The ischium (medically: Os ischium ) and the associated ischial tuberosity ( tuber ischiadicum ) are anatomical, bony structures of the human pelvis. Pain in the ischial region or the ischial tuberosity can present itself in different ways.

Often involvement of the ligaments or muscles as well as adjacent nerves is likely.
In order to find out the individual cause and initiate a suitable therapy, a specialist in orthopedics should be consulted.

Where are the pains? Link, right, or both sides?

Depending on the underlying condition of the pain, the pain may occur on the right or left as well as on both sides. Just because the pain is one-sided or bilateral, it can not be concluded, which disease picture is present. Thus, both tendon shortening and systemic disease can lead to bilateral pain.

In general, however, when systemic diseases, such as certain rheumatic diseases, usually lead to bilateral pain. Muscular causes, however, occur more often unilaterally and therefore rather on the right or left side to complaints.

In case of unilateral or central pain, the possibility of a coccyx fistula ( sinus pilonidalis ) should also be considered.

Causes of ischial pain

The causes of the pain on the ischial bone are manifold.
As a rule, the bones themselves are not the cause of the pain.

Naturally, breakage of the ischial bone can also lead to pain in this region, but this bone usually breaks only after very strong effects of violence such as a traffic accident or a fall from a great height.

Most of the seatbone pain is caused by structures that fit the ischial bone.
First and foremost, the ligaments and muscles must be considered. Not infrequently there is a shortening of the tendons on the pelvis. Since the ischial bone is the origin of many tendons, pain is relatively common in this region.
Especially this can affect endurance runners, who operate a very one-sided and heavy load on the legs.
But even untrained people often suffer from shortened tendons on the ischium.

Reasons for this can be:

  • Irregular training,
  • a wrong burden
  • and not enough stretching


An irritation of the muscles themselves can also be caused by heavy training or an incorrect load.
The pain is then usually acute and a burden is hardly possible.

Also certain diseases can be the cause of pain in the seatbone. First and foremost, systemic joint disease should be considered as a cause of chronic pain in the ischial area.

Finally, local inflammation around the ischial bone must always be considered. Common is the so-called ischial fistula ( sinus pilonidalis ) in which it comes to a chronic inflammation of the buttock fold and which also leads to pain in the region of the ischial bone.

Ischial fracture

Bone fractures on the pelvis and especially the ischial bone usually lead to very severe pain in this area.

Reasons for a fracture of the ischium are manifold. In general, a high force is necessary to cause a fracture of the ischium. This force can arise, for example, in a traffic accident or a fall from high altitude and direct impact of violence on the pelvis. If there are diseases that damage the skeleton of the pelvis, such as osteoporosis or a bone metastasis of a tumor, a break can sometimes occur even with less force.


The term rheumatism summarizes a number of different systemic diseases that may affect the musculoskeletal system of humans. Both older and younger people can suffer from a rheumatic disease. Also, pain in the seatbone can be an indication that a rheumatic disease is present.

This localization is particularly typical for the clinical picture of the so-called Bekhterev's disease. This chronic inflammatory rheumatic disease first infects the tendon insertions of the pelvis until the complete spine stiffens in the course of the disease.

Also, so-called fibromyalgia, also a form of rheumatism, can lead to pain in this localization.

Overall, however, these are relatively rare conditions, so rheumatic conditions should not be considered first for itchy leg pain.


The pressure ulcer is a defect of the skin. Permanent pressure on one and the same spot damages the skin. Anyone who puts the same area of ​​skin over the seatbone over a longer period of time can get decubitus. Due to the pressure, the stressed area is not sufficiently perfused, the skin cells can not regenerate and an open area is created. This typically affects people who are not particularly mobile, such as wheelchair users. They sit the entire day and can often shift their weight badly from one side of the buttocks to the other. Nerve damage can also promote the development of pressure ulcers. Affected persons do not notice due to the sensory disturbance, that the skin is loaded. Typically, a decubitus heals very slowly due to poor circulation, it can also be infected with bacteria, resulting in a painful inflammation.

Inflammation of the ischium

The ischial bone ( Os ischii ) is a part of the pelvic bone. This is the proportion of the pelvis on which the weight weighs when sitting, hence the name Sitzbein. The lower part of the ischial bone is protected by a fat pad. By reducing the fat cushion, the seatbone can ignite. It usually comes to a painful inflammation of the periosteum. The surrounding tissue may also be the source of the inflammation. In this case, a so-called aseptic inflammation occur, which is not caused by pathogens. If a small skin defect is present, germs can invade the skin and cause a superficial inflammation. This can spread in the depth and so trigger the inflammation of the ischium.

Accompanying symptoms of ischial pain

In order to find out which cause is responsible for the individual pain of the ischial bone, the attending physician will ask for further complaints, which occur together with the pain. These concomitant symptoms may vary depending on the cause of the pain.

If there are nerve irritations, the pain often radiates into the leg or foot of the affected leg. Shortened tendons may be associated with movement restriction in the hip and / or spine. If the muscle itself is affected, there is often a greater or lesser reduction in muscle strength.

If rheumatic disorders are the cause of the pain in the seatbone, they are often accompanied by general weakness and tiredness, sleep disturbances and other pain in the joints and the spine.

Also, nonspecific symptoms such as cardiac arrhythmia, susceptibility to infection, irritable bowel syndrome, or mildly elevated temperature may be indicative of the presence of systemic disease. It can also cause redness and localized swelling in the region of the ischial region. In these cases, the presence of a ischial fistula must be considered.

