Bursitis is a common, painful condition that affects many patients within the population. Our bodies are filled with small fluid-filled sacs called bursae that are located at certain friction points, such as joints or bony prominences. These bursa help cushion and protect the bone from friction as tendons and muscles cross over bone during movement, especially in places like elbows, knees, and hips. Bursitis occurs when these fluid-filled sacs become irritated and inflamed from too much friction or pressure. Bursitis can occur anywhere we have bursa sacs.
Ischial bursa is located between the hamstring muscle and the ischial tuberosity of the pelvis in the buttock area. This area bears the weight of the body when sitting. The hip joint is one of the largest joints in the body. It is composed of one osseous joint. The hip is generally built for weight-bearing and movement in several different planes. The stability of the hip joint comes from the capsule, ligaments, muscle, and cartilaginous tissue called the labrum. There are four bursae surrounding the hip joint. Therefore, the most commonly injured bursa is the ischial bursa (also known as ischiogluteal bursitis or weaver’s bottom).
Ischiogluteal bursitis is a condition in which fluid-filled sacs in the pelvis become swollen and painful. Sitting for long periods on hard surfaces is a common cause of ischial bursitis. Ischiogluteal bursitis can cause problems with walking, running, or sitting. Although a common condition, certain treatments are available to help reduce inflammation and improve symptoms. In addition, most people refer ischial bursitis as “weaver’s bottom” because the first noted cases of the condition were in weavers, who traditionally sit on hard surfaces for long periods.
Causes & Symptoms
The main cause of ischiogluteal bursitis is trauma to the affected area, thus leading to either of the three types; chronic bursitis, acute bursitis, and in severe cases, infections:
- Chronic ischiogluteal bursitis – Minor trauma by repetitive activity is the most prevalent cause of chronic ischial bursitis. An example is a prepatellar bursitis (at the front of the knee) caused by extended or repetitive kneeling on a hard surface, such as while scrubbing a floor or laying carpet.
- Acute ischiogluteal bursitis – Blood can leak into the bursa as a result of a direct impact (for instance, if you accidentally fall on a hard floor and land on your buttocks). This results in inflammation, which is accompanied by discomfort and swelling.
- Infections – Bursae near the skin’s surface are susceptible to bacterial infection, resulting in septic bursitis. Staphylococcus aureus or Staphylococcus epidermidis is by far the most common germ that causes septic bursitis. Septic bursitis is more common in people with diabetes, alcoholism, and skin lesions over a bursa.
Usually, bursae are supposed to protect the ischia bursa, cushioning movements between the muscles and bones in the area. With excessive use, however, friction on the bursa can make it inflamed and irritated. Therefore, symptoms include soreness, tenderness, and swelling in the lower buttocks, and patients often notice that this pain worsens with movement. The area may also feel warm to the touch, as heat often accompanies inflammation. Ischiogluteal bursitis can affect anyone, at any age.
Patients with the condition are not necessarily athletic or involved in physically demanding activities. Typically, they report sitting on hard surfaces for long periods of time, and some also report frequently riding horses. In physically active patients with ischiogluteal bursitis, the condition often develops after they perform activities that involve excessive contraction of the hamstrings (muscles at the back of the thighs), like running. These muscles can rub on the bursae, making them sore and irritated. Additionally, doctors commonly report redness on the skin of the area where the patient injured his or her buttocks.
Who gets Ischiogluteal Bursitis?
You are at a higher risk of ischioglutea bursitis via the following risk factors:
- Gout – Gout is a type of arthritis caused by a buildup of uric acid crystals in the joints. Uric acid is a breakdown product of purines that are part of many foods we eat. An abnormality in handling uric acid and crystallization of these compounds in joints can cause attacks of painful arthritis and kidney stones.
- Pseudogout – Pseudogout is a form of arthritis characterized by sudden, painful swelling in one or more of your joints. These episodes can last for days or weeks. The most commonly affected joint is the knee alongside the hip and ankles.
- Age – Many patients who are older than the age of 50 are more susceptible to experiencing bursitis in any part of their body.
- Vehicle accident – Most people who have dealt with trauma due to vehicle accidents are prone to infecting their hip if left untreated. The hip is one of the most common body parts to be impacted when experiencing vehicle/motorbike accidents.
Additionally, people who engage in the following activities are at a higher risk of developing ischiogluteal bursitis:
- Bicyclists who ride on a regular daily basis.
- Runners who repeatedly jog, especially those who do not warm up before performing certain activities.
- People who exercise in an incorrect manner.
- People who leap or kick repetitively.
How Does it Affect You? How Serious is it?
Complications are quite rare in cases of ischiogluteal bursitis, but they can occur in anyone who leaves this condition untreated. The bursae can become infected and could eventually cause you to have a limited range of motion in the affected bones and other tissues. Bacterial skin infection (cellulitis) and bacterial joint infection (septic joints) are two other possible complications that could happen.
