Sit bone pain

Sit bone pain: what causes it?

Sit bone pain is pain around the sit bone (ischial tuberosity), the bony protrusion at the bottom of the pelvis that you sit on. This is where three hamstring muscles attach with a shared tendon: the semitendinosus, the semimembranosus and the long head of the biceps femoris. The most common cause of sit bone pain is proximal hamstring tendinopathy. This is an overload of the hamstring tendon close to the pelvis, in which the structure of the tendon changes and the tendon becomes more sensitive to load.

The tendon mainly becomes overloaded when it is stretched and pressed against the sit bone at the same time. This happens with movements with a deeply bent hip, such as running uphill, sprinting, deadlifts, deep yoga poses and prolonged sitting. Risk factors are a rapid increase in training volume or speed, weak hamstrings and glutes, a stiff hip and a lot of desk work. The complaint is common in runners, footballers, hockey players and dancers, but also in people who do not play sport.

Tendon irritation, tear or bursitis?

Pain at the sit bone can have different causes:

• Proximal hamstring tendinopathy: gradually developing overload of the tendon. We see this form by far the most often.
• Partial tear: part of the tendon fibres has torn, often after a sudden sprint or slipping with a straight leg.
• Avulsion: the tendon has come completely off the sit bone. This happens with a forceful movement, such as water skiing or doing the splits, and requires prompt medical assessment.
• Bursa irritation: an irritated bursa between the sit bone and the large gluteal muscle, which mainly causes pain when sitting.

Common symptoms of sit bone pain

Do you feel one or more of these signs? Then it is smart to have your hamstring tendon assessed in good time.

• A deep pain low in the buttock, on the bone you sit on.
• Pain when sitting for long periods, especially on a hard chair, in the car or on a bicycle saddle.
• Pain when sprinting, running uphill or taking big strides.
• Pain when bending forward with straight legs or during deadlifts.
• A stiff feeling at the back of the thigh at the start of training, which decreases while warming up and then returns.
• Tenderness when you press on the sit bone.

Did you feel a sudden pop or tear in the back of your thigh during sport, followed by extensive bruising and difficulty walking? In that case, phone your GP on the same day. With a complete avulsion, acting quickly is important, because surgery is best performed within a few weeks. With numbness in the saddle area or loss of bladder or bowel control, call 112.

Why rest alone does not work for sit bone pain

An irritated tendon improves temporarily with rest, but it does not get stronger. As soon as you start exercising again, the pain often returns. Tendons recover precisely through measured loading. The secret lies in the right build-up: first exercises without deep hip flexion, so the tendon is not pressed against the sit bone. We then increase the load step by step, until the tendon can handle deep and fast movements again. This process requires patience, but delivers a lasting result.

Treatment of sit bone pain at De Fysio Man

We follow a phased build-up, with a fixed pain limit as a guide.

Building up the hamstring tendon step by step

• Explanation of tendon loading and a pain monitor: pain up to 3 on a scale of 10 is acceptable if it has settled again by the next day.
• Static muscle contractions (isometric exercises) of the hamstrings to dampen the pain.
• Heavy, slow strength exercises with a small amount of hip flexion, such as bridges and hamstring curls.
• Gradual expansion to exercises with more hip flexion, such as the Romanian deadlift.
• Strengthening of the glutes and trunk to relieve the hamstrings.
• Dry needling of cramped points in the hamstrings and glutes.

Back to running and sport

Once you can perform the strength exercises with little pain, we build up to faster movements, such as skipping, accelerations and running uphill. Only after that does sprinting at full speed follow. This reduces the risk of the symptoms returning as soon as you train fully again.

Sit bone pain, piriformis syndrome and overloaded glutes

Sit bone pain is often confused with other causes of buttock pain. With piriformis syndrome, the pain is higher and deeper in the buttock and can radiate along the sciatic nerve. With glute pain from overuse, mainly the muscle itself hurts after a heavy training period. You can find an overview of all causes under buttock complaints.

Sitting for long periods with sit bone pain

For people with desk jobs, the daily pressure on the sit bone is often the biggest challenge. Use a soft cushion or a cushion with a cut-out under the sit bones. Alternate sitting regularly with standing, for example with a standing desk. Do not sit with your legs crossed and avoid a chair that is too low, which keeps your hip deeply bent. On long car journeys, a break every hour helps.

How we work at De Fysio Man

1. Intake and assessment

We ask about your sport, your work and the moment the pain started. With specific loading tests for the hamstring tendon, we distinguish tendon irritation from a tear, a nerve problem or symptoms from the lower back.

2. Tailored treatment plan

You receive a phased training schedule, with a clear pain limit and exercises you can do at home or in the gym.

3. Back to full speed

We test your strength and sprint capacity before you return to full sport, so you go back to your matches or training sessions with confidence.