Ischial tuberosity pain

definition

The ischium (Os ischii) is one of three bones that make up the hipbone. The ischium thickens towards the ischial tuberosity (Sciatic tuberosity). On the one hand, this serves as the lowest point of the bony pelvis as a support point. On the other hand, many hip and thigh muscles have their origin here. In addition, a ligament that stabilizes the sacrum-iliac joint goes from the ischial tuberosity (Sacrotuberous ligament), which prevents the hips - more precisely the sacrum - from tilting backwards.

Furthermore, the so-called is from the ischium Ischiofemoral ligament which runs from the ischium to the thigh bone (femur). This band is responsible for limiting internal leg rotation and stretching the leg backwards. Since these structures can be irritated, overstretched or even injured, pain can occur in this area - depending on the affected structure. Often these occur after performing unfamiliar sports.

Read more on this topic at: Ischial pain

root cause

On the one hand, the bone can be injured from overuse or falls. For example, the bone may break or crack, causing pain. Inflammation of the bone tissue can also cause pain in the ischium. An inflammation of the bone can be triggered, for example, by sitting too long, as is typical for office jobs. In very rare cases, tumors can cause inflammation or fragility of the bone.

Mainly, however, the numerous structures such as muscles, tendons or tendon attachments that start from the ischium or ischial tuberosity are inflamed, with tendons being affected more often than muscles. A strain or a torn muscle fiber can also cause pain. If muscles, tendons and ligaments are not properly warmed up before exercise, the risk of injury is generally greater. Even if you do sports that you are not used to and that are too strenuous for your existing condition, strains and injuries can occur more easily. Furthermore, many vessels and nerves run in the vicinity of or through gaps in the ischium. These structures can also become irritated and cause pain.

Read more on this topic at:

• Fracture of the ischium
• Inflammation of the bone skin on the coccyx
• Pain when seated

Biceps tendon tendinitis

The ischial tuberosity forms the lowest part of the bony pelvis. In addition to its supporting function when sitting, the ischial tuberosity (Sciatic tuberosity) a starting point for many muscles, especially the muscles of the back of the thighs. Biceps tendon tendinitis is an inflammation of the attachment tendon of the biceps femoris muscle (two-headed muscle on the back of the thigh). Such inflammation is typically caused by overuse of the muscle. Biceps tendon tendinitis can also develop from long periods of sitting, as the tendon is irritated by the pressure when sitting. Such an inflammation is usually not only expressed by pain in the ischial tuberosity, but also swelling, reddening and overheating of the affected area can occur. The symptoms are best cured by relieving the affected ischial tuberosity over a longer period of time.

Tendon tear on the ischial tuberosity

The ischial tuberosity forms the starting point for many muscles of the back of the thigh. These include the following muscles: Musculus biceps femoriis, adductor magnus, quadratus femoris, gemellus inferior, semimembranosus and musculus semitendinosus. Overloading the tendons of these muscles can weaken them, which can quickly lead to a tear in the tendon on the ischial tuberosity when the strain is repeated. Very severe, sudden trauma to any of the muscles in the back of the thigh can also cause a tendon to tear. Such a tendon tear is often expressed as pain in the affected ischial tuberosity (Sciatic tuberosity). The pain is particularly noticeable when the ischial tuberosity is stressed when sitting.

Broken bone in the ischial tuberosity

The ischial tuberosity is the part of the pelvic bone on which the entire weight of the upper body rests when sitting. A fracture of the ischial tuberosity is comparatively rare, but it can be triggered by severe trauma such as a traffic accident. A fatigue fracture of the ischial tuberosity is also possible. Depending on the severity of the bone fracture, the treatment is conservative (to protect the ischial tuberosity) or surgically (using bone screws or plates).

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Concomitant symptoms

In the case of a fracture, there is usually strong pain radiating into the buttocks and this leads to a relieving posture with flexion of the hips to relieve the affected side. Pain also usually occurs more intensely when sitting or when getting up from a sitting position. Are surrounding nerves injured, such as the Pudendal nerve, it can lead to sensory disorders of the skin in the genital and perineum area, for example.

