Got Sit Bone Pain-What to do with that hamstring

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 Keil was introduced to yoga in 1989 by his Tai Chi Chuan teacher. Both the Tai Chi and Yoga practice at the ripe age of 17 began his research into his own mind-body connections. As an Instructor of Kinesiology at Miami's Educating Hands School of Massage, David had developed a fun, informal and informative style of teaching.

David has a private practice where he uses bodywork techniques to relieve chronic pain. A Licensed Massage Therapist and Certified Neuromuscular Therapist, David has taught seminars in Body Mechanics for Massage Therapists and has also worked with other local and national audiences. David's current practice is Ashtanga Vinyasa Yoga. For the past four years he has had the honor of studying with Sri K. Pattabhi Jois, in Mysore (four separate trips) as well as with John Scott, author of Ashtanga Yoga, who he also has the extreme honor of teaching with. David is authorized to teach Ashtanga Vinyasa Yoga by Sri K. Pattabhi Jois. For more information on David's Ashtanga yoga schedule visit Ashtanga Yoga Miami or visit his other site www.yoganatomy.com

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AlisonPotts, posted on March 9, 2014

Unbelievable how relevant this article is for me! Thanks David, will try your advice...makes sense!

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