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Clinically Relevant Anatomy
Ischiogluteal bursitis is inflammation of the bursa that lies between the ischial tuberosity and the tendon of a hamstring muscle. The bursa helps to reduce friction between the tendon and the bone. The bursa may be inflamed on its own or in conjunction with hamstring tendinitis or inflammation of tendon, which has the same symptoms.
Inflammation of the ischial bursa.
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Characteristics and Clinical presentation
- The symptoms of ischiogluteal bursitis are identical to hamstring tendon inflammation and include the following:
- Pain and tenderness at the ischial tuberosity.
- Pain when stretching the hamstring.
- Pain when flexing the knee against resistance.
- A gradually onset of pain following a sprinting session.
- Pain which may be aggravated by sitting.
- Piriformis syndrome
- Sacroilliac joint dysfunction
- Hamstring tendinopathy
- Trochanteric Bursitis
When examining the patient you are looking to source the route cause of the symptoms but also address areas that could pre-disposing the patient to this problem.
Quad, Hamstring and Glut strength should all be noted including a biomechanical assessment of gait.
Palpation is needed to localize the pain. During palpation – Is the pain specific and localised? Does it produce referred pain? As you get more familiar with palpation you will be able to recognize the feel of potential thickening and, to some degree, inflammation. Is there secondary muscle spasm?
Advice for patient.
- Rest. Particularly from aggravating factors such as sitting.
- Apply ice or cold therapy to manage pain (if no pain don’t use) (20mins 2-3 x daily).
- See a doctor or physiotherapist if symptoms persist.
- Carry out hamstring strengthening and rehabilitation as pain may have caused weakness through muscle inhibition.
- NSAID’s may help with pain – recommend that your patients speaks to their doctor for further information on this.
What can a health professional or physiotherapist do?
- Differentiate between a hamstring tendonopathy and ischiogluteal bursitis. This may involve analysing the effectiveness of treatment such as deep tissue massage. Bursitis will not respond to massage and may become worse following treatment.
- Inject a corticosteroid and local anesthetic into a fluid filled bursa.
- Advise on hamstring strengthening
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Click here for exempler notes for assessment and treatment.