Sitting bone pain

Also called: Ischial bursitis; weaver's bottom; proximal hamstring pain

Relief and prevention Strength Stretch Massage

Pain right on the sitting bone, worst on a hard chair and worst of all on a bike saddle. Either the bursa or the hamstring tendon at its attachment is being compressed - and the sitting itself is usually the aggravator.

How common: Common in cyclists, rowers and people who sit on hard surfaces for long periods

Open the Back Pain/Bulletproofing routine All problems

What it is

The ischial tuberosity is the bone you sit on, and the hamstrings attach directly to it with a bursa in between. Both the bursa and the tendon attachment can become irritated, producing well-localised pain at that exact point.

The two present similarly and need slightly different emphasis. Bursitis is primarily a compression problem - hard seats, a bike saddle, weight loss removing the padding. Proximal hamstring tendinopathy is a load problem, aggravated by running, hill work and stretching, and it needs progressive loading rather than rest.

What it feels like

Pain exactly on the sitting bone, pointable with one finger
Worst sitting on a hard seat, and on a bicycle saddle
Worse driving and after long periods sitting
In the tendon version, also worse with running, hills and stretching the hamstring
Sometimes referring down the back of the thigh, but not below the knee

What causes it

Most people have more than one of these at once, and they feed each other. Read the list looking for the two or three that sound like your week rather than for the one true answer — the ones that describe you are the ones worth acting on.

Compression against a hard seat: The bursa sits directly between bone and skin at the point that takes all the body weight in sitting. Hours on a hard chair or a narrow saddle compresses it, which is the classic mechanism.
Proximal hamstring tendinopathy: The hamstring attachment degenerates under repeated load - running, hill work, sprinting - producing pain at the same spot. It is a load problem rather than a compression one and it needs the opposite treatment.
Cycling: A narrow or poorly fitted saddle concentrates load directly on the sitting bones for hours. Saddle width matched to the rider's sitting bone width makes a substantial difference.
Weight loss: Loss of the fat padding over the sitting bones removes the natural cushioning. It is a recognised cause and it is easily overlooked.
Sudden increases in running or hill work: The classic precipitant for the tendon version. The hamstring attachment is loaded most in the lengthened position, which is exactly what hill running and long strides produce.
Hamstring stretching: Counterintuitively, stretching compresses the tendon against the bone at its attachment. In proximal hamstring tendinopathy, stretching consistently makes it worse rather than better.
Weak glutes: When the glutes under-contribute to hip extension, the hamstrings do more work on every stride, arriving at their attachment already loaded.
Prolonged sitting at work: Long unbroken sitting compresses the area continuously. It matters even in the tendon version, because compression plus load is worse than either.
Being mistaken for sciatica: Pain in the buttock referring down the thigh is readily assumed to be nerve-related. The pinpoint tenderness on the sitting bone and the absence of symptoms below the knee distinguish them.

Who tends to get it

Cyclists, particularly with a poorly fitted saddle
Runners, especially those doing hill or sprint work
Anyone sitting for long periods on hard seats
People who have lost weight recently
Anyone with weak glutes, which is most people who do not train them

What makes it worse, and what settles it

Makes it worse

Sitting on hard seats and narrow bike saddles
Hamstring stretching, which compresses the tendon at its attachment
Hill running and sprinting in the tendon version
Long periods driving
Deep hip flexion positions, which increase the compression

Settles it

A cushion with a cut-out, or a wider saddle matched to your sitting bone width
Progressive hamstring loading, starting with isometrics, for the tendon version
Glute strengthening so the hamstrings are not covering for them
Avoiding hamstring stretching, which is the opposite of the usual instinct
Reducing hill and sprint volume temporarily while capacity is built

What actually helps

The short version: Compression of the ischial bursa or proximal hamstring tendon against a hard seat

Strength work: Legs: Hamstrings - isometric and long-lever progressive loading; Glutes: Max

Stretching: AVOID deep hamstring stretching - it compresses the tendon at the ischium; Glutes: Piriformis instead

Massage: Glutes; avoid direct pressure on the ischial tuberosity

Also worth doing: Cushioned seat; stand breaks; avoid sitting on hard edges

What the evidence says: IMPORTANT INVERSION: proximal hamstring tendinopathy gets worse with hamstring stretching. Isometric loading in a neutral hip position is the treatment.

The names above are the Targets qFIT tracks — the Muscle Guide explains what each one does, and Quick Add switches on the Exercises you already have.

The qFIT routine for this

Ready-made routineBack Pain/Bulletproofing

qFIT already has this one built. It runs massage first, then stretching, then strength — the order that works on a body that is already sore — and every activity in it carries the reason it is there.

The button below opens your Checklist with this routine already selected, so instead of your whole list you land on just its Categories, Targets and Exercises, each with its checkbox, ready to tick as you work through them.

Open this routine in my Checklist

Have more than one problem? Tick yours under My Problems on My Profile and your Checklist's Routine list gains Recommended for my problems — every routine for the problems you picked, merged into one. Your picks stay private; that filter is the only thing they feed.

Get it checked if…

Numbness in the buttock or down the leg suggests nerve involvement

And whatever the body part: chest pain or unusual breathlessness on exertion; a fever alongside the pain; unexplained weight loss; pain that is constant and unrelated to how you move; new numbness, weakness or loss of bladder or bowel control; or one calf that is swollen, warm and painful. Any of those, stop and get assessed.

How it usually goes

Compression-driven bursitis settles within a few weeks once the seating is changed. Proximal hamstring tendinopathy is slower - three to six months of progressive loading is realistic, and it is one of the more stubborn tendinopathies. The single most useful piece of advice is counterintuitive: stop stretching it. Pain extending below the knee, or with numbness, points at a nerve cause instead and deserves a different assessment.

Prevalence basis: Clinical series

Others the same routine covers

These share the Back Pain/Bulletproofing routine, so the work is the same. If one of them also sounds like you, that is a reason to expect more from it, not less.

This is general information, not a diagnosis, and it cannot examine you. If it matches you, use it to ask better questions of a clinician rather than to replace one.

← All 267 problems 🪯 Muscle Guide