The ‘‘Yoga-butt”
When I was 23 years old, my life took place between my desk and the Yoga mat. I was just about to finish my Physiotherapy examination, and the more stressed I was, the more Yoga I practised, trying to empty and reset my mind by diving into a dynamic asana practice. Being a student, short on money and time, this usually took place within my own four walls, flowing either on my own or guided by a 20min YouTube video. It didn’t take too long until I experienced this annoying pain on my lower buttocks, a feeling that was already familiar to me. It was coming and going, something I thought I just had to "stretch out“. It peaked at a point where every Uttanasana was torture, it felt like my hamstrings were glued together to one big bundle, and every attempt to open that area would rip tissues apart. What was happening in the back of my thighs?
At the time, I had no clue about it and being stressed out by the exams, I didn’t properly research it. I just felt that some inflammation was going on, and the pain was so present that there was no other way than to stay away from my physical practice. Once I finally had time to look into it, the diagnosis was - “Yoga butt”, one of the most common asana-related injuries.
But, what is "Yoga-butt"?
Yoga butt's official name is Hamstring Tendinopathy, and it happens when there are many little tears in the origin of the Hamstring tendon around the sit bones. After some time, these tears cause a local inflammation that causes a typical burning pain and restricted feeling in the lower buttocks.
To make it clear, it's not the asana that causes this injury; it's the way we practice asana with a specific goal in our mind like "must reach my thighs". The phots of hypermobile yogis on social media may suggest that that is indeed a goal; a perfect forward fold with straight knees, chest resting on the thighs. But that shouldn't be the goal of yoga practice, and, in fact, it might be harmful.
Those more prone to this type of injury usually have quite flexible hamstrings but weak Gluteal and Core muscles. When using a lot of flexibility and momentum and not enough engagement, practising mainly short classes without a proper warm-up, lacking external supervision (I used to check all the boxes), this injury can easily happen. Uttanasana and similar forward bends can trigger tears, especially when we hang on the heels without control, lock the knees and try to go "deeper".
How to prevent “Yoga-butt” injury?
Hamstring attachments get irritated in deep forward bends (hip flexion), especially when the knees are straight, but also if you go into an extreme hip flexion even with bend knee like trying to get your leg behind the head (which really does nothing good for your body, but might cause harm). If you have been practising Yoga for a while and are familiar with Yogic philosophy, you probably know that the goal of Yoga is to achieve Moksha or liberation. I am pretty sure that more flexible hamstrings won't bring you closer to that goal, but being compassionate with your own body might. If that sounds like something that resonates with you, here are a few tips on avoiding this injury.
BEND YOUR KNEES! - especially in standing forward bends. By bending our knees, we are reducing the tension and pulling on our Hamstring-origin, we have more space to lengthen the spine, and we are making it easier for our muscles to work efficiently. Once you feel there is no “pulling” on the hamstrings, you can try and extend the knees.
DON’T LIFT YOUR SITBONES UP. You might have heard this cue in Uttanasana or Adho Mukha Svanasana, but if you're pretty flexible and you start to lift your sit bones to the ceiling, you will pull on those Hamstring origins. Lifting your sit bones might cause an anterior pelvic tilt instead of keeping the pelvis in a more neutral position from which you can engage the core.
DON’T HANG ON YOUR HEELS. Those with more mobility tend to hang on the heels in standing forward bends like Uttanasana because they can. Remember the three points on your foot and transfer some weight forward.
STRENGTHEN BEFORE YOU LENGTHEN. Make sure your practice is a good mixture of strength and mobility. If you already have good mobility, focus on strengthening, not stretching. If you are already quite strong, you may want to add more stretching into your practice.
What to do if already suffering from it?
TAKE A BREAK. Stay off the mat until your pain is gone. Take up another activity that doesn't have as many forward bends. I know this is hard to take in when you are passionate about your practice, but your body will thank you for it.
STRENGTHEN. Work on the strength and resistance of your hamstrings. Start by repetitively bringing the heel up to the buttocks while standing on one leg, upper body slightly leaning forward, resting on a table/kitchen counter/whatever you find around your house. Do this without weight at the beginning, with a high amount of repetitions, and slowly adding little by little ankle weights or resistance bands.
BE SMART. Once you return to your Yoga mat, adjust your practice according to previous points mentioned in "What to avoid."
This injury, like many others in Yoga, is unnecessary. We cause it mainly by not accepting our body's limitations while thriving for a specific shape that may not be healthy for us. Everybody is unique, and therefore a beneficial Yoga practice also varies and might look different for you than it does for me. Achieving mobility takes time, and the more mobile we are, the more strength we need to stay healthy and safe. Make it your goal to find that balance. A little cheesy but true: Your body is your temple, treat it with care!
Teresa Wohlmannstetter
Teresa is a physiotherapist and a manual therapist. After getting her 200 hour certification, she joined our team as an Anatomy teacher, and later bacame one of our Lead Teachers on our intensives in Portugal, Sri Lanka and India.
Ocean lover and a surfer girl, Teresa lives between her home in Germany and the closest surf spot, often in Portugal or Sri Lanka.