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Pelvic Bursitis

Pelvic bursitis is inflammation of the bursae that lie around or within the hip/pelvis. There are three main types of pelvic bursitis: (1) greater trochanteric, (2) ischial, and (3) iliopectineal (sometimes called iliopsoas). Greater trochanteric bursitis is discussed in detail in its own entry. This entry focuses on iliopectineal and ischial bursitis, which are both relatively common causes of hip, pelvic, or groin pain.

Anatomy

Bursae are small fluid-filled sacs that are usually found around joints or bony prominences. Their purpose is to create lubrication between two uneven surfaces and provide frictionless movement, as well as serving as a pad or cushion. The pelvis is the bony structure located at the bottom of the spine. It has three components: the ilium, ischium, and pubis. The ilium is the large bone one feels at the outside of the waist, the ischium is the bone one feels when sitting on the buttocks, and the pubis bone, also called the pubic bone, is in the front just above the genital area (see Figure 1).

The two ischial bursa rest under the ischial bone (specifically, the ischial tuberosity) on each side of the pelvis near the attachment of the hamstring muscle. The iliopectineal bursa lies in the front of the hip and deep in the groin and results from the iliopsoas (hip flexor muscle) tendon sliding over another muscle (pectineus) and the bony prominence where the ilium and pubic bones join.

Figure 1 Bursae of the Hip and Pelvis: (a) Front and (b) Posterior View

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Causes

Pelvic bursitis is caused by either overuse or direct trauma. Direct trauma such as a fall that causes the athlete to land on the buttock or a direct blow to the lower buttock or anterior hip may trigger an ischial or iliopectineal bursitis, respectively. These falls or blows will cause bleeding (hematoma) into the bursa, which then results in swelling. Usually, these hematomas are rapidly absorbed by the body, but not infrequently, they may result in scarring and thickening (calcifications), leading to a more chronic type of bursitis.

More commonly, chronic repetitive overuse is involved, which can occur from merely running or jumping. Injuries to the hamstring muscle or the hip flexor muscle can lead to ischial and iliopectineal bursitis, respectively. Other conditions that predispose athletes to this type of pelvic bursitis include postural abnormalities, which can be caused by scoliosis, degenerative spinal conditions, hip and knee arthritic conditions, leg length differences, flat feet, high-arched feet, overpronation of the feet, or even oversupination of the feet at heel strike. Improperly fitting shoes, worn-out shoes, running on uneven or hard (cement) surfaces, and sudden increases or changes in training are other causes of pelvic bursitis. At times, the bursitis develops spontaneously without any apparent cause, from infection or as a complication following hip surgery.

Symptoms

Ischial bursitis usually results from a direct blow or fall (such as in contact/collision sports), and athletes complain of pain at the ischial tuberosity that may worsen with sitting. Swelling and bruising may also be present. Pain mimicking ischial bursitis may be caused by hamstring syndrome. This syndrome also has pain around the tuberosity that gets worse with sitting, but athletes may complain of pain radiating down the back of the leg due to sciatic nerve compression within the hamstring muscle. Therefore, it is important to focus on the exact location and symptoms of this injury.

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