Hamstring Injury, Sciatica and Sacroiliac Pain in Yoga

By Niki Vetten

There are three muscles in the legs that are collectively referred to as the Hamstrings – the Biceps Femoris, Semitendinosus and Semimembranosus. All three Hamstrings attach to the Ischial Tuberosity of the pelvis – the sit-bone. At the knee, the Biceps Femoris attaches to the outside of the Femur and the knee and the Semitendinosus and Semimembranosus together are attached to the inside of the knee.

The Hamstrings can be visualized as forming a tripod with the knee as the base. It is useful to think of the hamstrings this way if you consider their function as knee stabilisers – they control and create rotary forces in the Femur. The inner Hamstrings, i.e. the Semitendinosus and Semimembranosus act as internal rotators of the Femur and the outer Hamstring, the Biceps Femoris, acts as an external rotator together with the Gluteus Maximus.

The inner Hamstrings are often injured in yoga in wide-legged asanas like Prasarita Padottanasana, Upavista Konasana or Kurmasana and the Hamstring tightens up after injury. Yogis that don’t take rest time for healing but keep right on practising might find that the Adductor muscles begin to compensate for the injured Hamstring, which gets ‘switched off’ neurologically. What happens then is that the Femur begins to rotate internally because the Adductors function as internal rotators of the Femur, and so does the tightened inner Hamstring.

The hip stabiliser muscles react to the increase in internal rotation with increased tension in the external rotator muscles – mostly in the Piriformis. A tight Piriformis is a major cause of sciatic pain. When a person goes to a doctor for sciatic pain, they will be told to stretch the Piriformis but their problem worsens because stretching a tense Piriformis weakens a muscle that is already stressed from trying to stabilise the excessive internal rotation of the Femur. A tight Piriformis on one side also exerts a twisting force on the Sacrum, causing Sacroiliac joint problems.

If you develop sciatic pain after a Hamstring injury it makes more sense to focus on eccentric stretching of the inner hamstring with standing balancing asanas like Ardha Chandrasana or Dighasana and by making sure that the foot is pointing forwards or slightly outwards – when the Adductors are being substituted for the hamstrings, the foot turns inwards – and to avoid stretching the hips excessively in asanas like Raja Kapotasana, Garudhasana, Gomukhasana or Parvritta Ardha Chandrasana.

Hamstrings are also important as Pelvic extensors and it is the balance between the Hamstrings and the various Hip Flexor muscles that determines pelvic tilt. Tight, injured hamstrings will cause lower back pain, because the Hip flexors, especially the Iliopsoas, will tighten up as a reflex response.

The outer Hamstring has a direct connection to the Sacrotuberous ligament, which is a crucial support ligament for the Sacroiliac joint. Abnormal tension in the hamstrings will be transferred into the Sacroiliac joint, creating pain and instability in the joint.

If you wish to avoid hip problems after a hamstring injury, it is vital to rest for 2-3 weeks to allow healing to take place. Thereafter, stretch the hamstrings slowly and gently and avoid hip-opening asanas if the hips begin to feel tight or painful. Hip strengthening with standing balancing asanas will be more helpful.

Reading sources: Brunnstrom’s Clinical Kinesiology, 1996, 5th edition Ellenbecker, De Carlo, DeRosa, 2009, Effective Functional Progressions in Sport Rehabilitation Cash, 1996, Sport and Remedial Massage Therapy

Author: Niki Vetten

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Visit Niki’s Website: Yoga Anatomy for the Perplexed

Here are some of the other articles posted here by Nikki Vetten:
  • Understanding and Managing Sacroiliac Pain in Yoga Practice March 11, 2013 By Niki Vetten It is common for yogis to develop painful sacroiliac joints, with serious consequences: dysfunction at the sacroiliac joint inhibits the hip muscles and starts a vicious cycle of hip instability and body misalignment. Painful sacroiliac joints must be treated and stabilised to avoid chronic pain and it is not advisable to continue with ...
  • Lateral Pelvic Tilt in Yoga Practice March 9, 2013 By Niki Vetten When the hips are can’t be held level in a horizontal plane while standing on one leg, lateral pelvic tilt occurs, caused by weakness of the Hip abductor muscles, especially the Gluteus Medius. The pelvis tilts down to one side and the head of the Femur is pushed outwards. This is called Trendelenburg ...
  • Using hip muscles effectively in yoga practice – part 1: bridging and back bending March 7, 2014 By Niki Vetten Weak Gluteal muscles are very common amongst yoga students and teachers alike and cause Sacroiliac pain and dysfunction, lower back pain and hamstring injury. Causes and symptoms are covered in the article on yoga butt and this post looks at the effects of various hip movement cues taught in yoga. Different instructions are ...
  • Practising Through Pain and Injury in Yoga March 11, 2013 By Niki Vetten Many athletes and many athletic yogis who experience pain believe that they should keep right on with what they are doing, and hope that the pain will eventually disappear. This is very short-sighted, especially if pain is not associated with a specific injury. Pain without a specific injury is often a sign of muscle ...
  • Back Flexibility with Yoga March 11, 2013 By Niki Vetten As we get older our spines bend less, mostly because of the effects of gravity on the spinal discs, which begin to dehydrate and become compressed after 30, reducing the spaces between the facet joints in the vertebrae and limiting movement. Gravity and an upright human posture also causes some the spinal muscles ...
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2 Responses

  1. jess says:

    This is very illuminating. I thought I had sciatica for many years that would come and go. In my recent flair up my yoga teacher said he thought it was a hamstring issue, I thought it might be Psoas stuff too… Then I stumbled upon an article about SI joint issues and that led me to Piriformis and now after reading your article I can see that all of those parts that I mentioned are involved and this makes the most sense. I’m still uncertain whether to just rest and do nothing for a while to allow inflammation to go down or whether I should do some combative stretching or exercise to prevent scar tissue becoming an issue. This latest flar up has lasted for about 3 months and I haven’t rested it, just pig headedly kept going with 2 or 3 hours of yoga a day, hoping it would just go away….. yes, yes, I know…. Anyway, Thanks for this, it’s very helpful, I’ll be reading more of whatever I can find here.
    P.S I’m on my way to india next week and would love to join a restorative/yin/insight yoga class in Goa, Kerala or Mysore. Can you recommend any teachers or schools to go to?
    Jess

    • Niki Vetten says:

      Hi Jess
      It would be a good idea to rest from your normal activities and see what happens when the muscles are more relaxed. You don’t mention whether you have had a hamstring tear or strain recently. After a hamstring tear, muscle imbalances usually develop in the hips, causing sciatica.
      It would be wise to consult a physiotherapist who can assess your hip and hamstring function and advise you on the best course of action.
      Contact Stu, who runs the website for a class recommendation – he is based in Goa

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