Ischial tuberosity pain (sit bone pain) can make it very difficult for one to sit comfortably. The name of this condition stems from its bony location found in the pelvis called the ischial tuberosity. This area is located at the bottom portion of the pelvic bone and is essentially a bony protrusion that carries much of the body weight when in the seated position. This area is also known as the sitting bone or stiz bone (stemming from the from German verb “sitzen,” meaning “to sit”).
The ischial tuberosity has many different muscle connections that make developing ischial tuberosity syndrome more common in athletes that take part in sports such as hurdling, cycling, running, skating, and soccer. Extended periods of forceful muscle pulling of this area can lead to pain development of ischial tuberosity pain.
Ischial tuberosity anatomy
The ischial tuberosity is located near the lateral boundary of the pelvic outlet. This bony protuberance is covered by the gluteus maximus muscle when standing but shifts behind it when sitting. The gluteus maximus is a broad, thin, and outermost muscle of the buttocks involved in rotation and extension of the thigh.
The ischial tuberosity is divided into two parts:
- Upper region: In the superior (uppermost) position of the bone, having a smooth shape consisting of four angles. It is subdivided into two sections by a ridge running downward and outward.
- Lower region: Appears as an irregularly shaped triangle situated at an inferior (lowermost) position. It is divided into two parts by a longitudinal ridge running from the base to the top of the structure.
Causes of ischial tuberosity pain
Extended periods of exercise and activity involving the legs can overload this area of the body, leading to ischial tuberosity pain. It can also be caused by direct injury to the sitting bones or accidental overstretching of muscles surrounding it. When this occurs, pain is felt in the lower area of the buttocks while walking, running, or just sitting.
Injuries to the following areas can lead to ischial tuberosity pain:
- Stress fracture of the ischial tuberosity
- A bruise at the hamstring attachment
- Stress fracture of the ischial tuberosity
Additionally, sitting for prolonged durations, especially on hard surfaces, can damage the ischial tuberosity and lead to a condition called ischial bursitis. This is a fluid-filled sac that acts as a cushion between the pelvis and the nearby tendons. The formation of a bursitis is to prevent additional damage but it tends to be painful in nature.
If proper care is not taken to help remedy a case of ischial tuberosity syndrome, inflammatory swelling may occur in this area, further exaggerating pain. This inflammation may also have an effect on the sciatic nerve, which passes the greater trochanter and ischial tuberosity. This can lead to the development of symptoms that extend down the leg.
Symptoms of ischial tuberosity pain
Symptoms may vary from patient to patient, as the type of injury or ailment leading to ischial tuberosity pain syndrome can differ. However, pain is a defining characteristic that may carry subtle nuances and it is up to the diagnosing physician to pinpoint where the pain originates from. Additional symptoms of ischial pain syndrome can include:
- Pain when sitting for extended periods of time
- Numbness of the lower buttocks and posterior thigh
- Pain that travels down the back of the calf, heel, and into the plantar tissues of the foot (if sciatic nerve involvement)
- Unable to sit in one spot for more than 15 minutes
- Burning pain in the ischial tuberosity
- A dull ache in the buttocks
- Having a pulled muscle sensation
- Tingling pain around the hamstring muscle
Treatment for ischial tuberosity pain
Ischial tuberosity pain treatment involves managing and further preventing symptoms. At home, treatment is recommended before seeking the aid of a medical professional and thankfully most remedies are easy to perform. The following are various treatment options to help reduce ischial tuberosity pain.
- Rest: It is important to stop all aggravating activities that may have brought on the pain to begin with. This will help promote healing and reduce recovery time.
- Ice: A common treatment for the reduction of pain and inflammation. Ice is also a great option for reducing swelling by constricting capillaries.
- Mild exercise: Can help with pain management. It is advised, however, to avoid any heavy exercise.
- Medications: Commonly found over-the-counter medications like NSAIDs (non-steroidal anti-inflammatory drugs) work great at reducing pain and inflammation. Common NSAIDs include ibuprofen and naproxen. Pain relief medication may also be found in the form of lotion and can provide additional relief.
Injuries that have not successfully healed using conservative management may require the use of more invasive procedures or other treatments.
- Steroid injections: If all other options for pain relief have failed, your doctor may recommend getting steroid injections. This is the most effective method for pain and inflammation treatment, however, it is not recommended for extended use.
- Prolotherapy: An injection procedure that aims to treat connective tissue injuries. It involves the injection of a substance into the site of injury, causing an inflammatory reaction and creating new blood vessels. This helps to promote healing of damaged soft tissue and the reduction of pain. This treatment is generally reserved for severe cases of ischial tuberosity pain.
- Stem cell therapy: A procedure that promotes inflammatory products to the affected ligaments with the aim to promote self-healing. They help to heal tissue and reduce pain.
Exercises for ischial tuberosity pain
Because your body is interconnected through muscles and tendons, various exercises that target the ischial tuberosity area can improve strength and flexibility, helping to reduce strain on the sitting bones. The following are suggested exercises that should only be performed if able. If you are experiencing increased levels of pain, it is recommended to see a physiotherapist to instruct you further.
- Hamstring stretch: Sit with your right leg straight and the left leg bent inward so that the sole of your left leg is flat against your right inner thigh. Now place both hands underneath your right knee while keeping the right leg straight on the floor. Slowly bring your chest down toward your right leg, holding the position for 30 seconds. Now repeat on the opposite side
- Frog adductor stretch: Begin by going on your hand and knees and keeping your back straight and chest lifted. Now, while keeping your upper body stationary, extend your legs like a frog and open up your pelvis area. Hold this stretch for 30 seconds.
- Leg curls: This exercise can be done with an exercise bike or with an outdoor bike. You could also use a machine to specifically perform leg curls as it strengthens your hamstrings. It is important to remember to rotate your legs so that your knees point outward to correctly target this muscle.
When to see a doctor
Experiencing pain in the buttock region should prompt you to be concerned about a serious injury that may have occurred. Not being able to sit comfortably should be the initial warning letting you know that something is not right.
If you are having difficulty sitting for more than 15–20 minutes at a time or are experiencing pain while walking, running, playing sports, or during moderate stretching, seeking professional medical attention for an expert evaluation of your pain should be done. This is especially true if pain symptoms persist for more than a few days.