Working With Sit Bone Pain and Achy Hamstrings

Tools for working with sit bone pain

I want to share with you an exercise that I regularly do with students who are dealing with achy hamstrings and/or mild sit-bone pain. This could be as a result of an earlier hamstring tear. Or it could be from general aggravation due to muscular imbalances. I do not offer this as “the” solution. But it’s one that I have used successfully a number of times.

It takes advantage of what are commonly known as PNF techniques. PNF stands for proprioceptive neuromuscular facilitation. This essentially means that we will take advantage of some neuromuscular principles. The specific neuromuscular principle at work here is called post-isometric relaxation (PIR). This neuromuscular principle says that when a muscle has sufficiently contracted against a resistance followed by a relaxation, the muscle goes into a somewhat “ultra” relaxed phase. At this point we apply a moderate stretch to the tissue, feeling for the next level of resistance, and repeat. Reference

This type of work plays with the edges of therapy and starts to deviate from what we would be doing in a typical yoga class. However, the number of hamstring-related pain problems is significant enough that this technique is worth knowing about. The popularity of two different sit-bone pain-related articles on this site is a testament to the number of people who are either dealing with this issue or who want to learn more about it. Those two articles are “Got Sit Bone Pain?” and “Sit Bone Pain – Revisited”.

The technique

This technique is fairly simple to understand and implement for both the teacher working with a student and for a student working on their own. Let’s take it step by step and then you can look at the two video examples at the bottom.

Step one

First, have the student stand close to the wall with their back against it. This removes the need for balance. The student should be leaning on the wall slightly. Have them lift their leg as high as they can and then hold their leg near the ankle or on their heel with your hand(s).

Step two

At this point, you want to put a little more pressure on the hamstrings than what they can do under the strength of their own hip flexors. Pay close attention and slowly start to lift your leg until you feel a change in the amount of tension in the hamstrings. The student should be able to confirm that you shouldn’t go much further but instead are on an edge of discomfort. This is what I refer to as resistance level 2 (R2) in my Hands-On Adjustment DVD. From the student’s point of view, the amount of pressure should remain tolerable but perhaps just slightly uncomfortable.

Step three

Once you have reached this point, you want the student to press down into your hand towards the floor with their heel and activate their hamstrings. This should be done with about 10 – 15 % of their strength. The pressure they create should remain steady for about 10 – 15 seconds. I usually count slowly up to eight. Try to have them avoid tightening their entire leg, for instance, the quadriceps shouldn’t need to contract.

Step four

When you reach eight have them stop pressing their leg into your hand. At this point, have them RELAX the leg. Then slowly take the leg up until you hit the next level of tolerable resistance. When I originally learned this, we were advised to repeat the process until there was no noticeable change in the tissue’s flexibility after relaxing the contraction. I usually find that three times is sufficient.

This process in some ways helps re-establish balance in the tissues. In this case, we are working to restore balance in the hamstrings. This imbalance can be the result of an initial injury or tear, or can be due to postural distortions, such as the pelvis being tilted or rotated.

Assisted

Unassisted