# Ischial tuberosity pain/Hamstring tendonitis



## JHK (Apr 2, 2004)

I "think" that the pain that I have in my left sitbones while sitting is tendonitis of the hamstring which came about do to a lot of MTB and not much stretching.... I have tight hamstrings as it is and when I added some gym work with a trainer last fall (lots of squats, lunges etc) I think that the additional arching of the back and more powerful movements might have strained the hamstrings where they connect to the ischial tuberosity.

I have been seeing a PT who is mobolizing the connection from the illium to the sacrum along with stretching the psoas muscles. This seems to be "slowly" improving things.

Has anyone had this type of prob.? Any other thoughts or explanations? What should I do from here to keep it from recurring?

Thanks in advance for any info.

John


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## drunkmonckey (Jul 24, 2006)

JHK said:


> I "think" that the pain that I have in my left sitbones while sitting is tendonitis of the hamstring which came about do to a lot of MTB and not much stretching.... I have tight hamstrings as it is and when I added some gym work with a trainer last fall (lots of squats, lunges etc) I think that the additional arching of the back and more powerful movements might have strained the hamstrings where they connect to the ischial tuberosity.
> 
> I have been seeing a PT who is mobolizing the connection from the illium to the sacrum along with stretching the psoas muscles. This seems to be "slowly" improving things.
> 
> ...


Hmm, all depends on what is actually going on. If it is actually tendonitis/strain of the hamstrings at their origin, then it should only hurt while sitting if there is pressure on that area; i.e. you slouch more and move the pressure off that area and it goes away. Otherwise the muscle really shouldnt be doing anything to cause pain.
If it doesnt go away, then you look further up the chain at the SI joint (what ur PT is treating) or the lumbar area (to rule out bulging/herniated disc impinging on a nerve). I did once strain my right hamstring in that area doing heavy lunges (maximal contraction combined with maximum stretch). With that it shouldnt feel fun to push right up against the bottom of ur buttock. If it truly is a hamstring it should hurt more when it is stretched and it should also hurt more when it is contracted. Just remember your going to stress that part of the hamstring more with hip extension than knee flexion.
Another possibility that I have seen in bikers is stress fracture in the ischial tuberosities and/or bone edema (swelling) from repeated trauma such as you get bouncing on/off a seat. Going to need an xray/MRI to get an idea of stress fracture and MRI to possibly visualize the edema. If you do go that route, see if you can get the lumbar as well on an MRI if anything above makes any sense as far as possibly not coming from that area.

Treatments: make sure your bike is fitted to you properly, possibly change seats if pressure is on that area, stretching like you are doing for the hamstring as well as the hip flexors, heat it/stretch it prior to riding but not to an extreme, ice it afterwards everytime for the next few months even when it doesnt hurt, when you return to riding, get off and walk around a little bit every 20-30 min to relieve the stress there at least the first few times until you see how it responds and definitely do strengthening for it which your PT I assume will do - body weight lunges, squats, etc.
dm, PT, CSCS


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## JHK (Apr 2, 2004)

*Thanks*

Great input thanks !!! for the time being things are improving. Hoping to get on the bike for a test next week.


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## billydanger (Nov 25, 2008)

*Same pain*

I've been diagnosed with hamstring tendonitis in both hamstrings (ischial tuberosity). Has anyone had this last for months on end? My doctor did an MRI and it showed edema around both sites, but no evidence of scar tissue (tendinosis).

This started towards the end of May 2008. I quit riding. Quit martial arts. Quit everything, including physical therapy since any exertion/ stretching seems to make the problem worse.

Now it seems like the inactivity is making things worse, i.e. more stiff, tighter hamstrings. I'm usually pretty flexible but this is killing me.

I was under the impression that tendinitis usually goes away when you quit the offending activity. Has anyone else had the same problem?


