What To Do About “Yoga Butt” AKA Hamstring Tendon Tears
Yoga butt, aka proximal hamstring attachment tears, are one of the most common “in practice” injuries I hear about as a yoga teacher. They also tend to linger for a really long time. Why do they happen so often, why do they linger, and what can we do about it? Before we get into the challenge of hamstring tears, we have to look at the conditions that are causing so many hamstring attachment tears.
“I have tight hamstrings.” I hear it almost every day. And while it may be true, it’s usually only a small part of the truth. In most modern cultures, we tend to be very strong and tight in our hip flexors (in large part because of how much time we spend sitting). Most of the muscles of the body work in an agonist/antagonist relationship, meaning that one muscle group works in contrast to another. Think of a tug of war.
Two sides are battling back and forth in attempt to pull all the tension over to their side. And that’s precisely what usually ends up happening. One side “wins” the tug of war. That muscle (or group of muscles) “wins” and ends up tight, short and strong. The muscle (or group of muscles) that “loses” ends up tight, LONG and weak. Generally, when we stretch tight, short muscles it feels good, because they are dying to be stretched. And conversely, generally speaking, when we stretch tight long muscles it can feel a little painful or uncomfortable as those muscles are already being pulled at length.
So while people might have tight hamstrings, they are usually tight, long and weak. They’ve lost of the tug of war, and when stretching a muscle that is already pulled long you are more likely to tear the muscle and/or its attachment.
So what do most people need to do in this situation? Strengthen the hamstrings and stretch the hip flexors! Poses like shalabhasana (locust) or any pose where you are extending your leg(s) and/or flexing the knee will help to strengthen the hamstrings. Lunges and backbends can be great ways to stretch the hip flexors.
What happens though, when there is already a tear in the hamstring attachment? After the tear, scar tissue forms and attempts to pull the torn tissue back together so it can heal. Every time we do a forward fold or go to pick something up off the floor, this scar tissue can get pulled apart again. If this keeps happening without rest and the necessary healing time, to body will shut down the site of the tear and build up scar tissue as fast as possible. But instead of nice uniform, layered scar tissue, the scar tissue is put together with speed as a priority instead of uniformity.
This scar tissue is actually harder for the body to clear and if the conditions persist (ie: no rest, continued practice including any folds that stretch the hamstrings, picking things up, etc), the scar tissue will continue to pile up in this disorganized manner. The scar tissue now becomes an impediment to the actual tissues of the hamstrings coming back together and healing. The actual tissue of the hamstring tendon has a hard time reconnecting, because it can’t make its way through the disorganized scar tissue.
This can create a situation where further tearing, more adhesions/scar tissue, and misaligned tissues can form in the area. This is one of the main reasons why these injuries can last so long. The chronic build-up of scar tissue prevents the reintegration and healing of the muscle/tendon tissues themselves.
So at this point, in order for the hamstring to heal, the scar tissue must be cleared. There are a number of means of clearing scar tissue. Manual therapy (massage), ultrasound technology, and resistive stretching are some of the things we can do to help break up the scar tissue.
Once we break up the scar tissue, we have to create conditions for the tissue to heal as well as support the area so new tears don’t occur. One of the ways we can help speed the healing process is through compression. Something I’ve used with students and clients with lots of success is wrapping a yoga strap around the affected leg at the heel and around the hip.
Pull the strap snug (make sure the strap is around the hip and not into the low back). I have students hold this position for 20-30 minutes a couple of times a day (the can use the time to read, rest, watch TV, meditate, listen to music, whatever). The tension of the strap pulls the femur (upper leg bone) up into the hip. Taking out some of the tone of the hamstrings, compressing the tissues closer together, making it easier for them to heal. (second pic)
Another helpful “hack” for those that might still be practicing or are looking for some more active support is to again use a yoga strap (athletic tape will work too) and wrap it high up on the thigh, so that on the back side it is just below the hamstring attachment. The strap (or tape) is snug, but not so tight that it cuts off circulation.
What happens is that the strap/tape create a new “attachment point” for the muscle. Most of the force of the pull when the hamstring is stretched goes to the distal side of the strap/tape, but the proximal side (the side closer to the actual attachment of the hamstrings) receives less force from the pull. This helps to prevent constant re-tearing of the tendon at the attachment site. (Note the black strap high on the hamstring in third pic)
While hamstring tendon tears can be notoriously difficult to heal, I’ve had students heal their tears quickly, while still practicing, using these methods. These methods are helpful, but should augment (not replace) appropriate rest, a healthy diet, and mindfulness in movement (whether it’s during an asana practice or just moving through life).