Ischiogluteal bursitis is also known as ischial bursitis.
Bursitis could be explained as an inflammation of the bursa which is a sac filled with fluid adjacent to the joints acting like a cushion for the joint.
A bursa is a sac that is filled with lubricating fluid situated between tissues like muscles, tendons, skin and bone that lessens irritation and friction between the tissues. The bursa causes pain when subjected to continual trauma resulting in swelling and inflammation. This could strongly affect athletes such as runners, footballers and soccer players.
The ischiogluteal bursa is situated at the base of the pelvis, at the level of the bony prominence called as the ischial tuberosity.
Ischiogluteal bursitis is a condition which results in painful buttock and is characterized by inflammation and tissue damage to the ischiogluteal bursa.
The hamstring muscles begin from the pelvis i.e. from ischial tuberosity and enter into the upper side of the lower leg bones. The hamstring muscles connect the pelvis through the hamstring tendon. The ischiogluteal bursa is a bursa which lies between the pelvic bone i.e. ischial tuberosity and the hamstring tendon.
The hamstring muscles help while bending the knee and straightening the hip while performing activities and sports such as jumping, kicking and running.
Stress is placed through the hamstring tendon when the hamstrings get contracted which sequentially result in placing friction on the ischiogluteal bursa. Stress may also be placed on the ischiogluteal bursa while sitting. Excessive forces such as too much repetition and high impact forces often result in inflammation and irritation of the ischiogluteal bursa. This condition is called as ischiogluteal bursitis.
Causes and Risk Factors of Ischiogluteal Bursitis
Ischiogluteal bursitis is caused by performing prolonged and repetitive activities that place stress on the ischiogluteal bursa. Ischiogluteal bursitis is frequently caused due to prolonged sitting, specifically on hard surfaces and by performing sports that involve repetitive jumping, kicking and running in which stress is placed on the ischiogluteal bursa through the hamstring tendon. In some cases individuals may also develop ischiogluteal bursitis suddenly followed by a direct blow to the ischiogluteal bursa such as falling down onto a hard surface.
Other causes may include:
- Inappropriate and excessive training.
- Poor core stability.
- Joint stiffness, specifically of the hip.
- Muscle weakness particularly the gluteals and hamstrings.
- 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 of Ischiogluteal Bursitis
The symptoms of ischiogluteal bursitis are more or less similar to the symptoms caused due to hamstring tendon inflammation. Common symptoms include:
- Tenderness and pain in the ischial tuberosity.
- Pain is experienced while stretching the hamstring.
- Pain is experienced while flexing the knee against resistance.
- Aggravation of pain on sitting.
- Exacerbation of pain while performing activities such as running, walking, jumping, kicking, climbing stairs and sitting excessively particularly on hard surfaces.
- In more severe cases symptoms may also restrict sports and regular activities.
- Pain is experienced on firmly touching the hamstring tendon and ischiogluteal bursa.
- In some cases weakness in the lower limb could also be experienced, specifically while attempting to accelerate during running.
Treatment for Ischiogluteal Bursitis
- Cold therapy helps in reducing inflammation and pain.
- Avoiding activities that aggravate the symptoms.
- Avoid massage.
- Corticosteroid injections, where the medication is injected into the bursa, not only helps in reducing the inflammation but also alleviates the symptoms.
Physical Therapy: Physical therapy for ischiogluteal bursitis is important in speeding up the healing process. Physical therapy also decreases 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 return to activity.
Exercises for Ischiogluteal Bursitis
Hamstring Stretch for Ischiogluteal Bursitis:
This exercise is performed by keeping the foot on a chair or a step. Now by keeping the knee and back in a straight position gradually lean in the forward direction towards the hips until a mild to moderate pain-free stretch is felt at the back side of buttock, knee or thigh. Hold the position for about 15 seconds and release. Repeat four times ensuring there is no exacerbation of pain.
Gluteal Stretch for Ischiogluteal Bursitis:
This exercise is performed by lying down on the back. With the help of hands, bring the knee towards the opposite shoulder until a mild to moderate pain-free stretch is felt along the buttocks or at the front side of the hip. Hold the position for about 15 seconds and release. Repeat four times ensuring there is no exacerbation of pain.
Investigations for Ischiogluteal Bursitis
Generally a complete subjective and physical examination is performed to diagnose ischiogluteal bursitis. Other tests that help in diagnosing and assessing the severity may include:
- CT scan.