If you have pain right underneath your buttock, especially when sitting, bending forward, exercising, or stretching, you may describe it as sit bone pain.
Your "sit bones" are actually called the ischial tuberosities, the bony areas at the bottom of your pelvis that bear weight when you sit.
Pain in this area can be frustrating because it is not always obvious where it is coming from. You may assume you pulled a hamstring, irritated your hip, or simply sat too long.
Sometimes that is the case. But the hamstrings are not the only structures connected to this area.
Your pelvic floor can contribute to pain around the sit bones too.
Why Does My Sit Bone Hurt?
There are several possible causes of pain around the sit bone, including:
Proximal hamstring irritation or tendinopathy
Pelvic floor muscle tension
Referred pain from the hip or low back
Nerve irritation
Changes in movement or exercise
Prolonged sitting or pressure on the area
Muscle imbalances around the hips and pelvis
Because so many muscles, tendons, nerves, and joints interact around the pelvis, determining the source of pain often requires looking beyond the exact spot that hurts.
What Does Sit Bone Pain Feel Like?
Sit bone pain can feel different depending on what is contributing to it.
You might notice:
A deep ache underneath one buttock
Pain directly over the sit bone
Discomfort extending toward the perineum or pelvic floor
Pain with prolonged sitting
Pain when bending forward
Discomfort during a forward fold or downward dog
Pain while running or exercising
Symptoms after yoga or stretching
Pain when activating or stretching the hamstrings
Discomfort that spreads into the buttock or upper thigh
Some people can point directly to one painful spot, while others describe a more vague sensation around the buttock, groin, or perineal region.
The Hamstring Connection
One of the first structures people think about with sit bone pain is the hamstring.
Your hamstring muscles attach near the ischial tuberosity. Because of this attachment, irritation of the proximal hamstring tendon can cause pain directly underneath the buttock.
Symptoms may become more noticeable with activities that place the hamstring under tension, such as running, hinging forward, deadlifting, or stretching.
But if stretching your hamstring over and over is not helping, it may be time to consider whether something else is contributing.
How Can the Pelvic Floor Cause Sit Bone Pain?
Your pelvic floor is a group of muscles that sits at the bottom of your pelvis. These muscles attach throughout the pelvis and work closely with the muscles surrounding your hips, tailbone, and core.
Some pelvic floor muscles have attachments near the sit bone and surrounding tissues.
When these muscles become tight, overactive, irritated, or poorly coordinated, pain can sometimes be felt around the sit bone, buttock, perineum, or deeper within the pelvis.
This is why pelvic floor dysfunction does not always feel like obvious "pelvic pain."
For some people, the first symptom is pain that feels orthopedic.
Why Would My Pelvic Floor Become Tight?
Pelvic floor tension can develop for many reasons.
Your pelvic floor may become overactive in response to:
Chronic hip or low back pain
Repetitive exercise
Muscle guarding after an injury
Stress or nervous system upregulation
Pregnancy or childbirth
Pelvic or abdominal surgery
Constipation and frequent straining
Habitually clenching the abdominal or pelvic floor muscles
Changes in hip mobility or strength
Sometimes the pelvic floor is trying to compensate for another area that is not doing its job efficiently.
That is why treating only the painful spot may provide temporary relief without addressing why the symptoms keep returning.
Why Does It Hurt When I Bend Forward or Stretch?
If your sit bone pain increases during a forward fold, downward dog, hamstring stretch, or other position that lengthens the back of the hip and pelvis, you may assume you simply need to stretch more.
Not necessarily.
Stretching places tension through several structures around the pelvis, including the hamstrings, nerves, and surrounding connective tissues.
If an irritated structure is repeatedly stretched, continuing to push deeper into that stretch can sometimes aggravate symptoms rather than improve them.
Instead of automatically stretching the painful area, we want to determine what is actually causing the pain first.
Could Sit Bone Pain Be Related to a Nerve?
