@rstollery This is a long post: I basically had a bursitis / tendonitis in the glute and high hamstring region. It was stubborn. The Doctor did think I had bursitis and perhaps a tendonitis, too. He said, “I do think you had some kind of myofascial pain syndrome”. Along with that was all kinds of myofascial tension. My Chiropractor said my tension was myofascial (piriformis trigger points / tension in glutes). This caused mostly sitting pain at one time.

Later, I got very stiiff, too, when standing and with continued sitting pain. It was a crushing and burning pain. If I was moving, the pain diminished somewhat.
With chronic pain you can also get central pain sensitization - where you feel it more intensely. The supplements like turmeric help ease this somewhat. While speculative, I believe my main issue was from excessive fibrin (i.e. the protein involved in blood clotting) on the bursa / tendons & nerves and in blood vessels (sort of like a phlebitis in the glute region; I’d had that in legs, too). . I had nerve pain (nerve compression; some type of myofascial pain in the glutes, and all manner of sitting pain), tight IT bands, tightness down into lower left ankle. Tight quads. I could actually sense tension in various nerve plexes's in my abdomen, too, including into the diaphragm. It's much better now but I still have minor issues. While speculative, the fibrin might cause not only stiffness but promotes inflammation as it naturally recruits white blood cells (granulocytes) that promote a mild autoimmune inflammation of the tissues. This is a natural process for fibrin- essentially what happens in a cut or wound - but it may be more prevalent for that process to go haywire - especially as we age. The enzymes (nattokinase / serrapeptidase / lumbrokinase) can help reverse this - a small amount is actually absorbed somehow. I had only marginal help from myofascial release therapy until I found the right combination of enzymes and supplements (including several doses of Vitamin C and quercetin (<500 mg/day) and resveratrol and turmeric (500-1000 mg /day Youtheory Extra strength). Then it went away rapidly – especially when I added the enzyme regimen, below.

I also had a prior history of plantar fascitis and also lower leg phlebitis (and pain when pressing on lower leg veins). This is all consistent with tissue stiffening. As you may be aware, many people are eventually put on anti-coagulants by Western medicine due to forming clots / fibrin deposition - which may be more common with age and improper healing / tissue remodeling. The enzymes and Vitamin C and stretching & exercise took care of much of it for me - I only have a little residual sitting pain now. I believe what I had could have led to many different issues including amyloid polyneuropathy (eventually) and possibly other related disorders (other neuropathies) - had I not intervened with the alternative treatments (I was getting burning and tingling down in my left foot - that is now lessened; it might have been sciatica). NSAID's don't help this and that is what Western medicine tries. The stiffness and irritation can definitely cause nerve compression and nerve irritation leading to burning pains, spasms, etc., and sitting pain.

The enzymes are taken on an empty stomach (i.e. between meals). About 10% of the people get digestive issues. Most people have no problems with the enzymes, though. I've been on them seven months with no issues at all. I can actually feel the tingling of healing in different areas. You'll need to listen to your body. I've used: 2000 U nattokinase (Drs. Best in both am and pm) as well as a couple Serrapeptidase (Biomedix Laboratories brand; several different strengths are available in the am and pm, too) from Amazon. Also, recently I’ve been using Lumbrokinase, too ( stronger enzyme; Drs. Best brand). Start slow and ramp your way up. See how it goes. My doctor checked and if you have a bleeding disorder or are already on anti-coagulants they might be counter indicated. Otherwise, barring you have a clotting disorder or if you have an infection (discontinue during an active infection; as infections are often walled off by fibrin). Many people use these without issue and my doctor found little information - but not much for adverse effects, either. Most likely, these enzymes are safer than Warfarin and other anti-coagulants.

I am convinced the enzymes and the other supplements I mentioned above helped "cure" me of my sitting pain which maps to the pudendal and other interconnected nerves, too. At least, that was my case. I am 100% convinced about my fibrin hypothesis - for me at least. Any manner of movement helps this by getting better blood flow. Myofascial massages (including myofascial by a Barnes trained person) did little until I was on the enzymes. I now mostly lift weights, do pilates, use a TRX suspension system (great for core strengthening) and use a vibration platform (that REALLY helps!) and do some stair climber. All these help loosen up my myofascial and nerve pain. I don't get much massage anymore. I'm finally feeling much better.

Two things really help my pain: I still need the set of supplements I’m on AS WELL AS the enzymes or I slip back into pain (minimally I have some type of sciatica pain / something like Cramping fasciculation syndrome with extreme stiffness anywhere below the lumbal region – and one of the other main symptoms is stiffness (which causes sitting pain and clamps on nerves causing burning / tingling pains down my legs). When I am on both regimens, I have virtually no pain. If you are able, perhaps try the regimen I detailed, above. Perhaps it might help you if this is the cause of your pain. In the meanwhile, you can try sitting on donut cushions like those used for hemorrhoids to ease ischial bursitis type pain. It will take time to reverse this, even if this is what ails you. Good luck, hope this helps.