Decoding Hamstring Pain + Yoga Butt
November 13, 2023

Proximal Hamstring Tendinopathy is also referred to as “yoga butt.” This condition usually presents as a recurring pain or ache in the buttock crease area or “sit” bone that gets aggravated by poses that stretch the hamstrings, or by activities like running, lifting, and jumping that involve strong hamstring activity. 

Not only can people who practice yoga on a regular basis experience this type of chronic injury (hence the nickname), but so can runners, dancers, martial artists, and other athletes who regularly and deeply stretch or take their hamstrings through large and deep ranges of motions.

While this pain-in-the-you-know-what is common, it is crucial that we understand the nuances of it. When you start to feel sharp, nagging or burning pain at the insertion point of the hamstring, your tendon is already changing due to chronic overuse – and it’s time to pay attention, back off, and learn more. With both tendinitis and tendinosis, it is crucial to stop doing the thing that hurts. Pain from overuse injuries gets worse – not better – when you continue to push through. Taking a break is key to allowing the tendon time to heal – and yes, this is often the hardest part. Imagine a scab that you keep picking at… it won’t heal until you leave it alone for a while.
When acute pain and sensitivity subside, it’s time to approach recovery, strength and resilience of the tendon. 

Want to hear and learn more about this?  

Check out our fascinating roundtable discussion/webinar hosted by Diana Florio with experts Hector Lozada and Marisa Sako. Hector (Board Certified Orthopedic Clinical Specialist, Certified Manual Physical Therapist, Certified Pilates Rehabilitation Instructor) and Marisa (Licensed Acupuncturist, Yoga Instructor, Mobility Specialist, Threes Teacher) educate us on the distinctions between identifying and treating tendinitis and tendinosis. You’ll be able to help yourself (or someone you know) pursue effective treatment.

 Proximal Hamstring Tendinopathy Roundtable 

What’s the science behind it?

Tendinopathy is a term we use that includes the spectrum of tendon injury, including both tendonitis and tendinosis. 

Tendons are tissues that connect muscles to bones. Hamstring tendons attach your hamstring muscles to bones in your pelvis, knee and lower leg. 

Hamstring tendonitis is acute inflammation (in the tendons at the back of your thigh) after an acute event and can occur from overuse or overstretch of the tendons. There is swelling but the general structure of the tendon is unchanged.

Tendinosis is a degeneration of the tendon in response to chronic overuse and/or biomechanics that can cause one of the proximal attachments to be in a state of compression. This leads to increased nerve and blood vessels, and decreased collagen fibers (which are the source of the tendon’s mechanical durability and strength). When the integrity of that tendon has been compromised, it becomes unable to withstand the forces that are applied to it.

 

So why does yoga butt happen?

When the hamstrings are deeply stretched for extended periods of time AND stretched often, the extreme intensity and frequency can create inflammation and pain from overloading in the hamstring tendon. The hamstrings then have trouble recoiling back to their normal functional level: their capacity has been surpassed. 

In addition to overuse, it’s important to note that certain common postural habits, strength deficits, movement patterns and hypermobility can also make someone more susceptible to this condition. 

So yes, some people may be at a higher risk for tendinopathy than others based on how they stretch as opposed to how deeply or how long they stretch.

Listen to Marisa recount her experience with tendinopathy and how it took time to realize her approach to treating her own tendinosis was perpetuating a vicious cycle. Once she understood the nuanced mechanism of her injury, she was able to break that cycle, engage in proper and effective movement patterns and actually heal.

How do you treat tendinopathy?

Tendinopathy is often initially treated with avoidance of engagement in the aggravating movement/activity), massage, and NSAIDS, while simultaneously making sure not to be sedentary for extended periods of time. 

During this time, we want to limit doing movements or activities that hurt excessively. Think of the healing tendon as a scab on your knee after you skin it. When you do activities like stretching, jumping, running, and experience pain in the yoga butt region, there’s a chance that pain is causing an inflammatory response, or opening up the scab trying to heal. In the initial stages of hamstring tendinopathy, it’s a good idea to avoid such activities so you can be your own anti-inflammatory, reducing new scab opening and giving the tendon a chance to heal. 

As time progresses, and there are less moments of acute pain, we shift to adding in strength exercises and cross training, supplemented with massage and/or acupuncture. Doing just yoga is not the answer to fully healing.

With prompt and correct treatment you can minimize pain, promote healing, return to function and exercise and reduce risk of developing a chronic tendinopathy and loss of function. 

Here’s what we really want you to know.

Untreated or insufficiently treated tendinitis can develop into tendinosis. Thus, it’s important to note that in both cases progressive loading, strengthening exercises AND cross training are integral to the healing process. Strength training and cross training actually improve the capacity of the tendon to manage progressive loading (while avoiding repetitive movements).

Is there a program that addresses hamstring health?

Threes offers a dynamic program led by Marisa Sako called Hamstring: Injury Support + Recovery. In this  program (webinar plus three lengthy, informative classes and four supplementary strength classes), Marisa integrates the science side of tendinopathy with her own experience – helping self and others –  with movement patterns that increase strength, mobility and overall hamstring health. 

Not only is this program highly beneficial for those suffering from tendinopathy, but for those who have bodies susceptible to injury. You can use it preventatively.

Hamstring: Injury Support + Recovery Program

Pain is complex. When you discern the source, you’ll understand how to address it with the most effective treatment modalities.

You’ll learn how to move mindfully, giving yourself time to listen to and respect your body’s response.


BECOME A THREES MEMBER and evolve into the best version of yourself. 

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