From the Guidelines
Weaver's bottom, or ischial bursitis, should be initially treated with nonpharmacological approaches, such as physical therapy, heat/cold, and orthotics, before considering pharmacological treatments like acetaminophen or aspirin at the lowest efficacious dose. This approach is based on the principle of starting with the least risky medication and escalating only if necessary, as recommended by the American Heart Association 1.
When considering pharmacological treatments, it is essential to weigh both safety and efficacy. The use of nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen may be considered, but it is crucial to start with the lowest efficacious dose and monitor for potential side effects.
Some key considerations for treating weaver's bottom include:
- Resting from the aggravating activity to reduce pressure on the affected area
- Using cushioned seating to alleviate pressure on the ischial tuberosity
- Applying ice packs for 15-20 minutes several times daily to reduce inflammation and pain
- Physical therapy exercises to stretch and strengthen the gluteal muscles and prevent recurrence
In severe or persistent cases, corticosteroid injections into the bursa may be necessary to reduce inflammation and relieve pressure on the affected area, allowing the tissues to heal naturally. It is essential to prioritize nonpharmacological approaches and use pharmacological treatments judiciously, considering both safety and efficacy, as outlined in the American Heart Association's scientific statement 1.