Monday, May 14, 2012

Yoga Shouldn't Hurt Part II: Upper-Hamstring Tendons

Avoid injuries on the mat with this practical guide to caring for your knees, hamstrings, and sacrum ~ by Roger Cole

Upper-Hamstring Tendons

The Road to Injury
Say that you're a flexible yoga teacher. Each day you wake up and practice hamstring stretches, then demonstrate deep forward bends in your classes. When you notice a pain just below one of your sitting bones, you stretch it more, thinking that will promote healing. But when the pain increases, you decide to rest it. After the pain diminishes, you stretch again and reinjure the area. The pain comes back, and the cycle repeats. This process can go on for years.

The hamstrings are three long muscles that cover the back of the thighs. At the top of them, tendons attach all three to the sitting bones. A nagging sensation just below the sitting bone is caused by a tear in the upper-hamstring tendon, near where it connects to the bone (called the attachment). To stretch hamstrings in forward-bending poses like Uttanasana (Standing Forward Bend), you straighten your knees while lifting your sitting bones. Any time you stretch a muscle, it pulls on its tendons, creating microscopic tears in them. If you wait 24 to 48 hours between practice sessions, these tiny tears heal. But the upper-hamstring tendons can take longer to heal because they are poorly supplied with blood. When you don't give your hamstrings time to rest, you set up a scenario for injury. Alignment can also be an issue. Teachers often tell beginners to lift their sitting bones in forward bends because beginners tend to round their backs in such poses, which can lead to disk compression and lower-back injuries. But people with loose hamstrings can lift their sitting bones so high that the tendon starts to wrap around the bone. This can weaken the tendon.

To recap: If you produce new tears in your upper-hamstring tendons faster than your body can repair the old ones, you'll end up with an injury. If you rest and start to heal, the partially healed tissue may still be too weak to withstand the pose and you'll tear it again, ending up with more pain than before. If you repeat this cycle often enough, scar tissue will eventually develop in the torn area—and rehabilitating scar tissue is typically a slow, difficult process. Often hamstring injuries that seem to occur suddenly are set up by a gradual weakening of the tendon over time, caused by overstretching and insufficient rest. The weakening can culminate in one powerful stretch that leads to injury.
Prevent and Prepare
To prevent an upper-hamstring injury, you need to approach straight-leg forward bends gradually and with awareness, taking any pain near the sitting bone seriously. Never force a forward bend (or any pose), and if you feel discomfort at or near the sitting bone while bending forward, stop stretching that hamstring immediately. If the discomfort recurs in a future practice, avoid any action that causes it for at least several days. This usually means you should avoid practicing forward bends over that leg or you can bend the injured-side knee in all forward bends. Bending the knee protects the hamstring tendons by taking some of the stretch off of them and giving them time to repair themselves before a significant injury develops. Reintroduce straight-leg forward bends on the affected side only when the discomfort is completely gone for at least a few days, and then do so gradually.

Another important preventive measure is to include plenty of hamstring-strengthening poses, such as Salabhasana (Locust Pose), Purvottanasana (Upward Plank Pose), and Virabhadrasana III (Warrior Pose III), in your asana practice. Building muscle strength also strengthens the tendons of these muscles. However, if you have an existing hamstring injury, be sure to introduce these poses gradually.
The Path to Healing
If your injury is new, especially if you experience a dramatic injury such as a sudden tearing sensation during a hamstring stretch, rest and ice the area immediately. Be sure to avoid stressing it in any way for several days before introducing any recovery exercises at all.

Recovering from an upper-hamstring tendon injury typically takes at least a year. There are different schools of thought on how to recuperate. Some people suggest that you avoid all stretching for about six weeks while slowly reintroducing very mild strengthening exercises such as tiny preparatory movements for Salabhasana and Dhanurasana (Bow Pose). You systematically build up strength over the next several months, eventually adding powerful strengtheners like Purvottanasana and exercises that combine strengthening and stretching, such as Supta Padangusthasana (Reclining Hand-to-Big-Toe Pose), against resistance. The key is to avoid any stretching that causes pain to the injured tendon while systematically introducing stronger hamstring-strengthening exercises, including those that strengthen the muscle in the stretched position, for several months. You shouldn't reintroduce any maximum-power hamstring stretches, such as Paschimottanasana (Seated Forward Bend), for at least a year after your injury.
Uttanasana (Standing Forward Bend), modification
If bending forward with straight legs causes pain below one sitting bone, you may have injured your hamstring tendon. To protect an injured hamstring, fold forward into Uttanasana while bending the knee on the injured side enough to eliminate any discomfort. This will give the tendon a chance to heal. Continue to stretch the hamstrings of the other leg normally.
Supta Padangusthasan (Reclining Hand-to-Big-Toe Pose), against resistance
During the later stages of recovery from a hamstring injury, you can build strength while stretching the hamstring muscles mildly in Supta Padangusthasana. Lie back on the floor through a doorway or in the corner of a room. Lift one leg at about a 60-degree angle from the floor and firmly press the heel against the door frame, holding for 10 to 30 seconds. Repeat 3 to 5 times.
Roger Cole, PhD, has practiced yoga since 1975 and taught since 1980. He is a certified Iyengar Yoga teacher trained at the Iyengar Yoga Institutes in San Francisco and Pune, India. He teaches at Yoga Del Mar in Del Mar, California. For more information, visit


Kristin said...

Ah ha, I say, feeling rather enlightened and deepressed...

This article may have just answered a nagging question I've had for the last couple of weeks: why does my hamstring insertion point hurt.

This might be why. Drat. Drat. Drat.

Thanks! I'm enjoying these articles.

Sara said...

Hi Kristin - I pulled my hamstring in high school track and it has never been the same. It's always stiffer than the other side. I hope yours heals quickly and well.

Kristin said...

Hi Sara,

From the article, it seems that quick healing is not an option. I should have added in my original comment, that this was not a yoga injury, though I may have compounded it by doing yoga (ala, 'if I just keep stretching it, it will get better'). I strongly suspect it was from doing CorePole (resistant bands and aerobics).

My concern actually lies with cycling this summer, and if the pressure from sitting on my road bike for hours at a time will exasperbate an already tender area, or even if the motion of cycling will be problematic.

Sara said...

Hi Kristin - I have been biking this summer already and I feel like it is beneficial to my hamstrings (and to my wobbly SI joints). I think the overall leg strengthening we get from biking is more helpful than hurtful. Of course I am bike commuting, not spending hours in the saddle.