Ischial Pain

Ischial Pain:


Commonly called as ischial tuberosity pain.

Ischial PainThe 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 pain, an extremely painful condition.

The ischial pain tuberosity is the point of origin of the adductor and hamstring muscles of the thigh, as well as the sacrotuberous 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 Pain apophysis.

Conventional medical treatments may help relieve the symptoms of ischial pain, but they do not address the root of the problem. By strengthening structural weaknesses in the body, as natural medicine treatments like Prolotherapy do, pain associated with the ischial tuberosity may be alleviated permanently.

Isolated fractures of the ischium are rare and quite often do not involve the weight bearing portion of the pelvis. Avulsion fractures of the ischium can occur with acute hamstring injuries. The majority of fractures of the ischium are associated with acetabular fractures that affect the posterior column. The obturator foramen is a fixed ring structure. A fracture in one part of the ring will almost always lead to a fracture of the ischiopubic ramus.

Patients typically present with pain in the absence of deformity. Patients may be able to ambulate or be completely obtunded in the polytrauma patient. The mechanism of injury usually dictates the degree of associated injuries.


The symptoms of ischial tuberosity pain are, plain and simple, “a pain in the butt or colloquially PITA.” Clients will typically describe pain on the bottom of the buttock and in the hamstrings, often quite severe and prolonged when sitting, especially on firm surfaces and when running or lifting objects. The area may also be quite tender and sensitive to touch.

Causes and Risk factors:

The ischial pain tuberosity is the point of origin of the adductor and hamstring muscles of the thigh, as well as the sacrotuberous ligaments. The forceful pull of these muscles 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. In rare cases, an avulsion fracture or separation of the Ischial Pain tuberosity or apophysis can occur.

In addition to its frequency in athletes, its common occurrence in bicycle riders results from the weight on the saddle being born by the ischial tuberosity. It also occurs with invalids confined largely to wheelchairs and no doubt those spending hours on computers sitting on inappropriate seats and or with inappropriate ergonomics.

The condition is normally that of hamstring tendonitis, less commonly it can be ischiogluteal bursitis of the bursar separating the gluteus maximus from the underlying bone or both. The pain is felt directly on the ischial pain tuberosity and in the hamstrings. These were the locations of my pain. In addition there appeared to be some entrapment of one or both of the sciatic/tibial nerve and possibly that of the descending cutaneous superior gluteal nerve. The numb sensation was felt in and down the mid to posterior-lateral aspects of the thigh and lateral to frontal in the calf. It was triggered by certain seating positions on a hard or firm seat but was not painful unless rolled across.

Typically treatments include RICE, NSAIDs, cortisone injections and physiotherapy.

Many muscles and ligaments can be involved in and associated with ischial pain and include the following where many related trigger points are found:

Sacrospinous, sacrotuberous and posterior sacral ligaments.

  • Semitendinosus and semimembranosus muscles.
  • Gluteus Maximus and Minimus muscles.
  • Quadratis and iliocostalis lumborum muscles.
  • Adductor Magnus and longissimus thoracic.
  • Biceps femoris-long head.


Any fracture in the pelvic should raise the clinical suspicion for associated injuries. A comprehensive physical examination is warranted in these situations per the ATLS protocol. After a physical examination, plain radiographs should include AP pelvis, inlet, outlet and Judet views. IsolatedIschial Pain fractures are rare and a CT may be warranted to evaluate the acetabulum.


Since ischial tuberosity pain is often misdiagnosed as Ischial Painl bursitis, modern medical treatment usually involves, and especially if the patient is an athlete, 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, 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.

Another standard practice of modern medicine is to inject steroids into the area or to prescribe anti-inflammatory medications. However, in the long run, these treatments do more damage than good. Although cortisone shots and anti-inflammatory drugs have been shown to produce short-term pain benefit, both result in long-term loss of function and even more chronic pain by actually inhibiting the healing process of soft tissues. Plus, long-term use of these drugs can lead to other sources of chronic pain, allergies and leaky gut syndrome.

When all else fails, patients who experience chronic pain are often referred to a surgeon. Unfortunately, surgery often makes the problem worse. Surgeons will use x-ray technology as a diagnostic tool, which does not always properly diagnose the pain source. And decisions to remove cartilage tissue often result in arthritis.

The Natural Medicine Approach to Ischial Tuberosity Pain: A better approach is to stimulate repair of the sacrotuberous ligaments and the hamstring tendon attachment with Prolotherapy. Chronic pain is most commonly due to tendon and ligament weakness, as may be the case with ischial tuberosity pain or cartilage deterioration. The safest and most effective natural medicine treatment for repairing the tendon, ligament and cartilage damage is Prolotherapy. In simple terms, Prolotherapy stimulates the body to repair painful areas. It does so by inducing a mild inflammatory reaction in the weakened ligaments, tendons, and cartilage. Since the body heals by inflammation, Prolotherapy stimulates healing.

Prolotherapy offers the most curative results in treating chronic pain. It effectively eliminates pain because it attacks the source: the fibro-osseous junction, an area rich in sensory nerves.

Medicine and medications:

Nonsteroidal anti-inflammatory medications for pain:

  • Ibuprofen.
  • Naproxen.
  • Ketoprofen.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.


  1. Claire

    Both times I had a flairup of polymyaglia rheumatica it started with painful ischial tuberosity. Fisrt time, pain was only in peltic girdle and went away after two years. This time pain also in hamstrings and shoulders, but started with ischial tuberosity pain only for about two months.

  2. theo ricci

    I’m happy i found this article. Now mt butt pain makes sense.


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