In the case of inflammation, the typical cardinal symptoms such as redness in the area of ​​the inflammation, pain, overheating, swelling and loss of function occur. The individual symptoms can occur more or less and are individually different. In rare cases, tumors are responsible for pain in the ischium. You can observe so-called B symptoms such as fever, night sweats and severe weight loss. Should these occur, a doctor should be consulted.

Tendinitis

If you have tendinitis (Tendinosis / tendovaginitis) the tendon itself or the tendon sheaths, the tissue that surrounds the tendons, become inflamed. This inflammation is common in athletes who have not warmed up muscles and tendons sufficiently before the activity. Of course, this can also be caused by excessive stress or unfamiliar stress. Tendonitis on the ischial bone caused by physical activity is relatively common.
The friction of the tendons over the nearby bones can also cause inflammation. This occurs, for example, with malpositions that are transferred to the ischium due to spinal or hip malpositions. In rare cases, inflammation is caused by a bacterial infection. Since tendinitis often causes only minor discomfort in the beginning, it is not treated at all or inadequately and the pain worsens as the disease progresses. This can lead to calcium deposits between the tendon and bone and degeneration of the tendon, which then requires difficult and lengthy treatment.

diagnosis

In the case of pain in the ischium or ischial tuberosity, a targeted questioning (anamnesis) about symptoms, course and possibly the cause of the injury is followed by a physical examination. When taking the anamnesis, questions about sporting activity are therefore very important. It is also important whether a job is carried out that involves a lot of sitting in order to further narrow down the diagnosis and the cause of the pain. If there is pain in the ischium, this can be felt especially when sitting. In addition, pain is often described in the lower buttocks or the back of the thighs. An x-ray of the pelvis can be made to rule out a fracture of the ischial bones. CT or MRI may be needed to confirm a suspicion.

Treatment / therapy

Therapy differs depending on the cause. Immobilization is required in almost all cases. If a ischial bone fracture is to blame for the pain, appropriate pain therapy using so-called NSAIDs (non-steroidal anti-inflammatory drugs) should be used in addition to immobilization. If an unstable fracture occurs, surgical treatment may be necessary. Physiotherapy should also be carried out and the load should slowly be increased again.
Relief should also be provided for inflammation of muscles and tendons. Local anesthetics (narcotics) or glucocorticoids can be injected at the point of pain in addition to normal painkillers. The glucocorticoids also work against inflammation, but should not be used too often as they can lead to tissue degeneration. Physiotherapy should also be considered when treating inflammation. Heat can be applied to relax the muscles. If the pain occurs as a result of sitting for too long during work, seat cushions or seat rings can make sitting easier and prevent future inflammation in the ischial area.

Duration

Depending on the cause and how much the disease has progressed, the healing time will vary. If the pain is fresh and an overload is to blame, the ischial pain can disappear after a few days and after resting. If the complaints are long-standing or recurring, the treatment can drag on for several weeks or months. Sometimes the pain does not go away and the course becomes chronic, in which more intensive treatment has to be carried out over months or years.

Ischium tuberosity during pregnancy

If the ischium hurts during pregnancy, this is normal. Most expectant mothers feel this pain when sitting, getting up or when they turn while lying down. On the one hand, the pain is due to the constant increase in weight and size of the child and the uterus. The extra weight presses on the pelvis and thus on the ischial bones and can cause pain. Hormones such as estrogen and relaxin also loosen the tissues and joints to prepare the pelvis for childbirth. This relaxation can trigger pelvic pain that radiates into the ischial bones.

Read more on this topic at: Tailbone pain during pregnancy

Pain in the ischial tuberosity after jogging

After jogging - especially if the muscles and tendons are overstrained - pain occurs when the ischial tuberosities are involved, especially in the lower buttocks and the back of the thighs. The pain can usually be felt at rest and while sitting. This is usually due to an inflammation of the bursa in the area of ​​the ischium. It should be immobilized for several days to weeks. In any case, the pain should no longer be felt before resuming physical activity. Of course, sore muscles can also cause pain in the ischial area and when sitting and getting up from a sitting position. This will go away within a few days and is not a cause for concern.