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Ischial sitting bone bursitis pain

Ischial bursitis can occur from sitting on a hard surface for too long. We explore the causes of ischial bursitis and available treatments

A bursa is a small, fluid-filled sac that sits near a joint. It acts as a cushion between the bones, muscles and ligaments. The bursa reduces the friction between these structures and allows them to slide past one another when a joint is moved. When a bursa becomes inflamed or irritated, it is called bursitis. Ischial bursitis is a condition that occurs when the ischial bursa becomes inflamed.

The ischial bursae are located between the large buttock muscles (gluteus maximus) and bony protrusions in the pelvis, called the ischial tuberosity. It prevents tendon in the buttocks from rubbing against the pelvic bone.

The condition can be particularly painful when sitting because the ischial tuberosity is the part of the pelvis that takes the body’s weight when you are sitting down. For this reason, it is also known as sitting bone, weaver’s bottom or tailor’s bottom. The condition is also sometimes called ischiogluteal bursitis.

Ischial bursitis is most commonly caused by sitting down on a hard surface for a prolonged period of time. People who lead a sedentary lifestyle are particularly prone to the condition.

The main causes of ischial tuberosity pain include:

  • Excessive or repetitive pressure: Excessive strain, whether this is through a consistent movement that or by prolonged bouts of sitting or standing can result in inflammation of the ischial bursa.
  • Injury: A hard fall on the buttocks or to the hip can cause damage to the bursa. An ischial tuberosity fracture from a fall may result in the lining of the sac being filled with blood, which in turn results in it becoming inflamed.
  • Physical condition: Joint conditions or a deformity of the lower limbs and spinal issues can also increase the pressure, which can result in a bursitis.
  • Other health conditions: Certain health conditions can also affect the membrane of a bursa, these include rheumatoid arthritis and gout. The condition can be diagnosed by your doctor or physiotherapist. They will give you a physical examination and take a look at your history of the condition.

Ischial bursitis can cause problems with walking, running, or sitting. Treatments are available to reduce inflammation and improve symptoms. X-rays are not helpful but a scan may be useful in cases which do not settle after conservative treatments.

Pain is commonly felt in the lower buttock area, usually located over the ischial tuberosity. In some cases, buttock pain may radiate down the hamstring muscles at the back of the thigh.

The pain may feel similar to sciatica, which occurs when sciatic nerve is irritated or compressed. Pain caused by sciatica is sharp and located in the lower back. It can often travel down the leg.

You can aggravate the pain by sitting in such a manner that it places direct pressure on the sitting bones. Activities that involve stretching or contraction of the hamstring muscles may also result in an increase in pain. Ischial tuberosity bursitis pain might become more intense when:

  • Walking
  • Running
  • Sitting for long periods
  • Doing sports that involve rapid accelerations and kicking movements.

Chronic ischial bursitis may cause an abnormal sensation in the buttocks, typically felt as pins and needles (paraesthesia). This sensation may become more severe when sitting down.

The first course of action to treat ischial bursitis is to tackle the sharp pain. This can be done with over-the-counter pain medication. Nonsteroidal anti-inflammatory drugs (NSAIDs) can help to relieve pain.

In the majority of cases, ischial pain can be managed very effectively by adhering to the following routines. The most effective aspects are avoiding aggravating activities and prolonged sitting.

The initial treatment for ischial bursitis pain will normally include:

  • Rest from the activity that caused the pain, such as sitting down.
  • Ice packs to reduce swelling.

Treatment will usually involve lifestyle changes and home remedies. If the symptoms do not improve, a doctor may recommend medical treatments.

Modifying seating positions

This could be using a seat with better cushioning to alleviate pressure on the painful area. Special ischial bursitis cushions are available if needed.

Temporarily stop doing some sporting activities

It is advisable that you are suffering from ischial pain then you stop doing some sports.

This does not mean that you will have to stop your chosen activity, such as cycling or running, forever. However, the ischial bursa and/or hamstring tendons may need four to six weeks of relative rest to settle symptoms while you work on strengthening the hip muscles. This does not mean that you should give up exercise altogether.

Exercises

Along with an ischial tuberosity massage, regular ischial bursitis exercises can help to strengthen the buttock muscles and tendon, these exercises include:

Bridge from floor

In each exercise, perform three sets of 10 reps each. This exercise should be performed three to four times a week.

https://youtu.be/nYNGezuyk-E

Side lying down abduction

In each exercise, perform three sets of 10 reps each. This exercise should be performed three to four times a week.

 https://youtu.be/52heN9vIdI0

Standing hip abduction

In each exercise, perform three sets of 10 reps each. This exercise should be performed three to four times a week.

 https://youtu.be/9mrKERs96Vo

These are suggested exercises only. If you are at all concerned about whether these exercises are suitable for you or if you experience any pain while doing them, please seek appropriate clinical advice from your doctor or physiotherapist.

Corticosteroid injection therapy

If you have followed a course of appropriate exercises and modified your activities in an attempt to reduce the pain from the ischial bursitis, but have noticed little improvement then you may be offered a course of corticosteroid injections.

Your consultant will discuss with you the use of ischial bursitis injections. These injections will bring down the inflammation and control the pain.

Ischial bursa injections are a simple and effective method as part of an ischial bursitis treatment course.You can read more about local steroid injections here.

Specialists Offering Ischial sitting bone bursitis pain

John Francis

Consultant in Anaesthesia and Pain Medicine

FRCA, FFPMRCA

BMI Woodlands Hospital

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Mr Nitin Badhe

Consultant Orthopaedic Surgeon

FRCS(Orth), Mch Orth, MS Orth, DNB Orth, FCPS Orth, D’Orth, MRCS Surg

BMI The Park Hospital

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Mr Harvey Sandhu

Consultant Orthopaedic Surgeon

MA MBB Chir FRCS (Tr & Orth)

BMI Bath Clinic

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Mr Adnan Bawarish

Consultant Trauma, and Orthopaedic Surgeon

MD. Mch ( Orth ) , FRCS

BMI Woodlands Hospital

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Dr Ashish Gulve

Consultant in Pain Management and Anaesthesia

FRCA, FFPMRCA, FFPMCAI, DPMed, FCARCSI, MD, MBBS

BMI Woodlands Hospital

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