Ischial Bursitis is a painful inflammatory condition that results in a deep aching sensation in the runners involved hip. The Ischial Bursa is a fluid filled sac that attempts to prevent friction between the Gluteus Maximus and the Ischial Tuberosity (SITS bone). This condition has also been referred to as “Runners Butt” because it can hurts while running and “Tailors Seat” because it hurts while sitting.
The pain will usually start with the runner feeling a sensation of weakness, stiffness, locking or catching in the involved hip. The sensation is often difficult to locate appearing in the front and/or back of the hip joint. The pain will often get progressively worse as the runner continues to run and cause a deep throbbing or ache in the hip joint.
Runners that present to our clinic with this painful condition have usually been either misdiagnosed by some other doctor or have misdiagnosed themselves through researching on the internet. The conditions Ischial Bursitis are usually confused with are Sciatica, Piriformis Syndrome, Gluteus Medius Syndrome, Trochanteric Bursitis, High Hamstring Tendonopathy and a Hamstring Strain. It is important to perform a thorough history, orthopedic, neurological and biomechanical examination to eliminate all the “usual” suspects and arrive at an accurate diagnosis.
In addition to the feelings of stiffness and weakness the runners may have specific tenderness and pain in the buttock right on the bone that makes contact with a chair while sitting. This is commonly called the ‘SITS” bone but is anatomically known as the Ischial Tuberosity and is the site where your hamstring inserts. For this reason hamstring muscles may also be involved which results in a misdiagnosis of a hamstring strain. It is quite easy to manually muscle test the hamstring to see if it results in pain or weakness. If there is no pain or weakness present during a manual hamstring muscle test than that can eliminate it as a possible diagnosis. Another but less common symptom reported can be numbness and tingling in the Gluteal region that sometimes radiates down the hamstring or back of the thigh. These are sciatic-like symptoms and is why this condition is often confused and misdiagnosed as sciatica. These conditions are easy to differentiate with a proper and thorough orthopedic and neurological examination. By performing a seated Slump’s test, Supine straight leg raise test and an Achilles reflex test you can eliminate sciatica as a diagnosis. Piriformis Syndrome is also confused with both Ischial Bursitis and Sciatica. Testing the length and strength of the Piriformis muscle is a quick and easy way to eliminate it as a possible diagnosis.
After the correct diagnosis is made Ischial Bursitis is easy to treat. With a little rest, correct and proper stretching technique and a home foam roller routine begun the runner will be well on their way to recovery. In addition to the home program it is often necessary to initiate therapy in our office to directly treat the bursa. Our office will usually use therapeutic ultrasound, electrical stimulation, transverse friction, cross friction or active release massage in addition to manual muscle and joint manipulation to treat this painful condition. We will also employ correct stretching and strengthening exercises as well as Kinesio or KT Tape to help stabilize the region between treatment sessions.
Ischial Bursitis is a painful condition that negatively affects your ability to run. It is often misdiagnosed resulting in prolonged periods of no running and unnecessary pain. If you are suffering from pain in the Gluteal region or hamstring it is important to have this condition accurately diagnosed and treated so that you may return to pain free running…..and sitting.
If you would like help in resolving this condition the San Diego Running Institute recommends Dr. Victor Runco. Dr. Runco is a running injury specialist as well as a marathon runner. He has helped hundreds of runners and non-runners with painful hip conditions like Piriformis Syndrome, High Hamstring Tendonopathy and Ischial Bursitis. If you would like to make an appointment call (858) 268-8525.