Bursitis is the inflammation of bursae, small, fluid-filled sacs found near joints. Ischial bursitis specifically targets the bursa located around the “sit bones” in the buttocks. This article provides an overview of ischial bursitis, including its causes, symptoms, diagnosis, and treatment.
Understanding Ischial Bursitis
A bursa is a fluid-filled sac that cushions bones and tissues like muscles and tendons, reducing friction and facilitating movement. Bursae are present throughout the body, particularly near large joints like the hips, knees, and shoulders.
The ischial bursa is located deep in the buttock, between the ischial tuberosity (the “sit bone”) and the gluteus maximus muscle or hamstring tendons. Its role is to prevent friction as these structures move against the sit bone, especially during activities that involve hip extension and flexion. Ischial bursitis occurs when this bursa becomes inflamed, causing swelling and pain.
Common Causes and Risk Factors
Ischial bursitis often develops from chronic irritation or repetitive pressure on the ischial bursa. A frequent cause is prolonged sitting, particularly on hard surfaces, which directly compresses the bursa.
Repetitive activities that involve hip and hamstring muscle use can also contribute to its development. Examples include cycling, rowing, and intense exercise involving the hamstring muscles, where friction between the muscle or tendon and the bursa increases. Direct trauma to the “sit bone” area, such as a fall, can also cause acute inflammation of the bursa. Certain medical conditions, including rheumatoid arthritis, gout, and other inflammatory diseases, can also predispose individuals to bursitis.
Recognizing the Symptoms
The characteristic symptom of ischial bursitis is pain in the buttock area, often described as a dull, deep ache. This pain is typically localized over the ischial tuberosity, or “sit bone,” and can worsen significantly with prolonged sitting or direct pressure on the affected side.
Tenderness to the touch over the ischial tuberosity is a common finding. The pain may also radiate down the back of the thigh, potentially mimicking sciatica or hamstring issues, although it originates from the inflamed bursa. Activities that stretch or contract the hamstring muscles, such as walking, running, climbing stairs, or squatting, can aggravate the pain. Swelling may be visible in the lower buttock and hip area, and a reduced range of motion in the hip might be experienced.
Diagnosis and Treatment Approaches
Diagnosing ischial bursitis typically begins with a thorough review of symptoms and a physical examination. A healthcare provider will assess the area for tenderness, particularly over the ischial tuberosity, and may perform specific movements of the hip to reproduce symptoms or differentiate from other conditions. While often diagnosed clinically, imaging tests can confirm the diagnosis and rule out other causes of buttock pain, such as hamstring injuries or stress fractures. X-rays may reveal calcification in chronic cases, while ultrasound or MRI can visualize inflammation or fluid accumulation within the bursa.
Treatment for ischial bursitis primarily focuses on conservative, non-surgical methods to reduce inflammation and pain. Rest from aggravating activities, such as prolonged sitting on hard surfaces, is often recommended. Applying ice packs to the affected area for 15-20 minutes several times a day can help alleviate swelling and discomfort. Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, are commonly used to manage pain and reduce inflammation.
Physical therapy plays a significant role in recovery, involving stretching exercises to improve flexibility of tight hamstrings and strengthening exercises to correct muscle imbalances. Therapists may also provide manual therapy and advise on ergonomic adjustments, such as using cushioned seats or donut pillows, to reduce pressure on the ischial tuberosity. For persistent cases, a healthcare provider might consider corticosteroid injections directly into the bursa, which can provide substantial pain relief by reducing inflammation. Surgical intervention to remove the inflamed bursa is rarely necessary, typically considered only in severe, persistent cases that do not respond to conservative treatments after several months.