Sports Medicine
Sports Injury Prevention & Rehabilitation

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Ischiogluteal Bursitis

(Also known as Ischial Bursitis)
What is ischiogluteal bursitis?
Ischiogluteal bursitis is a condition that causes pain in the buttock and is characterized by tissue damage and inflammation to the ischiogluteal bursa. A bursa is a small sac filled with lubricating fluid and is designed to reduce friction between adjacent soft tissue layers. The ischiogluteal bursa is located at the base of the pelvis.
The hamstring muscles originate from the pelvis and insert into the top of the lower leg bones. The hamstring muscles attach to the pelvis via the hamstring tendon. The ischiogluteal bursa lies between the hamstring tendon and the pelvic bone (ischial tuberosity).
The hamstring muscles are responsible for bending the knee and straightening the hip during activity and are particularly active during running, jumping and kicking. During contraction of the hamstrings, tension is placed through the hamstring tendon which in turn places friction on the ischiogluteal bursa. Pressure may also be placed on the ischiogluteal bursa during sitting. When these forces are excessive due to too much repetition or high force, irritation and inflammation of the ischiogluteal bursa may occur. This condition is known as an ischiogluteal bursitis.

Causes of ischiogluteal bursitis
Ischiogluteal bursitis most commonly occurs due to repetitive or prolonged activities placing strain on the ischiogluteal bursa. This typically occurs due to prolonged sitting (particularly on hard surfaces) or due to repetitive running, jumping or kicking activities (placing strain on the ischiogluteal bursa via the hamstring tendon). Occasionally, patients may develop this condition suddenly following a direct blow to the ischiogluteal bursa. This may occur due to a fall onto a hard surface.

Signs and symptoms of ischiogluteal bursitis
Patients with ischiogluteal bursitis typically experience pain in the lower buttock. In less severe cases, patients may only experience an ache or stiffness in the buttock that increases with rest following activities placing strain on the ischiogluteal bursa. These activities typically include sitting excessively (especially on hard surfaces), walking, running, jumping, kicking or climbing stairs. The pain associated with ischiogluteal bursitis may also warm up with activity in the initial stages of the condition.
As the condition progresses, patients may experience sharper or more severe symptoms that increase during sport or activity, affecting performance. Patients frequently experience pain on firmly touching the ischiogluteal bursa and hamstring tendon. Occasionally, a feeling of lower limb weakness may also be present particularly when attempting to accelerate whilst running.

Diagnosis of ischiogluteal bursitis
A thorough subjective and objective examination from a doctor may be sufficient to diagnose ischiogluteal bursitis. Further investigations such as an Ultrasound, X-ray, CT or MRI scan are often required to assist with diagnosis and assess the severity of the condition.

Prognosis of ischiogluteal bursitis
Most patients with this condition heal well with appropriate therapy and return to normal function in a number of weeks. Occasionally, rehabilitation can take significantly longer and may take many months in those who have had their condition for a long period of time. Early physiotherapy treatment is vital to hasten recovery in all patients with ischiogluteal bursitis.

Treatment for ischiogluteal bursitis
The success rate of treatment for patients with this condition is largely dictated by patient compliance. One of the key components of treatment is that the patient rests from ANY activity that increases their pain until they are symptom free. This allows the body to begin the healing process in the absence of further tissue damage. Once the patient can perform these activities pain free, a gradual return to these activities is indicated provided there is no increase in symptoms.
Ignoring symptoms or adopting a 'no pain, no gain' attitude is likely to lead to the condition becoming chronic. Immediate, appropriate treatment is essential to ensure a speedy recovery. Once the ischiogluteal bursitis is chronic, healing slows significantly resulting in markedly increased recovery times and an increased likelihood of future recurrence.
Patients with this condition should follow RICE in the initial phase of injury. R.I.C.E is beneficial in the first 72 hours following injury or when inflammatory signs are present (i.e. morning pain or pain with rest). R.I.C.E. involves resting from aggravating activities, regular icing, the use of a compression bandage (where possible) and keeping the affected leg elevated. Anti-inflammatory medication may also significantly hasten the healing process by reducing the pain and swelling associated with inflammation.
Patients with ischiogluteal bursitis should also undergo a graduated flexibility and strengthening program of the surrounding muscles to ensure an optimal outcome. The treating doctor or therapist can advise which exercises are most appropriate for the patient and when they should be commenced.

Contributing factors to the development of ischiogluteal bursitis
There are several factors which can predispose patients to developing this condition. These need to be assessed and corrected with direction from a therapist. Some of these factors include:
  • joint stiffness (particularly the hip)
  • muscle tightness (particularly the hamstrings and gluteals)
  • inappropriate or excessive training
  • inadequate warm up
  • muscle weakness (especially the hamstrings and gluteals)
  • inadequate rehabilitation following a previous buttock injury

Physical therapy for ischiogluteal bursitis
Physical therapy treatment is vital to hasten the healing process, ensure an optimal outcome and reduce the likelihood of injury recurrence. Treatment may comprise:
  • soft tissue massage
  • electrotherapy (e.g. ultrasound)
  • stretches
  • joint mobilization
  • ice or heat treatment
  • exercises to improve strength and flexibility
  • education
  • anti-inflammatory advice
  • activity modification advice
  • a gradual return to activity program

Other intervention for ischiogluteal bursitis
Despite appropriate management, some patients with this condition do not improve adequately. When this occurs the treating therapist or doctor will advise on the best course of management. This may include further investigations such as X-rays, ultrasound, MRI or CT scan, pharmaceutical intervention, corticosteroid injection, draining of the bursa or referral to appropriate medical authorities who will advise on any interventions that may be appropriate to improve the condition.