Weavers bottom
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Weaver's bottom condition
Weaver's bottom (also called ischial bursitis or ischiogluteal bursitis) is inflammation of the bursa located between the ischial tuberosity (the "sit bones" at the base of the pelvis) and the overlying muscles/tendons/skin. The name comes from the occupation of hand-loom weavers, who spent long hours sitting on hard benches and were particularly prone to it. It's also sometimes called "tailor's bottom" or "runner's butt."
Anatomy
The ischial tuberosity is the bony prominence you sit on. A small fluid-filled sac (bursa) sits between the bone and the overlying hamstring tendons and skin, reducing friction. When this bursa becomes irritated or inflamed, you get weaver's bottom.
Causes
- Prolonged sitting - especially on hard surfaces (the classic cause)
- Repetitive activities - running, cycling, rowing
- Direct trauma - a fall onto the buttocks
- Hamstring tendinopathy - inflammation can spread to the adjacent bursa
- Less commonly: gout, infection, or rheumatoid arthritis affecting the bursa
Symptoms
- Deep aching or sharp pain at the base of the buttock, over the sit bone
- Pain that worsens with sitting (especially on hard surfaces) and eases on standing
- Pain that can radiate down the back of the thigh (can mimic sciatica)
- Tenderness to direct pressure over the ischial tuberosity
- Possible local swelling
Diagnosis
- Clinical (history + examination) is usually sufficient
- MRI or ultrasound can confirm bursal swelling and rule out hamstring tears or other pathology
Treatment
| Approach | Details |
|---|---|
| Rest & activity modification | Avoid prolonged sitting on hard surfaces; use a padded cushion ("donut" cushion) |
| Ice/heat | Ice in the acute phase to reduce inflammation |
| NSAIDs | Ibuprofen or naproxen for pain and inflammation |
| Physiotherapy | Stretching and strengthening of the hamstrings and gluteal muscles |
| Corticosteroid injection | Ultrasound-guided injection into the bursa - effective for persistent cases |
| Surgery | Rarely needed; bursectomy reserved for refractory cases |
Prognosis
Most cases resolve with conservative treatment over weeks to months. Avoiding the provoking activity (prolonged hard-surface sitting) is key to preventing recurrence.
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