From the Guidelines
Treatment of ischial bursitis should focus on nonpharmacological approaches, such as physical therapy, heat/cold, and orthotics, as the initial step, with pharmacological treatments considered only if symptoms are not controlled. Ischial bursitis, also known as "weaver's bottom" or "tailor's seat," is inflammation of the bursa between the ischial tuberosity (sit bone) and the gluteus maximus muscle. The condition occurs due to repetitive friction or pressure on the ischial bursa, commonly from prolonged sitting, cycling, or rowing. Key considerations for treatment include:
- Nonpharmacological approaches, such as physical therapy, heat/cold, and orthotics, should be the first line of treatment, as recommended by the American Heart Association 1.
- Pharmacological treatments, such as acetaminophen or aspirin, should be considered only if symptoms are not controlled by nonpharmacological approaches, and the least risky medication should be tried first, with escalation only if the first medication is ineffective 1.
- Pain relief can be achieved with nonsteroidal anti-inflammatory drugs (NSAIDs), but their use should be carefully considered due to potential risks.
- Physical therapy focusing on stretching and strengthening the hip and gluteal muscles is beneficial for recovery and prevention.
- Apply ice for 15-20 minutes several times daily during acute phases, and heat for chronic cases.
- For persistent cases, corticosteroid injections into the bursa may be considered. Most cases resolve within a few weeks with proper treatment, but addressing underlying biomechanical issues is essential to prevent recurrence.
From the Research
Ischial Bursitis Treatment Options
- Ischial bursitis is a chronic pain condition that can be challenging to treat, often requiring injections when conservative treatments fail 2
- Two common injection techniques used to treat ischial bursitis are fluoroscopically guided and landmark-based approaches 2
Efficacy of Injection Techniques
- A study comparing the efficacy of fluoroscopically guided and landmark-based injections found that the fluoroscopically guided group demonstrated significantly greater pain relief, with a mean improvement of 86.25% ± 11.09% 2
- In contrast, the landmark-based group experienced a mean pain relief of 55.00% ± 13.23% 2
- Patients receiving fluoroscopic injections consistently reported ≥75% relief, while the landmark-based group experienced more variable outcomes, ranging from 40% to 75% 2
Comparison of Techniques
- The study suggests that fluoroscopically guided ischial bursa injections provide greater pain relief compared to landmark-based injections in patients with refractory ischial bursitis 2
- The precise delivery of medication under image guidance appears to enhance therapeutic outcomes, highlighting the superior efficacy and consistency of image-guided injections 2