It can be.
Several nerves travel through or near the pelvis, buttock, and sit bone region. Nerve irritation can sometimes create burning, tingling, aching, sensitivity, or pain that travels rather than remaining in one specific spot.
This is another reason an evaluation is important, particularly when symptoms extend into the perineum, groin, buttock, or leg.
Not every case of sit bone pain is muscular, and not every case is pelvic floor related.
What About Pain From Sitting?
Your sit bones are designed to bear weight while you sit, but prolonged sitting can still aggravate sensitive tissues.
If sitting consistently reproduces your symptoms, we may look at:
How you sit
How long you remain in one position
Hip mobility
Pelvic floor tension
Hamstring involvement
Low back mobility
Nerve sensitivity
How your symptoms change with movement
The goal is not necessarily to find the "perfect" sitting posture. Often, regularly changing positions and addressing the underlying cause is more important than trying to sit perfectly all day.
How Can Pelvic Floor Physical Therapy Help Sit Bone Pain?
At a pelvic floor physical therapy evaluation, we do not only assess your pelvic floor.
Sit bone pain may require us to look at your:
Pelvic floor muscles
Hamstrings
Hips and glutes
Low back
Core
Breathing mechanics
Nerve mobility
Strength
Movement patterns
Exercise routine
If pelvic floor tension is contributing, treatment may include pelvic floor relaxation, manual therapy, breathing strategies, mobility work, and improving coordination between the pelvic floor and surrounding muscles.
If the hamstring, hip, low back, or another structure is involved, your treatment plan can address those areas too.
Should I Stretch Sit Bone Pain?
This depends entirely on why it hurts.
If your pain is related to stiffness, certain mobility exercises may be beneficial. But if a tendon, nerve, or already irritated muscle is being repeatedly stretched, aggressive stretching may make symptoms worse.
Instead of assuming that tightness means you need more stretching, an evaluation can help determine what your body actually needs.
When Should Sit Bone Pain Be Evaluated?
Consider getting evaluated if your pain:
Persists despite rest or activity modification
Keeps returning
Makes sitting uncomfortable
Limits exercise, yoga, running, or lifting
Spreads toward the pelvic floor, groin, or perineum
Is associated with bowel, bladder, or sexual symptoms
Does not improve with traditional hamstring or hip treatment
New severe pain, significant weakness or numbness, changes in bowel or bladder control, saddle numbness, fever, unexplained weight loss, or pain following significant trauma should be medically evaluated promptly.
Your Sit Bone Pain May Be More Than a Hamstring Problem
Pain around the sit bone is a great example of why we cannot always treat the body as separate parts.
Your pelvic floor, hips, hamstrings, core, low back, and nervous system all interact.
If you've been stretching your hamstrings, changing your chair, or trying to work through the discomfort without improvement, it may be worth taking a more comprehensive look at what is contributing.
Pelvic Floor Physical Therapy for Sit Bone Pain in Rhode Island
At Rhode Island Pelvic Wellness, we provide individualized, one-on-one pelvic floor physical therapy for pelvic pain as well as hip, low back, tailbone, and sit bone symptoms that may be connected to pelvic floor dysfunction.
We take a whole-body approach rather than assuming the location of your pain is automatically the source of the problem.
Our goal is to determine why your sit bone hurts, address the factors contributing to it, and help you comfortably return to sitting, exercising, running, yoga, lifting, or whatever activities matter most to you.
Want to learn more about our whole-body approach to pelvic floor care? Visit our About Us page to meet our pelvic floor physical therapists and learn more about how we treat.
Wondering what happens during an evaluation for pelvic or sit bone pain? Visit our FAQ page to learn what to expect during your first pelvic floor physical therapy appointment.
Dealing with persistent pelvic, hip, tailbone, or sit bone pain? Explore our Services page to learn more about the conditions we treat and how pelvic floor physical therapy may help.
