What is Ischial Bursitis?
This is a medical condition that causes you to have pain in your buttock region. It is also referred to as ischiogluteal bursitis. This pain comes from inflammation and tissue damage in your ischiogluteal bursa, which is a little sac that is filled with a lubricating fluid called synovial fluid. It occurs in your lower buttocks where your hamstring muscles are attached to your ischial tuberosity. The people who most often suffer from this medical condition are athletes and runners. Ischial bursitis is considered a chronic medical condition, which means a medical condition that last three months or longer.
Ischial Bursitis Anatomy
As mentioned, this is also known as your ischiogluteal bursa. It is located on your pelvis and is considered a lubricating pad that is found between your tendons that pass over this area and your ischial tuberosity. Your ischial tuberosity is the bony area beneath your buttocks and what you sit down on. It is a thickened portion of your ischium, which is one of the three major bones that make up each half of your pelvis. The purpose of your ischial bursa is to help prevent the destruction of your tendons as they move over your ischial tuberosity. Your pelvis is what forms your hip joints and supports your spinal column.
Picture of Ischial Bursitis - Front and Rear view of hip
Symptoms of Ischial Bursitis
- Two of the symptoms of ischial bursitis are pain and inflammation, which are caused when your hamstring muscles rub against your protruding ischial tuberosity bone, causing irritation to the bursa sac.
- You may experience tenderness, swelling, or soreness in your lower buttocks that appear to become worse with movement.
- The area that is affected may also feel warm to the touch.
- Although the pain is usually in your buttocks area, you may also feel pain in your hip and possibly stiffness in the area.
- Some even have tingling and numbness in the buttock that is involved and could radiate down your leg.
- Constant dull ache-like feeling in your buttock that becomes worse with sitting in the same position or posture for a long time.
Ischial Bursitis Causes
This is a type of bursitis that is generally caused by prolonged sitting on hard surfaces that are pressing against the bones of the mid or bottom buttocks. It is not often related to any type of strenuous activity but it often occurs after sitting for a long period of time or even from horseback riding. It can even be caused by falling on your buttocks after a fall. If the cause is from strenuous or physical activities it is due to excessive contraction of your hamstring muscles, which are the muscles at the back of your thighs.
Risk factors
There are also certain contributing factors that can lead to the development of ischial bursitis such as:
- Joint stiffness, particularly in your hip
- Muscle tightness, particularly in your hamstrings
- Excessive or inappropriate training
- Hamstring muscle weakness
- Not warming up adequately for exercising or physical activities
- Excessive stride length
- Discrepancy in leg length
- Inadequate rehab after a previous buttock injury
Treatment of Ischial Bursitis
The treatment that is used will depend on how severe the injury is. Most of the time the treatment will include ice, rest, medications, rehabilitation exercises, and prolotherapy.
Tropical treatment
This includes rest, which means taking pressure off your buttocks because that is where the pain is felt when you sit down. To accomplish this you can use a donut cushion to help alleviate the discomfort and pain. When you rest the area it will also help to prevent further aggravation of the area that is affected and allow the ice packs time to also help control the pain and inflammation. When using an ice pack it will cause vasoconstriction. This will help to control the swelling by limiting the amount of lymph and blood flow to that area. To make the ice pack more effective make sure that it is compressed directly against the source of pain at twenty-minute intervals. Using pillows to help elevate the irritated area above your heart can also help to reduce the inflammation.
Medications
To help with the inflammation and pain you can take over-the-counter anti-inflammatory medications like ibuprofen. For more severe cases of ischial bursitis your physician may prescribe steroids.
Prolotherapy
If the inflammation and pain linger this may be recommended. It is an alternative to surgery and helps to stimulate additional inflammation in the area to force your body to heal itself. The procedure starts with an injection of a specific solution so the localized inflammation is forced to trigger a wound healing cascade that results in the deposition of new collagen in the area. This is the material that tendons and ligaments are made of and as it matures it will shrink, tightening the ligament that was injected making it stronger.
Physiotherapy
This is vital to help hasten the healing process to help ensure an optimal outcome and help to reduce the chances of this injury recurring. This type of treatment can include soft tissue massage, stretches, using crutches, heat or ice treatment, and exercises to help improve your core, strength, and flexibility stability.
Ischial Bursitis Pain
Ischial Bursitis Pain Locations
Exercises
Once your pain and swelling are under control you can start to do gentle stretching exercises to help loosen tight ligaments and muscles in order to prepare them for activity. Standing or lying down and performing knee-to-chest exercises can be highly effective. You can also lightly stretch your hamstrings to help re-acclimate the area affected to movement. It is important that the range of motion for these stretching exercises do not cause pain. Gradually you can work your way into more strenuous exercises such as light weightlifting or walking. The exercises should be performed two to three times a day but you need to make sure that you are not increasing or causing any other symptoms when doing them. If you have any problems talk to your physician. You should also talk to your physician before undertaking any gentle exercises to make sure it is okay to do them.
- Bridging — this exercise will help to strengthen your hamstrings. To do this exercise you will need to lie on your back and bend the knees up until your feet are flat on the floor. Raise your buttocks up by pushing down on the floor with your feet. Make sure that you are keeping your arms flat on the floor by your sides. Hold this bridge for a few second and then slowly lower yourself down. You should do this at least ten times.
- Hamstring contraction while seated — when you work your hamstrings from this position you will only be using your bodyweight to help strengthen those muscles without adding any other strain to your body. Make sure that you are sitting straight in a wooden chair with your heels flat on the floor and your toes pointed up slightly. Pull down into the floor just using your hamstrings and hold for a few seconds. Do this ten times.
- Lying hip extension — that is also another stretching exercise that will work your hamstrings. To do this exercise lay on your stomach on the floor and point your toe. Raise one leg straight up behind you only until you can feel your hamstring muscles working. Hold for a couple of seconds and then repeat. Do ten for each leg.
Healing Process
There is no set time frame for a person to overcome ischial bursitis as each person responds differently according to the severity of the condition. It is not unusual for you to have ischial bursitis for up to three months.
