What and where the sit bones are
The ischial tuberosities are the lowest parts of the pelvis. When you sit upright, most of your weight rests on them. The hamstring tendons attach to them, a small bursa cushions the tissues over them, and the sciatic nerve passes close by. Pain in this area is felt deep in the buttock, often at the crease between buttock and thigh.
Common causes
- Ischial bursitis («weaver’s bottom»): localised tenderness over the sit bone, worse sitting on hard surfaces, better standing.
- Proximal hamstring tendinopathy: deep pain at the sit bone worse with prolonged sitting, bending forward, running, lunges and hill climbing.
- Hamstring strain or partial tear after a sudden sprint or stretch, sometimes with bruising; see hamstring stretches for later recovery.
- Sciatica or deep gluteal nerve irritation: burning, tingling or pain spreading down the back of the leg; see piriformis syndrome.
- Tailbone pain: pain in the midline at the bottom of the spine when sitting.
- Weight loss that reduces natural padding.
- Cycling with a poorly fitted saddle.
How to tell the causes apart
- Pressing on the bone hurts and pain is mainly when sitting: bursitis.
- Pain when lifting the leg straight, bending forward or running: hamstring tendon.
- Tingling, numbness or pain down the leg: nerve.
- Pain in the middle, at the bottom of the spine: tailbone.
A physiotherapist confirms the cause with specific tests; ultrasound or MRI is used when the diagnosis is unclear or a tear is suspected.
Immediate relief
- Use a cushion: a gel cushion, a folded towel under the thighs or a cushion with a cut-out that takes pressure off the sit bones.
- Take standing breaks every 30 minutes; a standing desk helps.
- Sit with your weight shifted slightly forward onto the thighs rather than back onto the bones.
- Ice for 10 to 15 minutes for acute pain, or heat for muscle tightness.
- Paracetamol or anti-inflammatories for a short time if suitable.
- Avoid deep hamstring stretches, which compress an irritated tendon against the bone.
Exercises that help
- Isometric bridges: lying on your back with knees bent, lift the hips and hold for 30 to 45 seconds, five times.
- Hamstring curls against a band, starting light.
- Bridges and single-leg bridges as pain allows.
- Hip strengthening: side-lying leg raises and clams for the glutes.
- Romanian deadlifts with light weights in later stages, in a small range first.
- Gentle nerve glides if a physiotherapist confirms nerve involvement.
Progress gradually over 8 to 12 weeks. Mild discomfort that settles within 24 hours is acceptable.
Tips for cyclists and runners
- Have a professional bike fit; check saddle height, width and tilt.
- Choose a saddle that supports the sit bones and use padded shorts.
- Stand on the pedals periodically on long rides.
- Runners: reduce hills, speed work and long strides while the tendon settles, then build back gradually.
If it does not improve
A physiotherapist can design a progressive tendon-loading programme, use manual therapy and advise on workstation and sport changes. Shockwave therapy may help chronic hamstring tendinopathy. A steroid injection may be considered for bursitis that does not settle. Surgery is reserved for complete hamstring tendon avulsions after a significant injury. See also hip bursitis.
Setting up your chair and desk
- Choose a chair with a slightly softer seat and enough depth to support the thighs.
- Adjust the height so the hips are level with or slightly above the knees.
- Tilt the seat slightly forward if possible to move pressure from the sit bones to the thighs.
- Avoid crossing your legs or sitting on a wallet.
- Alternate sitting, standing and walking during the day.
- In the car, use a cushion and take breaks on long journeys.
When to see a doctor
- Sudden pain with a pop, bruising and weakness after a sprint or fall: possible tendon tear, assess within days.
- Numbness in the saddle area, bladder or bowel changes, or weakness in both legs: emergency.
- Fever, redness, swelling or a hot area over the sit bone.
- Night pain, unexplained weight loss or a history of cancer.
- Pain that does not improve after six weeks of self-care.
Key points to remember
- Sore sit bones are usually caused by bursitis or hamstring tendinopathy.
- Reducing pressure, frequent breaks and a good cushion give quick relief.
- Progressive strengthening is the key to recovery.
- Avoid deep hamstring stretching while the area is irritated.
Questions about sore sit bones
These answers are general information and do not replace an examination or individual medical advice.
Why do my sit bones hurt when I sit?
Usually from an irritated bursa over the bone or the hamstring tendons that attach there.
How long does sit bone pain last?
Bursitis often improves within weeks; hamstring tendinopathy can take three months or more with exercise.
What is the best cushion for sore sit bones?
A gel or foam cushion that offloads the sit bones, such as one with a rear cut-out.
Should I stretch my hamstrings if my sit bones hurt?
Avoid deep stretches early on. Strengthening is more helpful for tendon pain.
Can losing weight make your sit bones hurt?
Yes. Less padding over the bones increases pressure when sitting.
Is sit bone pain sciatica?
Sometimes. Tingling or pain spreading down the leg suggests nerve involvement.
Sources
This guide is for general information and does not replace medical advice. How a problem is diagnosed and treated depends on your examination and medical history. If you think you have an emergency, contact your local emergency services.