Earlier this week I saw a patient for PIRIFORMIS SYNDROME that had come quite a distance to see me. This person had some absolutely brutal FASCIAL ADHESIONS and Scar Tissue around the area of the buttocks / posterior hip. I had treated this person once before — several months ago; but in the meantime, they had been to an older “Country Doctor” (there are not many of these left) who told this individual that their problem was not Piriformis Syndrome, but was instead something called Weaver’s Bottom. Weaver’s Bottom?
Although I do not claim to be a very intelligent person, this term, “Weaver’s Bottom” was completely new to me — something I had never heard of before. My patient said that it is what people who used to sit on a hard stool or chair all day long, while weaving on a loom or wheel, used to get. Of course I wanted to know more, so I jumped online and started to read.
Weaver’s Bottom is the ‘Olde Tyme‘ common name for something called Ischial Bursitis. Let me help you find your Ischial Tuberosity. First (and this is extremely important), look around and make sure no one is watching you do this (you’ll understand why momentarily). Now lean to one side and run your finger along the bottom part of your bottom — right where you sit. Now feel for what I tell my patients is the “Butt Bone“. You just found your Ischial Tuberosity!
In the picture below, the Ischial Tuberosity is bony prominence that is just below the “eyes” of the pelvis —- the lowest part of the pelvis that you sit on. Now, take a look at how far the Piriformis Muscle is from the Ischial Tuberosity. Although the Sciatica (leg pain) could certainly radiate into the area of the Ischial Tuberosity, I do not typically see Piriformis problems referring pain solely to that particular spot.
WEAVERS BOTTOM -vs- PIRIFORMIS SYNDROME
There is a fluid-filled sac that sits on the bottom of the Ischial Tuberosity called the Ischial Bursa. The purpose of any bursae is to protect both tendons and bones from the friction that they create when they rub against each other during movement. The word ‘itis‘ means INFLAMMATION; and when used in conjunction with the word, “bursa”, you get BURSITIS — an inflammation of the bursa. Although I think that there are lots of people who suffer with Ischial Bursitis (Weaver’s Bottom), my guess is that it is frequently misdiagnosed.
I have always said that much, if not most of what is diagnosed as bursitis, is really Tendinosis. TENDINOSIS is the problem that doctors used to refer to as tendinitis. As far as the medical profession is concerned, it makes no difference to them what they call it because they treat it the same way —- anti-inflammatory drugs and CORTICOSTEROID INJECTIONS. In some cases of severe Ischial Bursitis, the bursa is actually removed surgically. There is a direct relationship between the Piriformis Muscle and the Sciatic Nerve — the nerve that causes leg pain when irritated. Look at the picture on the left. If you move down from the Piriformis, you will see the white tendon of the long head of the Hamstring Muscle anchoring itself to a bony prominence (red). This bony prominence is the Ischial Tuberosity or “Butt Bone” as I called it earlier.
Just from looking at the anatomy of the area, you should start to realize that Weaver’s Bottom (Ischial Bursitis) and Piriformis Syndrome (with sciatica or without) are two very different problems that in most cases should be fairly easy to distinguish from one another. For one thing, you will not get sciatica with Ischial Bursitis. For another thing, HAMSTRING TENDINOSIS will usually be helped by our Scar Tissue Remodeling work, but it may very well aggravate a true bursitis.
Sitting tends to aggravate both Piriformis Syndrome and Ischial Bursitis; and Ischial Bursitis is usually caused by either traumatic or repetitive injury — the same things that can cause Piriformis Tendinosis. This can sometimes make Weaver’s Bottom somewhat difficult to distinguish from Hasmstring Tendinosis. This is a very similar phenomenon to BICEPS TENDINOSIS being frequently misdiagnosed as Subacromial Bursitis. Just be aware that MRI will usually fail to identify any of these problems (HERE), and is not typically a good diagnostic tool for them.