does it feel like a dull ache that includes a larger area than the sit bone itself? In other words is it your sit bone and sometimes also radiating lower, perhaps the back or side of the leg?
Does it come on after sitting in a particular position for a while?
Does the pain come and go regardless of activity?
Does the pain go away when you practice yoga or do other activities?
Do you remember the moment that this began?
Has it changed since that moment if you remember?
What & where are the sit bones?
What are the sit bones?
As I mentioned, what we commonly refer to as our “sit bones or sitting bones” are more technically called the ischial tuberosities.
Ischial refers to the ischium, which is the posterior (back), inferior (lower) portion of the three fused bones that make up the pelvis.
Tuberosity refers to a large raised bump on a bone.
Where are they located?
The ischial tuberosities are boney bumps located on the posterior (back) side of the ischium.
We call them sitting bones because if you were sitting “properly” your pelvis would have a slight anterior tilt and hopefully you would be sitting on your sit bones! When we slouch and tuck our pelvis under we are also adding weight to the sacrum and or the coccyx (tail-bone).
Attachments to the sit bones
There are a number of important muscles and other structures that attach to the ischial tuberosities. They include each of the hamstrings (semimembranosus, semitendinosus, and biceps femoris-long head), adductor magnus, and the sacrotuberous ligament.
Let’s take a look at each of the muscles and how they possibly relate to sit bone pain.
The hamstrings are probably the muscles in this group that we’re most familiar with. These three muscles attach to the ischial tuberosity at their proximal (top) end. At their distal (lower) end, they cross the knee joint.
Because of their direct connection to the sit bone, repeated engagement, rapid engagement or stretching of these muscles can lead to inflammation or irritation of the boney attachment area. My observations are that chronically tight hamstrings that lead people to struggle and strain too much, especially in forward bending, can lead to irritation.
Hamstrings that are engaged while stretching may also lead to sit bone pain.
Adductor magnus is sometimes referred to as the fourth hamstring because it also attaches to the ischial tuberosity at its proximal end and a portion of its fibers extend the hip joint.
The most likely reasons for a sit bone injury at the adductor magnus are either being over-adjusted or simply going too far in a wide leg forward bend (upavishta konasana, or prasarita padottanasana).
The sacrotuberous ligament is a thick ligament that connects the sacrum to the ischial tuberosity. The tissue of sacrotuberous ligament is part of the same connective tissue as the paraspinal muscles that then becomes tissue that runs over the sacrum to connect to the ischial tuberosity and finally become the tendons of the hamstrings.
Although it is possible to injure this ligament, usually during some kind of sports activity, injuries tend not to occur at the sit bone attachment. This ligament is far less likely than either the hamstrings or adductor magnus to be the culprit in sit bone pain.
Sit bone pain
Why might you experience pain at or around the sit bones?
Sit bone pain is not uncommon even for those that don’t have a yoga practice. It is also common among activities that require running, such as soccer.
There are a couple of overlapping issues related to sit bone pain, so it can be coming from a number of different places. Figuring it out isn’t always so easy. However, there are a couple of scenarios that are somewhat common. Which scenario is occurring will change the way in which you work with sit bone pain.
Hamstring Tear or Irritation
One likely culprit if you are experiencing sit bone pain is a torn, irritated, or inflamed hamstring.
Clues that suggest the hamstrings are involved:
- There was an audible “popping sound when the original injury occurred.
- Pain is felt at the sit bones when forward bending, but only when keeping the legs together, not when stepping the legs wide
- The area of the hamstrings just above the knee joint is also sore when palpated
- It hurts when sitting for long periods
How to modify practice for suspected hamstring tear or irritation?
- Try keeping the legs straight when forward bending (best when doing the seated version). Lengthen the spine and get the pelvis to tilt forward, but only fold to the point where you begin to feel sensation. This keeps consistent tension throughout the hamstrings rather than directing additional pressure into the already sore attachments.
- Another technique that can be used in forward bending while doing sun salutations is to bend the knees slightly as your hands go down to the floor. Then, lean about half of your body weight into your hands. By taking the weight into the hands, you take it from the feet, and the hamstrings don’t have to contract as strongly to keep you from falling forward.
- You can bend the knees when transitioning in or out of standing postures and then straighten the legs again once in the posture. One student reported that using a strap around her feet during seated forward bends, when her legs were straight, helped her keep even pressure throughout the hamstrings and significantly reduced her sit bone pain.
- Try a PNF technique for re-balancing the tension between the quadriceps and the hamstrings
This exercise is appropriate for someone experiencing generally achy hamstrings and/or mild sit bone pain. If you’re experiencing more intense sit bone pain, explore some of the other contributing factors and modifications first. This is an exercise that I usually give to students at the end of practice as it seems particularly effective when the tissues are warmed up, however, you could really do it anytime.
You can read an explanation in this article or watch the video on this technique below.
Watch the PNF Technique
Another possibility if you’re experiencing sit bone pain is trigger points.
Clues that suggest trigger points could be involved:
- Sit bone pain comes on and/or increases when sitting for a long time, in a car, a long flight, or even just in a chair
- Palpation of gluteus minimus or gluteus medius reproduces the pain sensation
It’s important to note that trigger points can accompany other contributors to sit bone pain. It’s possible to have torn or inflamed muscles (hamstrings or adductor magnus) and also have trigger points contributing to pain sensations. It’s also possible that tension in the piriformis muscle is contributing to this pain pattern.
How to work with trigger points?
You can check your own muscles by placing a tennis ball where you see the X’s in the diagram and leaning some pressure into that spot with your body weight. You may also want to start with a larger or softer massage therapy ball if you are feeling a lot of sensation from trigger points.
Additionally, seek out a qualified massage or neuromuscular therapist.
A final possibility for contributions to sit bone pain is a torn, irritated, or inflamed adductor magnus.
Clues that adductor magnus might be contributing to pain:
- Sit bone pain is felt in forward bending, but only when the legs are stepped wide, not when they are kept together. Students have also reported sit bone pain in other postures like trikonasana that could indicate a torn or inflamed adductor magnus is contributing to pain sensations.
How to modify practice for suspected adductor magnus tear or irritation?
- Work wide-leg forward bends into your practice to continue stretching the adductors, but don’t fold as deeply. Keep light steady pressure on the muscles and go only as far as you can go without experiencing pain.
Remember that muscles will tend to lengthen as they warm up during movement. The sensations of pain may change as you warm up during practice, so be cautious about not overdoing the stretch as the muscles may also tighten somewhat as they cool down after practice.
Ischiogluteal Bursitis – Possible Cause of Sit bone pain
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?
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.
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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.
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
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.
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
Ciao David! Ho da tempo tendinite bilaterale Achillea e tendinosi dei hamstrings sul tuber ischiadicum, sopratutto dei bicipiti femorali. Cosa mi consigli? Grazie! Meg
I do have a pain / hamstring when i sit down and the mussel is pulling when i bend forward
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
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…
i had right side sitting bone pain for ten years and its just painful when im sitting.i have tried different things but the pain never left.
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.
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.
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.
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?
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!
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.
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
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?
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…
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!
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