Cellulitis is a common infection of the skin and the soft tissues underneath. It happens when bacteria enter a break in the skin and spread. The result is an infection, which may cause swelling, redness, pain, and warmth to the touch. As for septic joint infection (also known as septic arthritis), it is usually caused by bacteria. It can also be caused by a virus or fungus. The condition is an inflammation of a joint that is caused by infection. Typically, septic arthritis affects one large joint in the body, such as the knee or hip. Less frequently, septic arthritis can affect multiple joints at once.
Recommended Treatment & Rehabilitation
Generally, bursitis can normally be easily diagnosed by a doctor, however, because the symptoms of ischiogluteal bursitis are identical to hamstring tendonitis, it may be more difficult to diagnose. Therefore, your doctor will first ask you about pain history, the pattern of pain, and how symptoms affect lifestyle and training. Your doctor will then perform a physical exam to approximate the location and severity of the injury. Your doctor will try to replicate your symptoms by palpitating the injured area, passively moving your limbs, and asking you to perform certain physical activities.
Most patients with ischiogluteal bursitis will often have pain with sitting and tenderness to palpation at the bone. Similar to hamstring sprains, ischial bursitis may demonstrate side-to-side differences in the range of motion, with pain at the ischial tuberosity at the end range of hip flexion. Several tests with high sensitivity have been described for ischial bursitis, such as the Puranen-Orava test and the bent-knee stretch test. Performing these tests may result in a more accurate answer to whether this condition is either hamstring tendonitis or ischiogluteal bursitis.
In addition, there are other several available imaging techniques for hip and/or buttock pain injuries. X-rays of the hip and pelvis are commonly used, however, advanced imaging with magnetic resonance imaging (MRI) or dynamic ultrasound (sonography), may be required to determine the severity of the condition.
When available, musculoskeletal ultrasound provides several advantages over X-ray, computed tomography (CT), and MRI, including decreased cost, portability, and exquisite soft tissue imaging. Furthermore, ultrasound can provide the availability to test the tissues dynamically to rule in or out other diagnoses, and it has been found to be extremely accurate and precise at determining the location and extent of ischiogluteal bursitis.
Ischial bursitis can be treated homeopathically or by a physiotherapist. It is generally treated by gentle stretching to relieve tension, cross friction massage to the tendons to stimulate healing, and strengthening of the lower extremities to help address any weakness or muscular imbalances. Dry needling has also been shown to be effective to relieve any trigger points in the muscle bellies. Since ischiogluteal bursitis is often a chronic issue, your mechanics when running, walking, or exercising also need to be addressed. Often, a shorter stride and increased cadence when walking and running can decrease the amount of tension and prevent further inflammation.
With ischiogluteal bursitis, treatment initially focuses on reducing the tension and resting. Stretching of the muscle is not recommended because it will place increased tension on the sciatic nerve and will, often, cause increased pain and inflammation. Sitting on a wedge with the higher part positioned in the back, allows the hips to be flexed less and can provide some short-term relief. Improving the mobility of the sciatic nerve can also be helpful.
Since this nerve has a close relationship to the gluteal and hamstring muscles, activities such as walking, squatting, and sitting require the nerve to move with the muscles. When it becomes stuck in one position, any movement that stretches or compresses the nerve can be very painful. Exercises can usually be given in an attempt to break up this tissue and gently glide the nerve up and down restoring mobility and relieving symptoms.
Some examples of exercises and stretches include:
Lying buttocks stretch
Lie flat on the back with the head resting on a pillow and keep the legs straight. Next, slowly bend the right knee toward the chest. Placing the hands around the thigh, just below the back of your knee, pull the knee closer to the chest. Hold the stretch for 5-10 seconds before returning to the starting position. Repeat this method 6-10 times a day.
Start on all fours with the knees under the hips and the hands under the shoulders, keeping the neck straight. Afterward, stretch the left arm out in front and the right leg out behind. Slowly raise the outstretched left arm and right leg until they align with the back. Hold the position for 2 seconds before switching to the other side. Repeat this exercise 5 times a day.
Sitting rotation stretch
Begin by sitting with a straight back and both feet straight out in front. Bend the right knee and place the foot flat on the floor. Move the right foot to the outside of the left knee. Next, gently twist to the right, pushing the left elbow against the right knee and looking over the right shoulder. Hold the stretch for 30 seconds, then return to the starting position before repeating 4 times a day.
Alternative & Homeopathic Treatment
Treatment for ischiogluteal bursitis may typically involve lifestyle changes and home remedies. The following treatments may help you manage ischial bursitis:
- Using ice packs to reduce swelling in the area.
- Taking non-steroidal anti-inflammatory medications, such as ibuprofen and naproxen.
- Sitting on a supportive U-shaped cushion if you work in an office environment.
- Resting from the activity causing the issue, such as sitting on a hard surface for a long period of time.
- Taking warm showers twice a day. This may help increase blood circulation in your body. Epsom salts can boost your recovery if used while showering.