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These activities can cause an inflammatory reaction in the bursa and surrounding tissues resulting in swelling and tenderness over the lower buttock and upper posterior thigh.(1) Symptoms can include: Pain with prolonged sitting (especially on a hard surface) Pain when stretching the gluteal and/or hamstring muscles (pain with hip flexion and/or straight leg raise) Tenderness on ischial tuberosity Pain that my radiate into back of the thigh Swelling and limited mobility Pain with gluteal and/or hamstring muscle activation Sleep disturbances due to pain Difficulty or pain with walking and running Differential Diagnosis Many muscles attach on or near the ischial tuberosities including the hamstrings, adductor muscles, gluteal muscles, and the superficial transverse perineal muscle, which is part of the pelvic floor