Ischial Tuberosity Bursitis
1. Introduction
Ischial bursitis is a condition causing pain and swelling around the sitting bones (known as the ischium) of the buttocks (1). The bony prominence(s) of the buttocks are known as the ischial tuberosities. The tuberosities are an attachment point for the hamstring muscles that help straighten your hip and flex your knee joint. A bursa is a type of tissue that allows friction free movement between two or more structures. In this case, the ischial bursa enables the ischial tuberosity to move without creating friction against the skin or hamstring tendon attachment. Ischial bursitis occurs due to repetitive compression or irritation of this bursa, leading to inflammation, pain and swelling (1, 2).
It is often seen in those people who are sedentary and spend large periods of time sitting. It may also be seen in people who participate in repetitive bending and straightening of the hip, such as people lifting weights in the gym (3). It is often considered a non-serious cause of buttock pain that usually settles well within a matter of weeks with the right advice and education (3, 5). However, pain and swelling in the buttock may also indicate a group of extremely rare soft tissue tumours known as myoxoid tumours. Therefore, assessment and diagnosis from a medical professional should be sought for this condition as imaging may be required to rule it out (1, 2).
Frequently Asked Questions
Ischial bursitis is a condition causing pain and swelling around the ischium – sit bone of the buttock.
- Not common
- Ischial bursitis accounts for less than 1% of conditions causing pain in the buttock or upper hamstrings (1).
- No.
- Most cases of ischial bursitis settle well with the correct advice, education, and treatment.
- Ischial bursitis is predominantly linked to sedentary behaviour, ie; too much sitting. It can be managed through getting more frequently active (2).
- Younger adults, particularly those spend long periods of time sitting.
- People with occupations which involve long periods of sitting, such as office or computer-based working.
- Prolonged pressure on the buttock muscles during exercises such as heavy or high-volume squats or deadlifts can also cause it (2, 4).
- Localised pain to the bony prominence or the “sitting bones” of the buttock (called the ischium).
- Pain that may increase when you sit for long periods or apply direct pressure to this area.
- The lower buttock, particularly around the ischium, may appear swollen or feel swollen and hot to the touch.
- Discomfort when you fully bend forward with a straight leg or move into a deep squat or stooped position (2).
There are many things you can do to help recover:
- Avoid long periods of sitting or applying direct pressure to the ischium.
- Modify or reduce your activity to manage your pain.
- Use ice and anti-inflammatory medication (as advised by your doctor or pharmacist) (5).
- Most cases of ischial bursitis settle well with appropriate advice and activity modification in 6-8 weeks (4).
- Simple therapies can also help resolve symptoms. (1, 5, 6).
We recommend consulting a musculoskeletal physiotherapist to ensure exercises are best suited to your recovery. If you are carrying out an exercise regime without consulting a healthcare professional, you do so at your own risk. Book online with us today to get a programme tailored to your specific needs.
2. Signs and Symptoms
- Pain that is felt around the sitting bones of the buttock(s).
- Pain that is stereotypically produced with longer periods of sitting or activities involving deep hip flexion (such as squatting at the gym or using weights).
- There may be swelling located around the buttock and the area may feel warm and/or tender to the touch. (3, 5).
3. Causes
Ischial bursitis can occur due to repeated compression on the bursae, causing pain, inflammation and swelling. It is most often the result of sedentary behaviour ie; long periods of time sitting. Repeated compression on the ischium leads to inflammation, pain and swelling of the bursae and this makes it more likely that the tissue will then be re-aggravated with these activities in the future (5).
4. Risk Factors
This is not an exhaustive list. These factors could increase the likelihood of someone developing ischial bursitis. It does not mean everyone with these risk factors will develop symptoms (2, 5).
- Gender – men (often younger) are more likely to develop ischial bursitis than females.
- Sudden changes in activity or in training intensity – can result in overload to the hamstrings, buttocks, and bursa (4).
- Occupational factors – jobs that involve longer periods of sitting, such as office or computer-based work.
- Sedentary behaviour – longer periods of time sitting can result in overload to the bursa.
5. Prevalence
Ischial bursitis is a rare cause of pain felt in the buttock or hamstring region. It is thought to be responsible for less than 1% of causes of buttock pain (1). Other conditions, such as sciatica, or tendinopathy of the hamstring muscles, are much more common. It may be seen in greater amounts in young men than young women, particularly those who are inactive or spend longer periods of time sitting (1, 4).
6. Assessment & Diagnosis
Musculoskeletal physiotherapists and other appropriately qualified health care professionals can provide you with a diagnosis by obtaining a detailed history of your symptoms. A series of physical tests might be performed as part of your assessment to rule out other potentially involved structures and gain a greater understanding of your physical abilities to help facilitate an accurate working diagnosis. Your doctor or physiotherapist may move your hip joint into certain positions to apply pressure to the bursae and may perform a series of tests to evaluate the strength of the tendons that insert around the hip and pelvis.
