Ischiogluteal bursitis and Ischiogluteal tendonitis have similar symptoms of pain just below the buttocks at the top of the thigh. They may occur at the same time. Here we explain the symptoms, causes and treatment of Ischiogluteal bursitis and tendonitis.
Ischiogluteal bursitis is inflammation of the bursa which lies between the hamstring tendon and the bone. The bursa is there to reduce friction between the tendon and the bone and it may be inflamed on its own or in conjunction with hamstring tendinitis or inflammation of the tendon.
The symptoms of ischiogluteal bursitis are almost identical to hamstring tendon inflammation and include:
- Pain and tenderness at the ischial tuberosity.
- Pain when stretching the hamstring muscles.
- Pain may occur gradually over time, where the athlete cannot pinpoint exactly when the injury happened.
- Or following a sprint training session. It is likely to be aggravated by prolonged sitting, especially on hard surfaces.
Pain will be felt when stretching the hamstring muscles but sometimes bursitis is not painful when contracting the hamstring muscle against resistance. It is not usually possible to palpate or feel the bursa but an MRI scan or Ultrasound scan will confirm the diagnosis.
Treatment of Ischiogluteal Bursitis
- Rest. Apply ice or cold therapy to reduce pain and inflammation.
- See a doctor or physiotherapist if symptoms persist.
- When pain allows begin hamstring exercises (as pain may have caused weakness through muscle inhibition).
- A doctor or physiotherapist can differentiate between hamstring tendinitis and ischiogluteal bursitis. This may involve analysing the effectiveness of treatment such as deep tissue massage.
- Bursitis will not respond to massage and may become worse following treatment. Inject a corticosteroid and local anesthetic into a fluid-filled bursa.
Hamstring origin tendonitis (tendinopathy)
Hamstring tendinitis is inflammation of the hamstring tendon as it attaches to the ischial tuberosity at the top of the back of the thigh. This can be linked to overuse or a tear of the hamstring tendon which hasn’t properly healed.
Symptoms of hamstring origin tendonitis
- Symptoms include pain and tenderness at the ischial tuberosity just under the buttocks.
- The patient may experience a gradual onset of deep buttock or thigh pain following a sprinting session.
- Pain is likely to be felt when stretching the hamstring muscles and becomes worse with exercise, particularly repetitive exercises like long-distance running.
- An MRI can confirm the diagnosis.
Causes & anatomy
Hamstring tendinitis is inflammation of the hamstring tendon as it attaches to the ischial tuberosity at the top of the back of the thigh. It can follow a tear of the hamstring tendon which is poorly treated or more often is an overuse injury. The term tendinopathy probably describes the condition more accurately as tendonitis infers there is an acute inflammation of the tendon, which is not always the case, especially in long term chronic injuries.
There is three hamstring muscles, the semimembranosus, semitendinosus and biceps femoris muscle.
Reduce inflammation through rest, ice or cold therapy. Once pain and inflammation have gone develop a stretching and strengthening program. For chronic hamstring tendon injuries, there is likely to be muscle tightness and weakness which can be treated through massage, stretching and strengthening.
A doctor or physiotherapist may recommend NSAID’s or nonsteroidal anti-inflammatory drugs to reduce pain and inflammation as well as use electrotherapy such as ultrasound. They may apply deep tissue sports massage techniques once the acute stage has passed. This is thought to be the most effective form of treatment for this condition. However, if ischiogluteal bursitis is a problem then massage is will not help. A full rehabilitation program of stretching and strengthening exercises is important to avoid future injury.
If conservative treatment methods fail to be effective then ultrasound-guided corticosteroid injections with a local anesthetic may be effective in the short term but on its own is not likely to be effective long term. Shockwave therapy is also a treatment option if conservative methods fail.
Occasionally fibrous adhesion’s may develop on the tendon in chronic cases. These fibrous adhesions can irritate the sciatic nerve as it passes above the Ischial tuberosity and then down past the biceps femoris muscle. These adhesions may not respond to deep friction massage and stretching. This condition is known as hamstring syndrome and may require surgery.
References & further reading
- Google scholar – Ischiogluteal bursitis