By Lauren Opatrny, PT, DPT, PHRC San Francisco, CA
Ischial bursitis, or ischiogluteal bursitis, is a condition where the bursa that lies between the ischial tuberosity and the gluteus maximus muscle becomes inflamed.(1) Ischial tuberosities are the bones that we sit on and are commonly referred to as your “sits bones.” They provide support for the body while sitting and serve as an attachment site for several muscles and tendons. When this bursa becomes inflamed, it can cause pain, stiffness, and limited mobility in the affected area.
Image credit to Sports Injury Clinic
What is a Bursa and why does it get inflamed?
A bursa is a fluid-filled sac that serves to provide cushion and reduce the amount of friction between ligaments, tendons, and bones so our tissues can glide and slide past one another during movement. “Bursitis” refers to inflammation of the bursa. Bursitis is usually a temporary condition, and ischial bursitis is relatively uncommon. The bursa can become inflamed from injury or overuse. Typically, ischial bursitis is caused by prolonged sitting on a hard surface and is most common in individuals who have a sedentary lifestyle(1), but it can also be caused by trauma to the area such as a fall, or from injury to the hamstring muscle or tendon from activities like running or biking.
These activities can cause an inflammatory reaction in the bursa and surrounding tissues resulting in swelling and tenderness over the lower buttock and upper posterior thigh.(1) Symptoms can include:
- Pain with prolonged sitting (especially on a hard surface)
- Pain when stretching the gluteal and/or hamstring muscles (pain with hip flexion and/or straight leg raise)
- Tenderness on ischial tuberosity
- Pain that my radiate into back of the thigh
- Swelling and limited mobility
- Pain with gluteal and/or hamstring muscle activation
- Sleep disturbances due to pain
- Difficulty or pain with walking and running
Differential Diagnosis
Many muscles attach on or near the ischial tuberosities including the hamstrings, adductor muscles, gluteal muscles, and the superficial transverse perineal muscle, which is part of the pelvic floor. Because there are several different tendons, muscles, ligaments, and nerves in this region of the pelvis, it makes diagnosing pain in this area difficult. Besides ischial bursitis, differential diagnosis can include but is not limited to sciatica, hamstring tendonitis or tendinopathy, proximal hamstring or adductor muscle strain, pudendal neuralgia, and pelvic floor dysfunction. Your doctor may recommend imaging such as an x-ray or MRI to rule in or out certain diagnoses.(1)
How can physical therapy help?
Physical therapist will perform an evaluation to determine the most likely cause of your pain, which will determine the types of interventions that are appropriate. If it seems like ischial bursitis is the most likely source of pain, the treatment will depend on that individual’s specific presentation. Everyone is different! And it is possible there is more than one thing going on. Treatment may include but is not limited to patient education and activity modification, manual therapy to surrounding tissues to improve mobility and blood flow, gentle stretches to reduce compression of the bursa and restore mobility, postural and neuromuscular re-education, and strengthening.
Activity modification may include taking a look at sitting posture and habits, as well as possibly making ergonomic adjustments to someone’s work station set up. Nowadays, people spend a lot of time sitting at work, so it’s important to make sure you are implementing proper ergonomics. If you have access to a standing desk, this can be a great way to break up sitting throughout the day. While sitting, it may be helpful to use a cushion; below is a great video describing different types of cushions for pain with sitting:
If the injury is more acute, using ice to the affected area can be helpful to reduce pain and inflammation. Rest and modifying activities that cause pain are also very helpful, because this allows the tissues time to heal more effectively.
References:
- Johnson, Donovan B., and Matthew Varacallo. “Ischial Bursitis.” National Center for Biotechnology Information, U.S. National Library of Medicine, https://pubmed.ncbi.nlm.nih.gov/29493912/.
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Are you unable to come see us in person in the Bay Area, Southern California or New England? We offer virtual physical therapy appointments too!
Virtual sessions are available with PHRC pelvic floor physical therapists via our video platform, Zoom, or via phone. For more information and to schedule, please visit our digital healthcare page.
In addition to virtual consultation with our physical therapists, we also offer integrative health services with Jandra Mueller, DPT, MS. Jandra is a pelvic floor physical therapist who also has her Master’s degree in Integrative Health and Nutrition. She offers services such as hormone testing via the DUTCH test, comprehensive stool testing for gastrointestinal health concerns, and integrative health coaching and meal planning. For more information about her services and to schedule, please visit our Integrative Health website page.
Melissa Patrick is a certified yoga instructor and meditation teacher and is also available virtually to help, for more information please visit our therapeutic yoga page.
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