It is a condition that describes inflammation of the bursa that lies between gluteal muscles. The bursa is a fluid-filled sac, whose purpose is to reduce friction and minimise irritation on movement.
Investigations:-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:
1 X-ray.
2 MRI.
3 CT scan.
4 ultrasound.
Causes:-
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:
1 Inappropriate and excessive training.
2 Poor core stability.
3 Joint stiffness, specifically of the hip.
4 Muscle weakness particularly the gluteals and hamstrings.
5 Chronic gout and ischial pain.
6 Neural tightness.
7 Poor biomechanics such as excessive stride length.
8 Muscle tightness specifically the gluteals and hamstrings.
9 Inadequate rehabilitation followed by a previous buttock injury.
10 Leg length discrepancy.
11 Inadequate warm up.
Symptoms:-
1 Tenderness and pain in the ischial tuberosity.
2 Pain is experienced while stretching the hamstring.
3 Pain is experienced while flexing the knee against resistance.
4 Aggravation of pain on sitting.
5 Exacerbation of pain while performing activities such as running, walking, jumping, kicking, climbing stairs and sitting excessively particularly on hard surfaces.
6 In more severe cases symptoms may also restrict sports and regular activities.
7 Pain is experienced on firmly touching the hamstring tendon and ischiogluteal bursa.
8 In some cases weakness in the lower limb could also be experienced, specifically while attempting to accelerate during running.
9 Few patient may give history of gout, though bursitis of joint attack by gout is common than bursitis of Ischiogluteal Bursa.
10 Pain is experienced on firmly touching the hamstring tendon and ischiogluteal bursa.
11 In some cases weakness in the lower limb could also be experienced, specifically while attempting to accelerate during running.
Treatment:-
1 Rest.
2 Cold therapy helps in reducing inflammation and pain.
3 Avoiding activities that aggravate the symptoms.
4 Avoid massage.
5 Corticosteroid injections where the medication is injected into the bursa, not only helps in reducing the inflammation, but also alleviates the symptoms.
Physical therapy:-
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:
1 Application of heat and ice.
2 Electrotherapy like TENS and ultrasound.
3 Soft tissue massage.
4 Stretches.
5 Dry needling.
6 Joint mobilization.
7 Using crutches.
8 Correction of abnormal biomechanics such as using orthotics.
9 Anti-inflammatory advice.
10 Exercises for improvement of the strength, flexibility and core stability.
11 Activity modification and training.
12 Appropriate plan for return to activity.
Exercise:-
1 Hamstring Stretch:-
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.
2 Gluteal Stretch:-
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.