Treatment of Ischial Tuberosity Pain
The ischial tuberosity is a swollen part or broadening of the bone in the frontal portion of the ischium, the lowest of the three major bones that make up each half of the pelvis. As the point of fusion of the ischium and the pubis, it is attached to various muscles and supports the weight of the body when one is sitting. Ischial tuberosity pain may be experienced by a wide range of athletes, including soccer players, cyclists, baseball players, figure skaters, cheerleaders and any type of jumpers or runners. It is often misdiagnosed as ischial bursitis, an extremely painful condition.
Ischial tuberosity pain can be very debilitating and severe, especially when sitting, standing, or running. It can be aggravated by prolonged sitting, since we sit on the ischial tuberosities.
The ischial tuberosity is the point of origin of the adductor and hamstring muscles of the thigh, as well as the sacrotuberus ligaments. The forceful pull of these muscles, such as can happen during a variety of sports, as a result of a trauma such as a fall or other type of injury, or through the overuse of the hamstrings, as is common among runners and soccer players, results in a separation or detachment, also called an avulsion, of an open ischial apophysis.
What are the symptoms of ischial tuberosity pain?
The symptoms of ischial tuberosity pain are, plain and simple, “a pain in the butt.” Pain on the bottom of the buttock, especially when sitting and running is typical. The area may also be quite tender and sensitive to touch.
The typical pain management route
Ischial tuberosity pain is often misdiagnosed as ischial bursitis, especially with athletes. The treatment modality commonly prescribed in modern medicine usually involves the RICE protocol, which consists of rest, ice, compression and elevation. The problem with this approach is that it does nothing to repair the injured tissue in the area, in this case ususally the sacrotuberous ligaments and/or the hamstring tendon attachment, and, thus, does not alleviate the chronic pain that people with this condition experience. Rest and ice are particularly serious culprits when it comes to soft tissue damage because they decrease circulation to the area, which actually hinders rather than helps the healing process.
Physical therapy is commonly ordered and has its place for the treatment of ischial tuberosity pain, but once again, does not address the issue of weak or injured ligaments or tendon attachments.
Steroid injections and anti-inflammatory medications are another standard recommendation of modern medicine. These treatments may provide short term relief, however, in the long run do more damage than good. You can read more of our research on the acceleration of joint degeneration topic in the Journal of Prolotherapy.
A better treatment for Ischial Tuberosity Pain
Prolotherapy is a regenerative treatment that successfully treats ischial tuberosity pain. Prolotherapy injections to the sacrotuberous ligaments and the hamstring tendon attachment will stimulate repair of these damaged areas. A comprehensive exam by the experienced Prolotherapist is vital for a thorough treatment. Sometimes pain in other areas is also involved. For instance, pain in the ischial tuberosities may be coupled with pain in the pubic symphysis. There may also be pain in the sacroiliac joints. A comprehensive Prolotherapy treatment will include all of the weakened or injured areas.
Prolotherapy for ischial tuberosity pain involves injections of a dextrose solution which causes a mild inflammatory reaction at the weakened areas. This initiates a wound cascade that includes an increase of blood flow and immune cells to the treated area. There will be an influx of reparative cells and a deposition of collagen to repair the injured ligaments and attachments. Once this soft tissue is strengthened, the sacrotuberous ligaments and the hamstring tendon attachment and other involved soft tissue will now be strong and stable, and the ischial tuberosity pain will resolve.