Diagnosis of pain on the ischium

In pain, which occur on the ischial bone or the ischial tuberosity, it is basically a symptom, which can occur due to different diseases. In order to make the diagnosis, a doctor should therefore be consulted if pain on the seatbone persists.

The attending physician can use different methods to make the right diagnosis. First of all, the detailed medical history of the person concerned is relevant. Also, physical examination and pelvic and spinal movement can give an indication of which condition might be responsible for the pain.

Often, diagnostic imaging methods such as X-rays or MRI are necessary to make the diagnosis. In particular, in rheumatic diseases also certain parameters in the blood can be examined, which speak in an increase for the presence of such disease.

How are pain on the seatbone treated?

The therapy of the pain in the seatbone should always be guided by the underlying cause of the symptoms.

Basically, painkillers can usually improve the symptoms on the ischium. Depending on the cause of the symptoms, so-called non-steroidal pain medications such as ibuprofen or diclofenac may be used. In some cases, a temporary administration of stronger pain medications may be useful. Also, drugs that are normally used in depression or epilepsy can be effective. These drugs include, for example, amitriptyline, gabapentin or duloxetine.

Manual therapy in the form of intensive physiotherapy or physiotherapy may also help to improve the symptoms.

If fractures of the pelvis are present, surgery usually has to be performed in order to reconnect the bone fragments and to induce healing.

There are also a number of substances from the field of natural remedies, which can develop pain-relieving effects depending on the clinical picture. Here is an example of the Retterspitz called substance from naturopathy, which can relieve the pain of the ischium.

How long does pain on the ischium take?

Depending on the clinical picture, the pain on the ischial bone may last for different lengths. In principle, a distinction is made between acute and chronic clinical pictures. While acute clinical pictures, such as a fracture in the area of ​​the ischial bone, can be painless after a few weeks after correct treatment, chronic clinical pictures usually go hand in hand with a longer duration.

It may even be that certain clinical pictures in episodes over decades repeatedly occur and cause discomfort. In these cases, a therapy in the foreground, which can reduce the symptoms of the disease in the foreground.

Seatbone pain after birth

During the natural birthing process, the child must pass through the mother's pelvis. Even during pregnancy, the position of the pelvic bones is changed, so that the birth of the child is facilitated. This is how the ligaments of the bony pelvis loosen and the symphysis spreads significantly. After birth, these altered structures are not immediately as they were before pregnancy. It can sometimes take months for the ligaments and the symphysis to return to their original state. This can sometimes lead to pain in the area of ​​the ischium.

It is also possible that certain structures of the pelvis are harmed by the birthing process itself. In order to rule this out, a doctor should be consulted for clarification, especially with long-lasting pain on the ischium after birth.

Sick leg pain in pregnancy

During pregnancy, a variety of internal structures are postponed due to lack of space. There is also a hormonal change in the bony pelvis and its surrounding structures. So loosen up the ligaments and it comes to a relaxation of the symphysis. These significant changes often lead to discomfort, which can manifest in pain in the ischial bone.

Also possible is an overload of the spine or pelvis due to the weight load during pregnancy. This high stress can lead to pain in different regions.

If, due to the lack of space in the context of a pregnancy to nerve irritation, this can also lead to pain especially in the area of ​​the ischium.

Sore legs while sitting

If the discomfort caused by increased sitting or a pain-free sitting is generally not possible, this can have several causes. The name "ischial bone" already makes it clear that this part of the bony pelvis is particularly stressed when sitting. If there is a fracture of this part of the bone, sitting in particular will cause severe pain. Even if surrounding structures such as ligaments, tendons or muscles are responsible for the pain, sitting can lead to discomfort.

Seat-leg pain while cycling

If cycling causes pain on the ischial bone, this may have different causes, depending on the underlying clinical picture. For example, if tendon shortening occurs, the particular posture on a bicycle can serve as a trigger of pain.

Likewise, an unfavorably shaped saddle may cause pain in the area of ​​the ischial bone. Counseling in a bicycle shop and fitting the bicycle saddle to the individual distance of the ischial tuberosity can help to limit the pain of cycling.

Figure pain on the buttock: view back, buttocks, thighs and pain causes (AD)

Pain buttock

  1. Lumbar Spine (LWS)
  2. Iliac crest - Crista iliaca
  3. Lumbar sacral nerve plexus
    Lumbosacral plexus
  4. Iliac scoop - Ala ossis ilii
  5. Pear-shaped muscle -
    Musculus piriformis
  6. Big Roll Hill -
    Trochanter major
  7. Femoral head (= femoral head) -
    Caput femoris
  8. Seated leg - Os ischii
  9. Sciatic Nerve - Sciatic Nerve
  10. Thigh shaft -
    Corpus femoris
  11. Lumbar-sacral kink -
  12. Median gluteal muscle - gluteus medius muscle
  13. Sacrum - Os sacrum
  14. Big buttock muscle -
    Gluteus maximus muscle
  15. Bursa (big rolling hill) -
    Bursa trochanterica
  16. Ilium-tibia tendon -
    Tractus iliotibialis
  17. Cam impingement
  18. Pincer impingement
    A - Piriformis Syndrome -
    Irritation of the sciatic nerve
    Piriformis muscle
    B - lumboischialgia -
    Pain in the lumbar spine and
    Leg pain over the sciatic nerve
    C - Bursitis trochanterica -
    Inflammation of the bursa
    of the hip joint
    D - Combined Hip Girdles -
    Cam impingement
    (Camshaft Impingement) and
    Pincer impingement

An overview of all pictures by Dr-Gumpert can be found at: medical pictures

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