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## JHK (Apr 2, 2004)

*Hamstring Ischial Tuberosity*

2 years now...... but I only get minor irritation while sitting and sometimes nothing at all. The one thing that I discovered that I think can help is called Egoscue.... it is a systematic approach to restoring your proper postural alignment. go to egoscue.com and check it out. I go to the clinic about every month and get a new menu of exercises and stretches that I do daily. It is simple stuff, but seems pretty effective for any pain. They beleive that any chronic muscular skeletal pain that is not disease related comes from alignment issues (often at the hips).

good luck

JK


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## boisebiker (Dec 14, 2008)

*Ischial Pain*

Similar pain, symptoms and time frame as billydanger posted on November 2008.

Started having trouble in May 2008 and was not able to sit on the bike. Went through Celebrex, 2 doctors, 2 physical therapists and months of exercises and stretching.

Had a MRI done in October that ruled out everything but Ischial Tendonitis and Bursitis and have been back in treatment with the PT. I have seen a orthopedic specialist and they want to do a cortizone injection.

Very painful to sit and ride in a car, or ist in the office. The length of recovery has been frustrating and I am wondering if anyone else has experienced this? Any suggestions?

Thanks,


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## N10S (Sep 27, 2004)

I have had similar problems that have popped up over the years. I often get a popping in my hip as the IT band pops across the trochanter. Although this popping provides immediate perceived relief I think it actually helps aggravate and inflame the problem. Thi can cause pain all the way down the outside of my leg into my knee and even into my ankle at times.

I truly believe that the root cause is that the hamstrings and glutes get shortened by riding and without proper attention to stretching out the end result is that your pelvis and hips get tweeked. Many of the muscles affected tie in right across the rear and into the lower back. 

As someone noted it does seems like not riding can also aggravate the pain although I think this probably is the result of less blood flow and less muscle and joint flexibility as the range of motion is diminished during sedentary periods. Once this problem starts the overall alignment of the hips and pelvis gets screwed up and then its hard to get back in shape.

Not having any butt to speak of doesn't help matters either and my sit bones do feel bruised from time to time depending on the amount and type of riding I am doing at the time. I have considered trying a sella anatomica saddle to see if that makes longer ride more enjoyable, but again I think I need to spend more time doing stretching exercises to prevent the problems from flaring up. Bottom line (no pun intended) is that you are not alone.

JR


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## TrekChick (Mar 24, 2006)

I have had that same pain-in-the-butt since the middle of a biathlon on 01/19/08, but mine is from running, not biking. Originally I had it diagnosed as piriformis syndrome, and then later as high hamstring tendonitis. Sitting at work and sitting while driving would drive me crazy! The thing that finally got rid of it was not being able to run (or bike or anything!!!) for several months after I crashed MTBing in June and broke my shoulder. I initially tried running 2 months after the crash, but the butt pain came back after only 5 runs. I took more time off from running, and then backed off running to only one day a week, and now I'm doing okay w/o any pain so far. I've been back at running for 10 weeks now. I'm up to about 7 miles now, but that's only half the distance I want to be at... I am hoping & praying that as my runs get longer that the pain does not come back.

I think the hamstring tendonitis PT did a lot more for me than the piriformis PT. It's basically doing long hamstring stretches, the figure four stretch, internal & external rotation strengthening, glute strengthening, and core strengthening. Because this is a repetitive use injury, it is a very difficult injury to recover from unless you completely stop whatever is causing it. Best of luck to you!


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## SlackBoy (Mar 7, 2008)

Thread dredge

I had pretty much all of what everyone is saying. The whole not being able to roll over in bed trip was killing me.
Except I could Diagnosed with Ankylising Spondylitis (sp) which is a form of Arthritis. It manifested mainly in me with lower back and hip pain. I could Bursitis in the piriformis, and me glute med was so so so weak it wasn't funny. I could lift my physio with my right leg when lying sideways, yet with my left left, she could hold it down with 1 finger.
got told, ain't nowt you can do for it, cept painkillers and anti-inflammetories for the rest of your life, and if it gets real bad NSAIDS.
I did research on the net, and came up with a non starch Diet. I've been pain free for over 2 years. I've never ridden faster, nor been lighter (not living outa a bakery will do that). When I say pain free, that except for a few occasions, where I've let something starchy thru in my food, and I'll get pain for 1-2 weeks.


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