Ischial bursitis is the inflammation of the bursa located adjacent to the ischial tuberosity, commonly known as the “sits bone.” This small, fluid-filled sac acts as a cushion to reduce friction between the bony prominence of the pelvis and the overlying tendons and muscles. When the bursa becomes irritated and swollen, it results in deep, localized pain that can significantly interfere with daily activities. Relief often requires a dual approach, starting with immediate self-care before escalating to professional medical therapies if symptoms persist.
Understanding Ischial Bursitis
Ischial bursitis frequently develops from repetitive stress or prolonged pressure exerted directly onto the sits bone. Activities requiring extended periods of sitting on hard surfaces, such as long-distance cycling, rowing, or certain sedentary occupations, are common culprits that lead to irritation and swelling of the bursa. Historically, the condition was sometimes referred to as “Weaver’s Bottom.”
Symptoms manifest as a dull, deep ache localized to the lower buttock region, right at the base of the pelvis. The pain is characteristically exacerbated by sitting, especially on firm seats or when leaning back. It may sometimes radiate down the back of the thigh, potentially mimicking sciatica. Tenderness is present when pressure is applied directly over the ischial tuberosity, and discomfort may increase during activities involving forceful hip flexion, such as running or climbing stairs.
First-Line Home Management for Relief
Initial treatment centers on conservative strategies designed to reduce inflammation and eliminate mechanical pressure. The most important first step is strict modification of activities to achieve relative rest. This means avoiding prolonged sitting, especially on hard surfaces, and temporarily stopping high-impact activities like running or cycling for at least two to four weeks.
Applying ice (cryotherapy) to the affected area helps manage pain and localized swelling. Ice packs should be applied for 10 to 15 minutes at a time, several times daily, using a thin towel to protect the skin. Over-the-counter Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), such as ibuprofen or naproxen, can provide symptomatic relief by targeting the inflammatory process. These medications are typically used for a limited period, such as one to two weeks, and should be taken as directed.
Ergonomic Adjustments
Ergonomic adjustments are crucial to prevent continued irritation of the bursa. Individuals should utilize specialized seat cushions, such as foam or donut cushions, to redistribute pressure away from the ischial tuberosity. Placing a pillow under the thighs to slightly elevate the hips is an effective technique that helps unweight the sits bones while sitting. This modification prevents the bursa from being constantly compressed, allowing the tissue to begin healing.
Once acute pain subsides, gentle stretching can be introduced to maintain flexibility in the surrounding musculature, particularly the hamstrings and glutes. Simple, non-straining stretches, like the seated piriformis stretch or gentle hip extensions, help address muscle tightness that may contribute to friction on the bursa. Immediately stop any exercise that causes a sharp increase in pain, as the initial goal is to calm the irritated tissue.
Advanced Medical Interventions
If pain and functional limitations persist despite four to six weeks of consistent home management and activity modification, professional medical evaluation is warranted. A healthcare provider can confirm the diagnosis and rule out other causes of pain, such as hamstring tendinopathy or a lumbar spine issue. Professional interventions focus on targeted treatments to resolve lingering inflammation and restore function.
Physical Therapy
Physical therapy (PT) is the first line of professional treatment, emphasizing a structured program of therapeutic exercises and manual techniques. A PT regimen targets strengthening the core and hip muscles, such as the gluteus medius, to improve overall biomechanics and reduce strain. The program also includes specific stretching routines for the hamstrings and hip rotators, along with manual therapy to address soft tissue restrictions.
Corticosteroid Injections
For cases resistant to physical therapy and home care, corticosteroid injections may be recommended. This delivers a potent anti-inflammatory medication directly into the bursa. The procedure involves using image guidance, such as fluoroscopy or ultrasound, to ensure precise placement within the inflamed sac. The corticosteroid, combined with a local anesthetic, can provide significant pain reduction.
Surgical intervention, known as a bursectomy, is considered only in persistent cases where all non-surgical treatments have failed to provide lasting relief. The procedure involves the surgical removal of the inflamed bursa. It is reserved for chronic conditions that have not responded to conservative care or injections over an extended period. Outcomes following surgical excision are generally favorable, though most individuals find resolution through less invasive methods.