Whenever you’re seated — whether in a desk chair, on the couch, or cross-legged on the floor — most of your body weight is resting on your buttocks. No matter what your butt looks like, everyone has some fat in this area. Underneath that is a layer of muscle. And under those muscles are your sit bones — two rounded bones that make up the lowest part of your pelvis (otherwise known as the ischium). The sit bones are literally the bones you sit on, and a tiny fluid-filled sac, known as bursa, cushions each one. If one or both of those sacs becomes inflamed or irritated, you can end up with pain and swelling that’s known as ischial bursitis.

Ischial bursitis may be a mouthful, but it’s a relatively common form of sit bone pain. Fortunately, there’s plenty you can do to relieve the discomfort. 

Read on to learn more about what causes ischial bursitis and how to feel better with help from our Hinge Health physical therapists.

What Is Ischial Bursitis?

Ischial bursitis is an inflammation or irritation of the bursae (fluid-filled sacs) that cushion your sit bones on the bottom of your pelvis. You might hear this problem referred to as “weaver’s bottom” or “tailor’s bottom,” because it was first reported in workers who spent a lot of time sitting on hard surfaces.

If you’ve heard of bursitis before, it may be because there are many forms of it. There are hundreds of bursae all over the body, including around your knees, hips, shoulders, and elbows. They act as a gliding surface to cushion an area where bones would otherwise rub on muscles, tendons, or skin, to prevent friction and inflammation during movement. Anywhere there’s bursae, there’s always the potential for bursitis. 

Symptoms of Ischial Bursitis

Ischial bursitis is a literal pain in the butt, but your tailbone shouldn’t hurt; instead, the discomfort will be concentrated around the sit bones, says Sarah Kellen, PT, DPT, a physical therapist at Hinge Health. The most common symptoms are:

• Pain in the buttocks that gets worse when you sit for a long time. “The pain will mostly be around one or both sit bones, though sometimes it radiates so you might feel it at the top of the butt or on the undersurface of the thigh around the hamstrings,” says Dr. Kellen.

• Pain when cycling or running. Cyclists may notice the pain when sitting on a bike seat, says Dr. Kellen, and runners may also experience this problem due to friction caused by repetitive motion.

Ischial Bursitis: A Hinge Health Perspective

Learning about conditions that cause pain can be alarming. We know from Hinge Health members and research studies that anatomical labels can backfire when it comes to your treatment and recovery. When people hear they may have a condition like ischial bursitis, it may cause feelings of panic, like you have something "wrong" with your sit bones that needs to be fixed. This way of thinking about pain is largely outdated. 

The fact is that experts say pain is more complex than simply what may or may not be happening to your sit bones. Other factors, like life stressors, can also play a big role in how you experience pain. And for most common musculoskeletal conditions, regardless of what may or may not be contributing to pain in your tissues, the solution is often the same. Movement — through physical and exercise therapy — builds strength and flexibility and resilience to pain. 

And keep in mind: The most common cause of ischial bursitis is prolonged sitting, so sitting down less — and moving more — is often key to feeling better. If you notice ischial bursitis when cycling or running, however, don’t fret: You don’t have to stop doing the activities you love, says Dr. Kellen. “There are almost always ways to modify activities to make them more comfortable and take some pressure off your sit bones,” she says.

Causes of Ischial Bursitis

The most common causes of ischial bursitis are:

• Sitting for too long, especially on a hard surface, which puts pressure on the sit bones and bursae that cushion them.

• Friction and repetitive motion. This is a common problem among cyclists and runners. Cyclists put pressure on this area by sitting on a bike seat. Runners are also impacted because they repeatedly and frequently contract the muscles (like the hamstrings and glutes) that attach to the sit bones. “This repetition can cause inflammation and bursitis if you ramp up too quickly,” says Dr. Kellen.

Treatment Options

The most common cause of ischial bursitis is sitting too much, especially if you’re perched on a less-than-comfy surface, says Dr. Kellen. Once the bursae become inflamed, sitting down puts pressure on them and further increases the pain, she explains. 

Treatment for ischial bursitis centers around taking pressure off the inflamed bursae so they have time to heal, says Dr. Kellen. Options include:

• Icing the area, which may be soothing and help relieve inflammation. Remember to keep a barrier (like pants or a towel) between your skin and the ice pack.

• Taking over-the-counter medication. Pain relievers such as ibuprofen (Advil, Motrin), naproxen (Aleve), and acetaminophen (Tylenol) can be helpful for ischial bursitis pain. It’s important to make sure that you are safely able to take these medications, based on your medical history.

• Modifying your exercise routine, such as by cycling more often out of the saddle instead of staying seated the whole time. Both cyclists and runners typically benefit from decreasing mileage and intensity for a short period until the inflammation decreases, then gradually working back up to their usual activity level. 

• Changing positions frequently, especially if you sit a lot. If you have a desk job, that might mean using a standing desk part of the time or taking more frequent breaks. When you do sit, try to sit on something softer (like a foam or gel cushion) and change your position periodically.

• Doing stretching and strengthening exercises. “You want to increase blood flow to the area as well as strengthen the surrounding muscles, which will take some pressure off the muscles that attach closest to the sit bones,” says Dr. Kellen. A physical therapist can devise a customized plan for you. You can see a physical therapist in person or use a program like Hinge Health to access a PT via telehealth/video visit.

These are some moves that Hinge Health therapists often recommend for ischial bursitis to help speed healing and recovery. Stretches can provide some immediate relief, while strengthening moves will have a longer-term payoff as they eventually enable you to take pressure off the bursae, says Dr. Kellen. 

The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.

Preventing Ischial Bursitis

The best way to prevent ischial bursitis is to avoid sitting for prolonged periods, says Dr. Kellen. Other prevention tips include:

• Changing position frequently throughout the day.

• Avoiding sitting on a hard surface; use a cushion, if needed.

• Warming up sufficiently before doing repetitive exercise like cycling or running. Increasing mileage or intensity gradually can help too.

PT Tip: Support Your Lower Back 

Adding some support to your low back when you sit can help prevent or manage sit bone pain, including ischial bursitis. Try rolling up a towel and putting it behind your lower back when you’re sitting, says Dr. Kellen. “By putting it right at your lumbar spine, it will help tip the pelvis forward so you’re not sitting directly on the sit bones as much,” she says.

How Hinge Health Can Help You

If you have joint or muscle pain that makes it hard to move, you can get the relief you’ve been looking for with Hinge Health’s online exercise therapy program. 

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app, when and where it works for you.

Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you.

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References 

1. Johnson, D. B., & Varacallo, M. (2020). Ischial Bursitis. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK482285/ 

2. Ischial Bursitis. (n.d.). Sports Medicine Information. Retrieved from https://sportsmedinfo.sg/condition/ischial-bursitis/.