‘Yoga Butt’ Injury

‘Yoga Butt’ is a term for a range of symptoms frequently experienced in Ashtanga and other forms of Vinyasa or Power yoga after a few months of regular practice. It often starts as

• Pain or discomfort at either of the Ischial Tuberosities (sit-bones)
• Discomfort in all forward bending and a feeling that the hamstring won’t stretch
• Inflexibility or pain in Kurmasana and Supta Konasana.

Yogis with these symptoms might then tear a Hamstring, but even if they don’t force the hamstring stretches, but continue to practice, these symptoms can get worse, until they have some or all of these symptoms:

• Pain at the outer side of the hip at the Greater Trochanter of the Femur
• Lower back pain
• Sciatica
• Sacroiliac joint problems
• Pain at the outside of the knee

Yogis try all kinds of modifications to their practice, without much success. Visits to Physiotherapists usually results in a diagnosis of Ischial Tendonitis and being told to rest. Resting and stopping yoga practice may relieve the pain but it often recurs when practice is resumed, and these symptoms usually become chronic if they are not treated. Continuing to practice while you have pain makes hip problems worse: please refer to Practice and Pain.

An emphasis on hamstring stretching in yoga is considered to be the main cause of yoga butt and many health-professionals focus on treating the Hamstrings. However, the reason why a hamstring becomes inhibited and tight is due to hip-muscle weakness and body alignment problems.  Yoga Butt will improve if these are assessed and treated.

When the Gluteus Maximus is weak, the Sacroiliac joint becomes unstable. The hamstrings have an important role in pelvic stability –Hamstring attachments are connected to the Sacrotuberous ligament and a Hamstring becomes neurologically inhibited and tight if its movements affect the stability of the sacroiliac joint. Forcibly stretching an inhibited hamstring will injure it.

As explained in Hinging from the hips, Surya Namaskara and the Ashtanga Standing Sequence involve a lot of hinging forward with a straight back, weakening the Gluteus Maximus. Keeping the feet together in Utkatasana, as well as constant hip flexion and extension weakens the Gluteus Medius.

Treatment by a sports-rehabilitation professional can be very effective. Yoga butt should never be ignored – it doesn’t improve without specific treatment. Finding a professional who can help is not always easy, and treatment will be most effective if it includes

• A thorough assessment of hip function
• Hip strengthening
• Quadriceps strengthening
• Strengthening the Abdominal Oblique muscles
• Correcting body alignment, especially shoulder imbalances – shoulders have a direct influence on hip alignment.

The Ashtanga Primary- and Intermediate series consists of forward and backward movements, which can be problematic because the stabiliser muscles are found at the sides of the body – neglecting side-strengthening asanas causes weakness in the hips and oblique abdominals- these muscles help to stabilise the Sacroiliac joint.

All yoga practice is symmetrical, i.e. practised equally on both sides but this doesn’t correct left- right imbalances, which are natural in humans, as explained in Hip pain and injury. Correcting body asymmetry requires about three times as much strengthening work on the weaker side, not just paying attention to alignment.

After a successful treatment, it may be possible to resume Ashtanga or Vinyasa practice if you

• Are no longer in pain
• Avoid practices that focus on leg strengthening
• Avoid anterior pelvic tilt in all standing asanas
• Avoid lateral pelvic tilt
• Avoid self-practice and large classes: an attentive teacher corrects bad alignment habits
• Instead of hinging from the hips with a flat back in forward bending, roll up and down through the spine, using the buttock muscles to move the Sacrum first
• Back strengthening with Salabhasana unless you are practicing Ashtanga Intermediate series
• Practice asanas that focus on the sides of the body: a modification of Surya Namaskara B as described in Adductors, the Pelvic Floor and Lower Back Pain, and also regular practice of Vasistasana, Parsva Bakasana and similar asanas
• Work on lifting and lowering the legs from Sirsasana to Urdhva Dandasana and back. This requires a strong butt and is often skipped in Ashtanga practice because yogis are too tired.
• Eka Pada- variations of Setu Bandasana, Urdhva Dhanurasana and Viparita Dandasana are great butt-strengthening asanas

Many yogis are reluctant to give up Ashtanga practice, because it is a moving meditation but ignoring pain will not make it go away.

If these problems recur, it’s time to change your yoga practice if you wish to avoid chronic pain and lasting damage. A rigid approach to any yoga practice is not conducive to a healthy body

Reading sources:
Kendall, McCreary, Provance, 1993, Muscles, Testing and Function
De Franca, 1996, Pelvic Locomotor Dysfunction
Cook, 2003, Athletic Body in Balance
Ellenbecker, De Carlo, DeRosa, 2009, Effective Functional Progressions in Sport Rehabilitation
Sharkey, 2008, The Concise Book of Neuromuscular Techniques