Ischial pain


The ischium (medical: Ischium) and the associated Ischial tuberosity (Sciatic tuberosity) are anatomical, bony structures of the human pelvis. Pain in the ischium or ischial tuberosity can present in different ways.

Often the ligaments or muscles and adjacent nerves are likely to be involved.
In order to find out the individual cause and to be able to initiate a suitable therapy, an orthopedic specialist should be consulted.

Also read on this topic: Ischial tuberosity pain

Where is the pain? Left, Right, or Both Sides?

Depending on which clinical picture the pain is based on, the pain can occur on the right or left as well as on both sides. The mere fact that the pain occurs on one or both sides cannot be used to determine which clinical picture is present. Both tendon shortening and systemic disease can lead to pain on both sides.

In general, however, if systemic diseases, such as certain rheumatic diseases, usually lead to pain on both sides. Muscular causes, on the other hand, occur more often on one side and therefore tend to lead to complaints on the right or left side.

In the case of unilateral or central pain, the possibility of a coccyx fistula (Pilonidal sinus) be considered.

Causes of ischial pain

The causes for the occurrence of pain in the ischium are diverse.
Usually, the bones themselves are not the cause of the pain.

A fracture of the ischium can of course also lead to pain in this region, but this bone usually only breaks after very strong violence, such as a traffic accident or a fall from a great height.

Read more on the topic: Rupture of the ischium and inflammation of the skin on the coccyx

Most ischial pain is caused by structures that are adjacent to the ischial bone.
Above all, the ligaments and muscles must be considered. It is not uncommon for the tendons to be shortened in the pelvis. Since the ischium is the origin of many tendons, pain is relatively common in this region.
This can particularly affect endurance runners who put a very one-sided and heavy load on the legs.
But even untrained people often suffer from shortened tendons on the ischium.

Reasons for this can be:

  • Irregular exercise,
  • a false burden
  • and insufficient stretching


An irritation of the muscles themselves can also be caused by vigorous training or an incorrect load.
The pain then usually occurs acutely and stress is hardly possible.

Read more on the subject Pain when seated

Certain diseases can also be the cause of the pain in the ischium. Above all, systemic joint diseases should be considered as the cause of chronic pain in the ischium area.

Ultimately, local inflammation in the ischial area must always be considered. The so-called ischial fistula (Pilonidal sinus) in which there is a chronic inflammation of the gluteal folds and which also leads to pain in the region of the ischium.

Read more on this topic at: Tailbone Pain - These are the watch things

Ischial fracture

Broken bones in the pelvis and especially the ischium usually lead to very severe pain in this area.

There are many reasons for a fracture of the ischium. Usually a lot of force is required to fracture the ischium. This force can arise, for example, in the event of a traffic accident or a fall from a great height, as well as direct violence on the pelvis. If there are diseases that damage the skeleton of the pelvis, such as osteoporosis or a bone metastasis from a tumor, a fracture can sometimes occur even with less force.

You can find more information about this at: Ischial bone fracture

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The term rheumatism encompasses a number of different systemic diseases that can affect the human musculoskeletal system. Both older and younger people can suffer from rheumatic disease. Pain in the ischium can also be an indication that a rheumatic disease is present.

This localization is particularly typical for the clinical picture of the so-called Bechterew's disease. This chronic inflammatory rheumatic disease initially affects the tendons of the pelvis until the entire spine stiffens in the course of the disease.

So-called fibromyalgia, also a form of rheumatism, can also lead to pain in this location.

Overall, however, the clinical pictures are relatively rare, which is why rheumatic clinical pictures for pain in the ischium should not be considered first.

Read more about this under: Rheumatism

Pressure ulcer

A pressure ulcer is a defect in the skin. Continuous pressure on one and the same place damages the skin. Anyone who stresses the same area of ​​the skin over the ischium for a long time can develop a pressure ulcer. Due to the pressure, the stressed area is not sufficiently supplied with blood, the skin cells cannot regenerate and an open area is created. It typically affects people who are not particularly mobile, such as wheelchair users. They sit all day and often find it difficult to shift their weight from one side of the buttocks to the other. Nerve damage can also lead to pressure ulcers. Affected people do not notice that the skin is stressed because of the sensory disorder. Typically, decubitus ulcers heal very slowly due to poor blood circulation, they can also become infected with bacteria, which leads to a painful inflammation.

Read more on this topic at: Pressure ulcer

Inflammation of the ischium

The ischium (Os ischii) is part of the pelvic bone. This is the part of the pelvis on which the weight rests when sitting, hence the name ischium. The lower part of the ischium is protected by a pad of fat. The ischium can become inflamed due to a reduction in the fat pad. This usually leads to a painful inflammation of the periosteum. The surrounding tissue can also be the origin of the inflammation. So-called aseptic inflammation can occur, which is not caused by pathogens. If there is a small skin defect, germs can penetrate the skin and cause superficial inflammation. This can spread into the depths and thus also trigger the inflammation on the ischium.

Accompanying symptoms of ischial pain

In order to find out which cause is responsible for the individual pain in the ischium, the attending physician will ask about other complaints that occur along with the pain. These accompanying symptoms may vary depending on the cause of the pain.

If there are nerve irritations, the pain often radiates to the leg or the foot of the affected leg. Shortened tendons can be associated with restricted movement in the hips and / or spine. If the muscle itself is affected, there is often a greater or lesser decrease in strength of the respective muscle.

If diseases of the rheumatic type are the cause of the pain in the ischium, these are often associated with general weakness and fatigue, sleep disorders and other pain in the joints and the spine.

