Ischial bursitis occurs in the lower buttocks area where hamstring muscles are attached to the ischial tuberosity, a bone at the bottom of the pelvis. Runners and athletes often suffer from this condition, which can also be considered tendinitis. Inflammation and pain are caused when hamstring muscles rub against the protruding ischial tuberosity bone and irritate the bursa sac (contains synovial fluid to protect joint). This causes inflammation and pain in the hamstrings and buttocks. Treatments can vary depending on the severity of the injury, but usually include rest, ice, medications, prolotherapy and rehabilitation exercises.
Types of Topical Treatment
Since ischial bursitis can often be felt when sitting down, rest usually includes taking pressure off the buttocks. This may entail using donut cushions to alleviate pain and discomfort. Rest prevents the further aggravation of the affected area. It also allows the ice time to control inflammation and pain. Ice causes vasoconstriction which controls swelling by limiting the amount of blood and lymph flow to the area. Ice will be most effective if it is compressed directly against the source of pain at 20-minute intervals. Elevating the irritated area above the heart (with pillows) can also help reduce inflammation.
Types of Medications
Anti-inflammatory medicines such as ibuprofen and naproxen can help alleviate pain and inflammation. These medications are Cox-2 inhibitors which limit the inflammatory effects of Cox-2 enzymes and prostaglandins. Doctors may prescribe steroids for more severe ischial bursitis.
Effects of Prolotherapy
If pain and inflammation from ischial bursitis continue to linger, prolotherapy may be recommended. Prolotherapy is an alternative to surgery. It stimulates additional inflammation in the affected area to force the body to heal itself. The procedure starts with an injection of a specific solution. According to Dr. Ross A Hauser, a medical doctor with 16 years experience in prolotherapy, "the localized inflammation triggers a wound healing cascade, resulting in the deposition of new collagen, the material that ligaments and tendons are made of. New collagen shrinks as it matures. The shrinking collagen tightens the ligament that was injected and makes it stronger."
Benefits of Exercise
Once the swelling and pain are under control, gentle stretching exercises can be used to loosen tight muscles and ligaments, preparing them for activity. Lying or standing and performing knee-to-chest exercises can be highly effective in the rehabilitation process for someone with ischial bursitis. Lightly stretching the hamstrings can also help re-acclimate the affected area to movement. The range of motion for stretching exercises should be limited to movements that do not cause pain. Gradually, a person can work their way into more strenuous activity such as walking or light weightlifting.
There is no set time frame for overcoming ischial bursitis. Because of its location, it is not unusual for someone to have this condition for two or three months. A doctor will usually be able to provide a better prognosis and recommend the best course of action regarding treatments.
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