Ischial bursitis is also known as ischiogluteal bursitis. Bursitis is an inflammation of the bursa. The bursa is a sac filled with lubricating fluid. You can find it between different tissues like muscles, tendons, skin and bones. Its role is to lessen the irritation and friction between the tissues. When it is subjected to continual trauma, the bursa becomes painful and results in swelling and inflammation. If you are an athlete, this can be translated into a severe pain.
What are the main causes of Ischiogluteal Bursitis?
The persons who perform prolonged and repetitive activities (football players, athletes, etc) are more prone to ischiogluteal bursitis. These activities place a lot of stress on the ischiogluteal bursa. This condition appears as a consequence of prolonged sitting, specifically on hard surfaces. It can also appear in persons who perform several sports like repetitive jumping, kicking, and running, where the tress is placed on the ischiogluteal bursa through the hamstring tendon. There are also cases when people develop this condition when they fall down onto a hard surface.
There are also other causes that trigger ischiogluteal bursitis:
- Inappropriate and excessive training.
- Poor core stability.
- Joint stiffness, specifically of the hip.
- Muscle weakness particularly the gluteals and hamstrings.
- Chronic gout and ischial pain
- Neural tightness.
- Poor biomechanics such as excessive stride length.
- Muscle tightness specifically the gluteals and hamstrings.
- Inadequate rehabilitation followed by a previous buttock injury.
- Leg length discrepancy.
- Inadequate warm up.
Signs and symptoms
The symptoms are in most cases similar to the symptoms caused by the inflammation of the hamstring tendon. These symptoms include:
- Tenderness and pain in the ischial tuberosity.
- Pain when stretching the hamstring.
- Pain whenever you flex the knee against resistance.
- The pain becomes stronger when sitting.
- The pain increases in intensity when performing activities such as running, walking, jumping, kicking, climbing stairs and sitting excessively particularly on hard surfaces.
- When the pain becomes severe, it is recommended to restrict sports and regular activities.
- Pain is experienced when firmly touching the hamstring tendon and ischiogluteal bursa.
- There can be cases when weakness in the lower limb is experienced. Specifically, when you attempt to accelerate during running, the pain becomes even more severe.
- Pain is experienced on firmly touching the hamstring tendon and ischiogluteal bursa.
Testing For Ischial Bursitis
Whenever you feel any of the symptoms and signs above, it is recommended to discuss with your doctor and ask for an orthopedic and neurological examination. The most common tests to determine whether you are suffering from Ischial Bursitis is the seated Slump’s test, Supine straight leg raise test and an Achilles reflex test. These tests will help the doctors determine whether you suffer from this condition or not and will enable your physician to eliminate sciatica as a diagnosis. Ischial Bursitis can often be confused with Piriformis Syndrome or Sciatica. Therefore, many doctors will test the length and strength of the Piriformis muscle. This is a quick and easy way to eliminate it as a possible diagnosis.
Treatment for Ischiogluteal Bursitis
As soon as your doctor will establish the diagnosis of ischial bursitis, he will have the following recommendations for you:
- Cold therapy. It will help you reduce inflammation and pain. The cold therapy is also known as cryotherapy. This is a form of treatment where low temperatures are used either locally or generally for treating a variety of conditions. It is very efficient in different conditions such as injury to the muscle or ligament, pain, inflammation, swelling etc. and to encourage healing.
- Avoiding activities that aggravate the symptoms.
- Avoid massage.
- Corticosteroid injections. The doctor will inject the medication into the bursa. It will help not only in reducing the inflammation but it will also alleviate the symptoms.
In ischiogluteal bursitis, the physical therapy is important in speeding up the healing process. Even though the doctor will recommend initially to rest, the physical therapy will decrease the likelihood of recurrences in the future. Physical therapy may include:
- Application of heat and ice.
- Electrotherapy like TENS and ultrasound.
- Soft tissue massage.
- Dry needling.
- Joint mobilization.
- Using crutches.
- Correction of abnormal biomechanics such as using orthotics.
- Anti-inflammatory advice.
- Exercises for improvement of the strength, flexibility and core stability.
- Activity modification and training.
- Appropriate plan for the return to activity.
Non-steroidal anti-inflammatory medications are also of great help. For some people, a corticosteroid injection into the bursa can be of great help.
Gentle stretching also helps ease symptoms. A good exercise will be to lie on your back, with your head on a cushion and the knee on your affected side bent upward. Grasp the back of your knee with both hands and gently pull the knee toward your chest. Hold this position for 5–10 seconds and repeat 6–10 times.
Another good exercise is the piriformis stretch. While you sit on the floor, you can cross the leg on your affected side over the other leg, placing your foot alongside the knee. Using the opposite hand, pull the upright knee across the midline of your body. You should feel a stretch in the affected buttock and in your outer thigh. Hold this position for 10–30 seconds.
As sitting can aggravate ischial bursitis you can help alleviate the pay by trying a specialized pillow to help ease pressure on the ischial tuberosities. You can even make a pillow by yourself. Cut two holes in a three-inch-thick foam rubber cushion. The holes should be about 3 inches in diameter and 3 inches apart.