Non-specific symptoms such as cardiac arrhythmias, susceptibility to infections, irritable bowel syndrome or a slightly elevated temperature can also be indications of the presence of a systemic disease. It can also lead to reddening of the skin and localized swelling in the ischial region. In these cases, the presence of an ischial fistula must be considered.

Diagnosis of ischial pain

In the case of pain that occurs in the ischium or the ischium, it is basically a symptom that can occur due to various diseases. In order to make the diagnosis, a doctor should therefore be consulted if the pain in the ischium persists.

The attending physician can use different methods to make the correct diagnosis. First of all, the detailed anamnesis of the person concerned is particularly relevant. The physical examination and movement of the pelvis and spine can also give an indication of which illness may be responsible for the pain.

Diagnostic imaging methods such as X-rays or MRI are often necessary to make the diagnosis. Particularly in the case of rheumatic diseases, certain parameters in the blood can also be examined which, if increased, speak for the presence of such a disease.

How is pain in the ischium treated?

Therapy for ischial pain should always be based on the underlying cause of the symptoms.

Basically, pain medication can usually improve the symptoms in the ischium. Depending on the cause of the symptoms, so-called non-steroidal pain medication such as ibuprofen or diclofenac can be used. In some cases, it may make sense to give stronger pain medication temporarily. Medicines normally used for depression or epilepsy can also be effective. These drugs include amitriptyline, gabapentin or duloxetine, for example.

Manual therapy in the form of intense physical therapy or physical therapy can also help improve symptoms.

If there are fractures of the pelvis, surgery usually has to be carried out to reconnect the bone fragments and stimulate healing.

There are also a number of substances from the field of natural healing methods, which, depending on the clinical picture, can have a discomfort-relieving effect. An example of this is the Retterspitz as a substance from naturopathy that can relieve pain in the ischium.

How long does ischial pain last?

Depending on the clinical picture, the pain in the ischium can last for different lengths of time. A basic distinction is made between acute and chronic clinical pictures.While acute symptoms, such as a fracture in the ischium area, can be pain-free after a few weeks after correct treatment, chronic symptoms are usually associated with a longer duration.

It can even be that certain clinical pictures occur again and again in attacks over decades and cause symptoms. In these cases, the focus is on therapy that can reduce the symptoms of the disease.

Ischial pain after childbirth

During the natural process of childbirth, the child has to pass through the mother's pelvis. The position of the pelvic bones is changed during pregnancy so that the birth of the child is made easier. Above all, the ligaments of the bony pelvis and the Symphysis expands significantly. After birth, these changed structures are not immediately back to what they were before pregnancy. It can sometimes take months for the tapes and the Symphysis return to the original state. This can sometimes lead to pain in the ischium area.

It is also possible that certain structures in the pelvis may be damaged by the birth process itself. In order to rule this out, a doctor should be consulted for clarification, especially in the case of persistent pain in the ischium after the birth.

Ichial pain in pregnancy

During pregnancy, a large number of internal structures are displaced due to the lack of space. There is also a hormonal change in the bony pelvis and its surrounding structures. In this way, the ligaments loosen and the symphysis is loosened. These significant changes often lead to complaints, which can be expressed in pain in the ischium.

Overloading the spine or the pelvis is also possible due to the weight load during pregnancy. This high stress can lead to pain in different regions.

If nerve irritation occurs due to the lack of space during pregnancy, this can also lead to pain, especially in the area of ​​the ischium.

Please also read: Tailbone pain during pregnancy

Ichial pain when sitting

If the symptoms are triggered by increased sitting or if it is generally not possible to sit painlessly, this can have several causes. The name ischium already makes it clear that this part of the bony pelvis is particularly stressed when sitting. If there is a fracture of this part of the bone, sitting in particular will cause severe pain. Even if surrounding structures such as ligaments, tendons or muscles are responsible for the pain, sitting can lead to discomfort.

You might also be interested in: Pain when sitting

Ichial pain when cycling

If cycling causes pain in the ischium, this can have different causes, depending on the underlying clinical picture. For example, if there is a shortening of the tendons, the special posture on a bicycle can trigger the pain.

An unfavorably shaped saddle can also lead to pain in the ischium area. A consultation in a bicycle shop and the adjustment of the bicycle saddle to the individual distance between the ischial tuberosity can help to limit the pain when cycling.

Figure pain in the buttocks: view of the back, buttocks, thighs and causes of pain (A-D)

Buttock pain

  1. Lumbar spine (lumbar spine)
  2. Iliac crest - Iliac crest
  3. Lumbar sacrum nerve plexus
    Lumbosacral plexus
  4. Iliac scoop - Ala ossis ilii
  5. Pear-shaped muscle -
    Piriformis muscle
  6. Great Rolling Hill -
    Greater trochanter
  7. Femoral head (= femoral head) -
    Head femoris
  8. Ischium - Os ischii
  9. Sciatic nerve - Sciatic nerve
  10. Femoral shaft -
    Corpus femoris
  11. Lumbar and sacrum kink -
  12. Gluteus Middle - Gluteus medius muscle
  13. Sacrum - Sacrum
  14. Gluteus Muscle -
    Gluteus maximus muscle
  15. Bursa (large rolling mound) -
    Trochanteric bursa
  16. Iliac-tibial tendon -
    Iliotibial band
  17. Cam impingement
  18. Pincer impingement
    A - Piriformis Syndrome -
    Irritation of the sciatic nerve
    Piriformis muscle
    B - Lumboischialgia -
    Pain in the lumbar spine and
    Leg pain over the sciatic nerve
    C - trochanteric bursitis -
    Inflammation of the bursae
    of the hip joint
    D - Combined hip impingements -
    Cam impingement
    (Camshaft impingement) and
    Pincer impingement
    (Pincer impingement)

You can find an overview of all Dr-Gumpert images at: medical illustrations