You have no idea how many times a yoga student complains, “I think I had an injury in my thigh, and I have been stretching it for months and it still hurts.” Then for some reason, the student is shocked to hear the reply, “Well then… stop stretching it.” Yoga people: Stretching is not the answer for everything! In fact, we would argue that it is RARELY the answer for anything.
“But, I was told to keep stretching it.” So you did that, right? And it didn’t get any better? Time to do something else, perhaps seek the advice of a medical professional? Bottom line: If you have a pain that lasts for months, please go see a doctor, not a yoga teacher! Ok, now that we have that out of the way, this brings up an interesting question for those of us who teach. Why is this always the same story?
After advising students to seek medical advice and digging a little deeper, there seems to be a fairly predictable story concerning this kind of hamstring pain. It’s so common, in fact, that some teachers have termed it “yoga butt.” Students generally complain about a soreness near one of their sitz bones that becomes more painful when they are in hip flexion (a forward bend). Sometimes it can be a cumulative effect, and sometimes it can be an acute injury (some say they even hear a pop), but it almost always happens in a deep forward bend. So what the heck is going on here?
First off, it should be noted that contemporary yoga practices are largely hamstring-centric. Perhaps, it’s to counter our modern Western life of sitting in chairs all day (although that still does not make complete sense, but let’s just go with that), but people seem to be obsessed with stretching their hamstrings to absurd degrees. The potential for injury is compounded by the fact that most of this hamstring work is done through passive stretching (the hamstrings are doing a minimal amount of ‘work’, if any). Even in a standing forward bend, a pose in which the hamstrings are supposed to be active, teachers cue to put weight into the front of the foot, contract the quads to straighten/protect the knee and then try to pull the face towards the lower leg. Yikes! You can touch your forehead to your shin? That’s cool, but it kinda sucks that you can’t stand on one leg very easily… It also sucks that you are probably going to get the aforementioned injury known as “yoga butt” with your obsessive hamstring “opening.”
That soreness you feel up by your sitting bone? Yeah, that’s probably the tendon of one of your hamstrings that you just keep tearing over and over. Do it long enough and you can even get an avulsion, a soft tissue tear that can include pieces of bone tearing away from the attachment point. Fun! What most likely happened was that you stretched too far, too fast. When this happens, a mechanism called the myotactic stretch reflex causes the muscle to contract to resist the stretch and prevent injury. If your leg is not in a position where the muscle contraction will stop the movement (let’s just say… I don’t know… in a loaded forward fold with the weight of your body coming down with gravity???), then the muscle will still contract, but something else has to keep lengthening because of the position you are in. That something else would be the tendon, which is why the sensation is up at the attachment point of your ischial tuberosity, aka sitting bone. With enough force, it will tear.
So, you have a tendon injury, why shouldn’t you stretch it out? After the tendon tear, most people will experience limited range of motion (as well they should; inflammation is the body’s way of telling you to NOT MOVE the joint while repairs are being done). If you continue to stretch through this limited range of motion caused by injury, the muscle will continue to protect itself by contracting and then you are just tearing the tendon more. Then, of course, there is the scar tissue formation after repeated offenses, as well as not so helpful compensation patterns, bla bla bla.
By now it should be pretty clear why all the stretching you were doing may not have been the best choice. So, what do you do? For one, you should probably treat it like an actual injury that you would have anywhere else in your body and STOP doing the thing that caused it and go to the doctor! Yes, that means no more crazy forehead-to-shin forward folds for 4-6 weeks (that’s how long it generally takes a soft-tissue injury to heal). Take an epsom salt bath, get a massage, all that stuff. If you really just don’t want to lay off of it, you could continue with your practice and modify (bending your knees is actually ok sometimes). Whatever you do, you must do it with awareness. Yoga is slow for a reason. It is methodical. This isn’t a who-can-shove-their-face-to-their-leg-the fastest contest. No one is paying you to injure yourself, so please, treat your body kindly….