Got Sit Bone Pain? – What to do with that hamstring
By David Keil
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 pain at her 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.
Although not my regular advice, the most common way people are told to deal with this problem 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 end of the hamstrings that connect to the sit-bones.
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.
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 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 and seeing 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 seems 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 3 days in a row. She kept her knees extremely straight and guess what? Pain was reducing after just these few days.
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 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 student at this time
David Followed this up with:
Sit Bone Pain – Revisited
There have been a couple of overlapping issues to the original article on Sit Bone Pain. It just shows that whatever the issue, problem, or pain is… it can be coming from a number of different places. Figuring it out isn’t always so easy. We also naturally try to come to some conclusion about what is going on and sometimes wrongly assume that all, in this case, sit bone pain is created equally. What I’d like to do is offer a couple of other scenarios that are somewhat common. They would also change the way in which you work with sit bone pain. In the original article, I’m specifically talking about dealing with sit bone pain as a result of a hamstring tear or irritation.
First we have the Trigger Point. There is a trigger point in the gluteus minimus or sometimes the gluteus medius which can create pain around the sit bone. One of the most common complaints that goes along with one of these two being the culprit in sit bone pain is this. The pain tends to increase when I’ve been sitting for a long period of time, in a car or in a seat. Yes, this could be the sign of other things as well, including everyone’s favorite… piriformis.
As always, proceed slowly and be willing to change course based on the feedback of the person you’re working with.
Take a look at the Interview I did with David recently when he was at Purple Valley in Goa, India.
Here are some of the articles posted here by David Keil:
- Your Shoulders in Upward Facing Dog March 30, 2013 By David Keil This is a play off an article I wrote for the newsletter back in May. That one was titled Your Shoulders in Downward Facing Dog. There are perhaps as many variations in what we are told to do with our shoulders in Up Dog and it is sometimes just as confusing for students. As ...
- To Squeeze or Not to Squeeze? That’s the question May 30, 2013 By David Keil This month’s newsletter article comes out of a recent trip to the Midwest. I was at a new studio with new students and hosts. This piece is actually a request from one of the hosts, Evan at Tapas Yoga Shala. As always on the first day of practice, I mostly watch and get ...
- Supta Kurmasana Goes Pop! May 30, 2013 By David Keil Some time ago I threatened to write an article about pain showing up in the joint that connects the collarbone to the breastbone. I have had a couple of more recent requests to talk about this potential problem in Supta Kurmasana. As always I try to look at the anatomy, its function, observations ...
- Turning Your Feet Out When Doing a Yoga Drop-Back? September 9, 2013 By David Keil The inspiration for this month’s article comes from a question posed in an email. The question, from Catherine, asks specifically about keeping the feet straight in drop-backs. For those of you not sure what a drop-back is… it’s when you stand at the front of your mat and drop into a backbend. It’s ...
- Gluteal and Psoas Relationship for Yogis March 24, 2013 By David Keil There is a pattern that has shown itself to me over the last few months. I don’t think that this pattern is a result of practice but probably an underlying pattern that already existed. As often happens, regular practice can uncover any number of problems or imbalances in our body. Hopefully the practice ...
- Is Your Hip “Pinching” in a Twist? March 30, 2013 By David Keil This situation can show up in parvrita parsvakonasana, ardha matsayendrasana, marichyasana C, or other twists. The sensation is anything from mild discomfort to an ice pick sensation in the front and inside of the pelvis. The most common description however is that it seems as though something is getting “pinched.” This is a situation ...