ischeal bursitis

hi all
yesterday a ptient came with the complaint of pain in the ischeal area and difficulty in sitting.
detailed examination and x rays helped to come to the conclusive diagnosis as ischeal bursitis.
as i am coming across ischeal bursitis for the first i need your treatment suggestions
we started with local ultrasound and gluteal setting exercises
expecting your feedbacks

Hi linbin. I hope more people respond to you as I have to admit that I HATE treating any bursitis.....unless it is related to ongoing biomechanical fault (i.e. rather than a traumatic insult). So...if more folks respond....I may just learn something!!!
When it's due to trauma (like a direct blow to the area), I say I hate treating it because I find my options with treatment are so limited. As we all know, research supporting the use of u/s is limited however I'm sure most us have clinical experiences that support its use from time to time. Personally, however, I have never found u/s to be all that useful in treating bursitis. That being said, when I have seen and palpated those old, recurrent bursitis' that seem "gritty" and / or "boggy", I have used u/s with the thought that perhaps high intensity, continuous u/s may help in re-starting an inflammatory response, activating some cells and just generally getting the body doing something in the area to jump-start the healing process. (Don't know if it actually works; just based on theory and my thoughts...)
When a bursitis is due to biomechanical faults (repetitive stress type of injury), I think it's easier to treat because there is more to work with but the bursitis itself still may take some time to settle. So for an ischial bursitis, I may be wondering about the status of the gluts, hams,....then related to that the deeper stabilizing musculature that if not adequate may be putting more demand on gluts, hams. Related to that, Lsp and pelvis mobility and/or dynamic stability. From an ergonomic perspective...what does this person do during the day. Do they sit alot? Can you alter their chair so that they don't have direct pressure on the ischial tuberosity?

hi
thanks a lot for sharing your thoughts.
she had a history of fall on her buttocks 3 m back.initially it was not so painful over the area.
she is a housewife.she spends more time sitting,which is causing her pain.even lying supine will also cause pain.
even i personally don't believe ultrasound is an option in this case. nothing much we can do i feel

Could there be an associated tendinopathy in the area that is causing increased pressure / irritation to the bursa? Other than the bursa, can you find anything related to gluts or hams (muscle belly or tendons)? If so, would you be able to treat as a tendinopathy without irritating the bursa (ie. eccentric exercise, local soft tissue techniques/frictioning to the tendons)?

If she does sit a lot, I would probably try to focus on finding a way that she can sit without continually irritating the bursa. A few thoughts...
1. soft chair / cushion?
2. the "doughnut pad" idea comes to mind too but can't think how this could be done for the ischial tuberosity without causing discomfort to the perineum?
3. remember those chairs that were marketed years ago to decrease back stress (but then people found out they are really hard to get out of without falling over and hurting your back...haha) that had a pad where the shins would rest against and the actual seat was on an angle? The pressure may still be on the ischial tuberosities (if in good sitting posture) but at least some of the body weight would be put on the legs and thus taking some of the pressure off the bursa???
4. How is she on a ball? Again she would still have pressure on the ischial tuberosities but A)it would be a wee bit softer than a chair and B) the direction of the force may be slightly different just due to the shape of the ball vs. a flat chair.

hi
thanks a lot for the reply
all the related muscles over there is not showing any signs of tendinopathy.it was ruled out
she sits in a hard chair
i will forward to her your suggestions

Hi there
I would like to advice you to try using Laser as I have found it very useful. However if the patient not responding for 4 to 5 sessions I believe you need to ask the pt to see her doctor or GP to have local Non steroidal anti-inflammatory Injection.
wish you the best
take care

Let us not rule out that biomechanically, posture and movement patterns may contribute to altered sling patterns, or altered joint spread across joints that may exacerbate the conditions/situation.

What is the theory behind laser in bursitis?

I know there is weak evidence for U/S in general but clinically I have got quite good results treating other bursa such as G troch (unsure if its bursa or gmed tendon etc) and ITB.

My application varies from classical recommendations, however. I aim for light to moderate symptom reproduction during the application and adjust intensity as accommodation/sensitisation occurs. I typically use the highest intensity tolerable and long Rx times (10-15min) and usually keep it on continuous but may flick to I/T if symptoms build. Don't ask me why it works; I could speculate numerous neurophysiological effects that all lack sufficient evidence. Perhaps the lack of evidence for U/S stems from very conservative dosage parameters studies in research - I was taught this approach by a clinician with over 40 years exp and it seems to work. Though I haven't used it on an ischial bursitis/area pain.

hi
science could not able to explain pain efficiently.new concepts are suggested based on the understanding during various time periods
pain gate
neuromatrix
biopsychosocial

so its difficult to find out the mechanisms behind analgesic effects of physical therapy modalities and manual therapy