Ischiogluteal or proximal hamstring tendonitis and bursitis present similar symptoms, including pain at the upper thigh just below the buttocks. These conditions can also coexist.
Medically reviewed by Dr Chaminda Goonetilleke, 10th Feb. 2022.
Ischiogluteal bursitis
Ischiogluteal bursitis involves inflammation of the bursa situated between the hamstring tendon and the bone. This bursa serves to minimize friction between the tendon and the bone. Ischiogluteal bursitis can occur independently or in conjunction with hamstring tendinitis.
Symptoms
Ischiogluteal bursitis shares similar symptoms with hamstring tendon inflammation, often developing gradually over time.
Common symptoms include:
- Pain and tenderness at the ischial tuberosity (sit bones).
- Discomfort when stretching the hamstring muscles.
- Aggravation of symptoms with prolonged sitting, particularly on hard surfaces, as well as during sprint training.
- Pain may be experienced during hamstring muscle stretching but not when contracting against resistance.
- Palpation or direct feeling of the bursa is typically not feasible, but confirmation of the diagnosis can be achieved through an MRI scan or ultrasound scan.
Treatment of Ischiogluteal Bursitis
To address ischiogluteal bursitis and hamstring tendinitis, consider the following steps:
Rest: Allow time for proper healing and recovery.
Apply ice or cold therapy: Use this to reduce pain and inflammation.
Consult a doctor or physiotherapist: Seek professional guidance if symptoms persist.
Initiate hamstring exercises: Gradually begin exercises once pain allows, as muscle weakness may have developed due to pain-related inhibition.
Professional assessment: A healthcare professional can differentiate between hamstring tendinitis and ischiogluteal bursitis, analyzing the effectiveness of treatments such as deep tissue massage.
Bursitis treatment: Keep in mind that massage is not effective for bursitis and may worsen symptoms. In such cases, a healthcare professional may recommend injecting a corticosteroid and local anaesthetic directly into the fluid-filled bursa.
Remember to consult with a healthcare professional for an accurate diagnosis and appropriate treatment plan.
Hamstring origin tendonitis (tendinopathy)
Hamstring tendinitis is the inflammation of the hamstring tendon which attaches to the ischial tuberosity at the top of the back of the thigh. Tendonitis or tendinopathy can result from overuse or an inadequately healed tendon tear.
Symptoms of hamstring origin tendonitis
Symptoms of hamstring tendonitis include:
- Pain and tenderness at the ischial tuberosity, located just under the buttocks.
- Gradual onset of buttock or thigh pain after engaging in sprinting activities.
- Discomfort when stretching the hamstring muscles.
- Exacerbation of symptoms during exercise, especially repetitive movements like long-distance running.
- An MRI scan is typically employed to confirm the diagnosis.
Causes & anatomy
Hamstring tendinitis refers to the inflammation of the hamstring tendon at its attachment point on the ischial tuberosity in the upper back of the thigh. It can result from a poorly treated tendon tear or, more commonly, from overuse. The term tendinopathy is a more accurate description of the condition, as tendonitis implies acute inflammation, which may not always be the case in chronic or long-term injuries.
The three hamstring muscles include the semimembranosus, semitendinosus, and biceps femoris muscles.
Treatment
For chronic hamstring tendon injuries, rest and cold therapy reduce inflammation. Follow with a stretching and strengthening program. Healthcare professionals may recommend NSAIDs for pain relief. Ultrasound and deep tissue sports massage are effective treatments.
For stubborn cases, ultrasound-guided corticosteroid injections or shockwave therapy may help. Surgical intervention (hamstring syndrome) may be necessary for severe cases with fibrous adhesions irritating the sciatic nerve.
