From the Research
The most effective treatment for ischial bursitis is fluoroscopically guided injections, which have been shown to provide significantly greater pain relief compared to landmark-based injections, with a mean improvement of 86.25% ± 11.09% 1.
Treatment Approach
The treatment for ischial bursitis typically begins with conservative measures, including:
- Rest and activity modification to avoid direct pressure on the affected area
- Over-the-counter NSAIDs, such as ibuprofen (400-800mg three times daily) or naproxen (500mg twice daily), to reduce pain and inflammation for 1-2 weeks
- Ice application for 15-20 minutes several times daily to reduce pain and inflammation
- Cushioned seating or donut pillows to reduce pressure on the ischial tuberosity
Physical Therapy and Injections
Physical therapy focusing on stretching and strengthening the hamstrings and gluteal muscles is beneficial, typically 2-3 sessions weekly for 4-6 weeks. For persistent cases, fluoroscopically guided corticosteroid injections (such as methylprednisolone 40mg with lidocaine) directly into the bursa may provide relief for several months 1. These injections work by reducing inflammation at the source, and the use of fluoroscopic guidance has been shown to enhance therapeutic outcomes compared to landmark-based injections.
Surgical Intervention
In rare, severe cases unresponsive to conservative treatment for 6+ months, surgical intervention to remove the inflamed bursa may be considered. Recovery is enhanced by addressing contributing factors such as improper sitting posture, prolonged sitting, or activities that place pressure on the ischial tuberosity. It is essential to note that while NSAIDs can provide relief, their long-term use should be carefully considered due to potential organ damage, as highlighted in a review of NSAID-induced organ damage 2. Additionally, a systematic review with network meta-analysis found that exercise therapy, NSAIDs, and opioids have similar effects on knee osteoarthritis pain, with exercise therapy ranking as the best treatment option 3. However, the most recent and highest quality study on ischial bursitis treatment supports the use of fluoroscopically guided injections as the most effective treatment option 1.