Sitbone Pain from Yoga Asana | Love Yoga Anatomy

(proximal hamstring and adductor magnus tendon injuries)

by Jenni Crowther

Unfortunately enough yoga practitioners suffer from sitbone pain that it has been nicknamed ‘yoga butt’.  We may more correctly refer to this condition as ‘proximal hamstring tendon injury’.The length of time that it may take to heal and the way it will influence your physical practice make it a concern for both new and experienced practitioners.

hamstring-attachments-webI’m a Level one Anatomy and Physiology student of Stuart Girling, and not an expert in matters of the body by any stretch of the imagination.  I have myself struggled with pain from a proximal hamstring tendon injury for over a year and so I have much personal experience to go by. This article is the result of my research into what to do with my injury and how to heal it. The source articles of my research are listed at the end of the article, I have merely combined their findings and summarised them in my own words with my own experience overlaid.

What’s a hamstring?

The hamstrings are a group of three muscles on the back of the thigh that connect the pelvis to the knee and the lower leg. They are responsible for extending the hip, flexing the knee, keeping the body upright and the pelvis stable.

The individual muscles are called semimembranosus, semitendinosus (that sit on the medial side) and bicep femoris (that sits on the lateral side). Their proximal attachments are to the ischial tuberosity, or sit bone, at the base of the pelvis, and their distal attachments are to the outsides of the tibia and fibula (lower leg). The adductor magnus muscle, sometimes referred to as the fourth hamstring, also connects to the ischial tuberosity, just medial to the hamstring attatchments. Damage to its proximal tendon will cause pain to be experienced in a very similar area (although slightly more medial) especially in wide legged forward folds.

What are we calling this?
What does it feel like?

Symptoms may include pain and discomfort in the sit bone area

What’s causing the pain?
Who is most likely to be affected?

Anyone can suffer, but those at greatest risk:

Theories of causational factors
Bad technique – what might I be doing wrong?
Good technique – What could I be doing better?
Prevention is better than cure: Teacher general guidelines
To bend or not to bend?

Some teachers tell you to always bend the knee(s) of the leg with the affected hamstring(s), some tell you to keep legs straight. Which is correct?

In my personal experience, some poses worked better with bent legs, some worked better with legs straight and just not going as deep into the fold. I would often modify differently to keep a balance, for example, Padangustasana with legs straight to gently elongate the hamstrings, then Padahastasana with deeply bent legs to get a lumbar spine stretch. I agree with David Keil’s findings on the bent knee causing more tension at the site of the injury, but sometimes I just wanted to extend my spine fully.

As a teacher, if you can see the student has a bent knee then you know that the student is being mindful and modifying the pose, with legs straight it’s less obvious if they are causing themselves pain. So my advice would be to, talk to the student, explain the problem, the options and the potential injurious consequences of not modifying, and then get them to try different versions, and let them know that it’s OK to choose their own modification on each day for each pose, depending on how it’s feeling. But really emphasise patience, some days it feels fine and that’s when they’re most likely to over-stretch and go back to square one.

DON’T
DO

Stage one: Inflammation.

The first 48-72 hours

The body needs to stop the bleeding, clear away damaged tissue and prevent infection.

Supported Setu Bandha Sarvangasana

Supported Setu Bandha Sarvangasana

 Stage two: Repair

The body needs to construct a delicate cellular and molecular matrix to reconstruct capillaries and connective tissue. It will then start filling it with haphazard fibres.

We need to gently stretch and strengthen to help align those fibres.

1. Frictioning

For long term injuries where scar tissue has already built up, start a program of frictioning to break down the scar tissue. Frictioning is ‘plucking’ the scar tissue with your fingers across the fibres of the tendon. Or you can sit on a tennis ball and rock back and forth.

5-15 minutes before asana practice.

2. Warm up

Walk for ten minutes before asana to warm up the muscles

Swing the leg like a pendulum back and forth gently to get the same effect.

3. Repair asanas: detailed later
4. RICE after practice – or just Ice if not entirely practical.

To strengthen the hamstrings and glutes

Partial Shalabasana – 5 reps each leg.

partial shalabasana

Lie prone drawing in the abdomen. Engage hamstrings and glutes as if lifting right leg into Sarvagasana but don’t lift the foot. Hold for 10 breaths, Repeat left.

Dhanurasana Prep.- 5 reps.

dhanurasana prep

Both feet over a bolster, engage as if lifting legs off the bolster but don’t lift. Hold for 10 breaths.

Partial Supta Padangustasana – 5 reps each leg

partial supta padangustasana

Place right heel on a brick, press heel down, hold for 10 breaths. Repeat left.

Week 3-6, daily practice

To further strengthen the hamstrings and glutes

Partial Shalabasana – 5 reps each leg.

Weeks 3-4 Start to lift the leg an inch

Weeks 5-6 Lift the leg a few more inches, no more than 5.

Dhanurasana Prep.– 3-5 reps.

Weeks 3-4 Start to lift the feet off the bolster a little

Weeks 5-6 Remove the bolster and work on lifting the legs from the floor at a right angle

Partial Supta Padangustasana – 5 reps each leg

partial supta padangustasana 2

Weeks 3-4 Move up to a firm bolster

Weeks 5-6 Graduate to a chair, no more than a 45 degree angle

Week 1-6, daily practice

To further strengthen the glutes and then gently lengthen the hamstrings

Setu Bhanda Sarvangasana – 3 reps of 5 lifts.

setu bandha sarvangasana bridge

Very gently start working to lift into bridge, it may be that you start Week 1 just intending to lift and gradually work up a few inches at a time to full bridge.

supta padangustasana

Weeks 1-6 with a belt – 5 minutes each side

Loop a belt over the right foot and take it perpendicular to the body, on the comfortable side of the hamstring – no stretching sensation. Take the leg out to the side after 3 minutes, supporting the hip with a block. Repeat left.

Stage 3: Re-modelling

6-12 months of love

We need to help the body to strengthen the healing tendon and build long, strong hamstrings.

The number one rule is NO PAIN.

Any further damage will take you back to stage one and the whole process will have to be repeated from scratch.

Shalabasana – build up to full pose and then on to Urdhva Danurasana.

setu bandha sarvangasana bridge

Come up into bridge and isometrically pull the heels towards the shoulders – without actually moving them, hold for 30 seconds.

Eka Pada Setu Bhanda Sarvangasana

Eka Pada Setu Bhanda Sarvangasana

When comfortable with stage one, add in a leg lift to further strengthen the glutes.

Supta Padangustasana with resistance

supta padangustasana 2

Working up from the chair at 45 degrees, to a doorjamb pressing the heel away to extend the leg from the hip. Gradually work up to 90 degrees with NO PAIN.

I hope you have found this helpful or at least a starting point for further research. Please feel free to contribute your own experiences in the comment area below.
Jenni

Jenni created a little iphone video to demonstrate some of the exercises mentioned above
Sources with gratitude

jenny
Bio: Jenni Crowther has been practicing Ashtanga Primary series since 2009, after attending her first class and becoming instantly hooked. Practice was initially with Joey Miles in Leeds, where she had a corporate office life, and it gradually took over her life (early nights, no booze etc) until eventually she quit it all to go to France, then Crete, then India as a yoga student and now qualified teacher, after recently completing her 200+ YTT with Heather Elton et al in Goa. She is also pretty injury prone – hence this article

You can visit Jennie’s website here.

I really hope this article can be a springboard for a discussion on this topic. Hamstring injuries can be an upsetting problem for many yoga practitioners . If you have found something that really worked for you it’s time to share! Add you comment below and let’s see if we can help as many people as possible.

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