Injuries: Hamstring Attachment

This is part of a series about Injuries In Yoga.

The single most common injury that we see in the yoga world is a hamstring attachment injury. It happens due to over-stretching the hamstrings. Since so many postures and exercises target this muscle group on the back of the thighs, what often ends up happening is we over-stretch and the tendon that attaches the hamstrings to the sit bones gets damaged. Quite often, we mistake this new, intense sensation for a "deeper" hamstring stretch, so we continue to push (or more often pull). This makes it worse, and many of us don't realize there is an injury until serious damage has been done.

Stretching the hamstrings has become central to many styles of yoga. Like many other physical elements of modern practice, this emphasis comes from gymnastics, contortion and dance. In any given class, we may stretch the hamstrings from numerous positions: standing, seated, legs together, legs split, one leg, both legs, etc.

This injury creates pain at the point where the hamstrings attach to the sit bones (ischial tuberosities), at the base of the pelvis in the back, pictured to the right and circled in red. It can be painful in forward folding positions, and may be sore after class so that it hurts to sit down. It is sometimes called "yoga butt". This injury is so common that almost half of yoga practitioners---men and women---have it currently or have had it in the past. 

Common postures that could strain the hamstrings are: Hands to Feet, Standing Separate Legs Stretching (pictured above), Standing Bow, Standing Splits, Stretching, Separate Legs Stretching and Tortoise, etc. Take a moment to notice the similarities in these positions, pictured below. They all tilt the pelvis forward with relationship to the femur (thigh bone). This makes the hamstrings long, which is why we feel the "stretching" in the back of the leg. The deeper these postures are, and the harder we push them, the more likely it will be to damage the attachment of the hamstrings.

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Hands to Feet

Standing Bow

Standing Splits

Stretching

Tortoise

HOW TO HELP
First and foremost: rest. I know you don't want to hear this, and resting can be a real challenge for the mind and ego. This injury can take months or years to heal, and the more we aggravate it the longer it will take. Avoid forward folds for several months. Seriously! You can still do lots of other exercises and postures, but avoid forward bending of the hip for awhile. DO NOT STRETCH YOUR HAMSTRINGS!

Second, don't overstretch the hamstrings, even after you're healed. The natural range of motion of the hamstrings only gets the femurs (thigh bones) to about 90 degrees with the pelvis when the knees are straight. This means that the vast majority of contortion-influenced yoga postures that "stretch" the hamstrings take it too far, which is why injury is so common. You might not be able to do Standing Splits with the same picturesque beauty, but you will be able to walk and sit without pain.

Third, strengthen and shorten the hamstrings. We did a whole blog on this, where we explain a handful of postures and exercises that will make the legs strong and help prevent injury. These include Balancing Stick, Squatting, Bridge and Jastiasana.

IN CONCLUSION
The most important thing to take away from this is that you can get hurt from yoga practice. If you have pain at the back of your hip, the top of your hamstrings, at or near your sit bones, and this is exacerbated when you do forward folding postures, STOP IMMEDIATELY! It is very likely that you are damaging the upper attachment of the hamstrings. Take the time to let it heal, and then perhaps adjust your approach to the physical postures so that they have less likelihood of injury.