Your treating clinician will want to know how your condition affects you day-to-day so that treatment can be tailored to your needs and personalised goals can be established. Intermittent re-assessment will ascertain if you are making progress towards your goals and will allow appropriate adjustments to your treatment to be made. Imaging studies like MRI or ultrasound scan are usually not required to achieve a working diagnosis of ischial bursitis, but in unusual presentations they may be warranted (2, 5).
7. Self-Management
As part of the sessions with your physiotherapist, they will help you to understand your condition and what you need to do to help the recovery from ischial bursitis. This may include reducing the amount of sitting that you perform, as well as other advice aimed at reducing your pain. Icing the region regularly and taking any prescribed anti-inflammatory medications as recommended by your doctor is important. If you are given specific exercises to try and improve your symptoms, it is important that you try and complete the exercises you are provided as regularly as possible to help with your recovery.
8. Rehabilitation
Exercise may be used to help mobilise the hip and build strength in the affected tissues. The aim of rehabilitation exercises is to promote movement, reduce pain and swelling and prepare you for a return to activity, work, or sport to prevent the likelihood of recurring episodes.
Below are three rehabilitation programmes created by our specialist physiotherapists. In some instances, a one-to-one assessment is appropriate to individually tailor targeted rehabilitation. However, these programmes provide an excellent starting point as well as clearly highlighting exercise progression.
9. Ischial Tuberosity Bursitis
Rehabilitation Plans
Our team of expert musculoskeletal physiotherapist have created rehabilitation plans to enable people to manage their condition. If you have any questions or concerns about a condition, we recommend you book an consultation with one of our clinicians.
What Is the Pain Scale?
The pain scale or what some physios would call the Visual Analogue Scale (VAS), is a scale that is used to try and understand the level of pain that someone is in. The scale is intended as something that you would rate yourself on a scale of 0-10 with 0 = no pain, 10 = worst pain imaginable. You can learn more about what is pain and the pain scale here.
This programme focuses on early, gentle mobilisation of the muscles that attach and insert around the buttock to prevent these from shortening and adding to your pain. The aim is to promote movement and assist in the reduction of swelling around the bursa. These can be performed 2 – 4 times per day as pain allows.
- 0
- 1
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- 910
This is the next progression. More focus is given to progressive loading of the hamstring tendon (if implicated) to restore any strength deficits that may be apparent.
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- 8
- 910
This programme is a further progression with challenging progressive loading of the affected region if this is indicated from assessment. This can be performed 2 – 3 times per week as it is likely by this stage that your symptoms will have improved and you will feel ready to return to your usual levels of activity.
- 0
- 1
- 2
- 3
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- 5
- 6
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- 8
- 910
10. Return to Sport / Normal life
For patients wanting to achieve a high level of function or return to sport we would encourage a consultation with a physiotherapist as you will likely require further progression beyond the advanced rehabilitation stage.
As part of a comprehensive treatment approach, your musculoskeletal physiotherapist may also use a variety of other pain-relieving treatments to support symptom relief and recovery. Whilst recovering you might benefit from further assessment to ensure you are making progress and establish appropriate progression of treatment. Ongoing support and advice will allow you to self-manage and prevent future re-occurrence.
11. Other Treatment Options
In recurring cases, investigations with appropriate medical imaging may help to clarify the diagnosis. In some cases, a steroid injection (under image guided conditions) may be recommended to help reduce swelling and pain (6).
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References
- Kim S, Shin M, Kim K, Ahn J, Cho K, Chang J, Lee S, Chhem R. (2002) Imaging features of ischial bursitis with an emphasis on ultrasonography. Skeletal radiology. ;31(11):631-6.
- Van Mieghem IM, Boets A, Sciot R, Van Breuseghem I. Ischiogluteal bursitis: an uncommon type of bursitis. Skeletal radiology. 2004 Jul;33(7):413-6.
- Hitora, T., & al, et al. (2008). Ischiogluteal bursitis: a report of three cases with MR findings. Rheumatol Int , 455-458.
- Timur Ekiz MD, Vedat Biçici MD, Cem Hatioglu MD, Süha Yalçın MD, Kagan Cingöz MD. Ischial pain and sitting disability due to ischiogluteal bursitis: visual vignette. Pain physician. 2015 Jul;18:E657-9.
- Hammer, W. I. (2007). Hip Bursitis. In Functional Soft-Tissue Examination and Treatment by Manual Methods (P. 281). Jones and Bartlett Publishers Inc.
- Weiss, L., & al, et al. (2007). Ischial Bursa. In Easy Injections (pp. 92-94). Philadelphia: Elsevier.
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Hip Labral Tear
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