Causes, Diagnosis and Treatment of Buttocks Pain

Your buttocks are made up of a group of four powerful muscles – the gluteus maximus, gluteus medius, gluteus minimus and tensor fascia lata. They work together to extend, rotate, abduct and adduct the hip. Their location in the lumbopelvic region means your buttocks share space with multiple organs, nerves, blood vessels and bony structures. Buttocks pain can arise from a variety of causes, so it’s critical to get an accurate diagnosis before initiating treatment.

Learn about the various potential causes of buttocks pain, the most sophisticated diagnostic tools for differentiating among them, and the most advanced evidence-based treatment options.

Buttocks Anatomy and Function

The muscles of the buttocks and lower back provide hip and pelvic stability, enabling humans to stand erect and walk upright. They work with the abdominal muscles to mediate force loads between the upper and lower body, providing dynamic stability during physical activity. Weakness and imbalances in gluteal muscle tension can cause a broad range of mechanical issues that impact other structures within the pelvis and along the lower kinetic chain.

Major muscles of the buttocks are:

• Gluteus maximus – the largest and densest muscle in the human body, and the most superficial of the gluteal muscles. Its main functions are extension and external rotation of the hip joint, and it contributes to hip adduction and abduction.
• Gluteus medius – a fan-shaped muscle that lies between the gluteus maximus and minimus. Its actions are hip abduction and medial rotation, and it works as a pelvic stabilizer during physical activity.

• Gluteus minimus – the deepest and smallest of the superficial gluteal muscles. It is fan-shaped like the gluteus medius, and its actions include hip abduction and medial rotation of the lower limb. It also works as a pelvic stabilizer.
• Tensor fascia lata – a small superficial muscle that runs along the outer edge of the pelvic iliac crest. It provides tension for the iliotibial (IT) band – a tough band of connective tissue that spans your outer thigh from the iliac crest to the knee. The tensor fascia lata abducts and medially rotates the hip joint, and its tension on the IT band helps to stabilize the outer knee.

A group of smaller muscles called the deep lateral rotators work with the gluteals to laterally rotate the leg. They Include the quadratus femoris, piriformis, gemellus superior, gemellus inferior and obturator internus.

Because your buttocks span the posterior pelvis, they interact with numerous nerves and blood vessels that supply the lower extremities. The buttocks can profoundly affect other pelvic structures such as the sacroiliac joints that connect the spine to the pelvis.

Modern lifestyles that involve extensive bouts of sitting can cause the buttocks to weaken and become lax, impeding their function as stabilizers. Sitting also weakens the abdominals. Weak abs and glutes dramatically reduce your ability to mediate forces, increasing your risk of back and buttocks pain.

Diagnosing Buttocks Pain

The complex architecture of the pelvic region encompasses multiple organs and structures, including the lumbosacral spine, sacroiliac (SI) joints, hip joints, and numerous nerves and blood vessels. Multiple muscles and a network of fascia provide tensile integrity – tensegrity – to guide and control movement and hold the various structures in place.

Buttocks pain is a symptom that can arise from a variety of causes, and treating the locus of pain is unlikely to resolve it. A skilled practitioner with an in-depth knowledge of pelvic anatomy, along with expertise in high-resolution ultrasound imaging, are needed to accurately diagnose buttocks pain. Unlike MRI, diagnostic ultrasonography enables dynamic visualization of the pelvic structures in real time.

A clinical diagnosis made without dynamic high-resolution ultrasonography is essentially a guessing game, turning the patient’s condition into an experimental testing ground for a broad range of treatments and drugs. Without an accurate diagnosis, patients can suffer for months or even years while draining their bank accounts in hopes of resolving their condition.

Differentiating Potential Causes of Buttocks Pain

There are four general subcategories of buttocks pain: lumbar-related, SIJ-related, hip joint-related and myofascial-related. Pain may arise from a single cause, or from a combination of factors.

Lumbar-related buttocks pain

Buttocks pain originating from the lumbar spine is most often related to nerve compression, either from stenosis, disc herniation, or facet joints. It often involves compression of the sciatic nerve somewhere along its path, often causing buttocks pain where it runs beneath the piriformis muscle.

Lumbar-related characteristics are:

• Pain in the upper buttocks associated with back pain
• Pain that extends below the knee
• Tingling and numbness in the legs and/or feet
• Symptoms on both sides of the body
• Pain that intensifies with lumbar loading

Sacroiliac joint-related buttocks pain

SIJ-related buttocks pain is grossly over-diagnosed, and efforts to reposition the pelvis and enhance pelvic stability can sometimes do more harm than good. Patients are often convinced that they need frequent adjustments to realign the pelvis, when in fact the SI joint may not be the source of pain. SIJ-related buttocks pain is most common in pregnant and postpartum patients, and in patients who have suffered pelvic trauma.

Characteristics of SIJ-related buttocks pain are:

• Pain in the upper buttocks near the posterior edge of the iliac crest
• Pain that extends from the posterior iliac crest to the groin
• Instability when standing on one leg
• Difficulty lifting the leg in a supine position
• Pain when rising from sitting to standing

Hip joint-related buttocks pain

Hip-related causes of buttocks pain are commonly overlooked, leading to maltreatment or undertreatment of the condition. Posterior femoroacetabular impingement (FAI) and chondrolabral pathology are conditions affecting the ball-and socket architecture of the hip, where the head of the femur rubs against its socket, creating friction that can tear the labrum – the socket lining – and damage the hip’s articular cartilage. FAI often affects patients with joint hypermobility syndrome. Hip-related buttocks pain can also be linked to hip osteoarthritis.

Characteristics of hip-related buttocks pain are:

• Pain in the mid-buttock region
• Anterior hip and groin pain
• Referred pain to the anterior knee and leg
• Hip stiffness
• Instability during weight-bearing activities
• Pain in the buttocks when walking

Myofascial-related buttocks pain

Myofascial pain syndrome is a common cause of buttocks pain affecting the large gluteus maximus and gluteus medius muscles. Myofascial pain can be generated from entrapment of the sciatic nerve, the posterior femoral cutaneous nerve, or the superior gluteal nerve. Pain can also be generated by myofascial trigger points – tightly contracted knots of muscle fibers that cause a sharp pain in the buttocks when pressed.

Myofascial buttocks pain symptoms include:

• Pain and tension in the buttocks or low back
• Pain that radiates to the back of the thigh, especially when pressed
• Reduced internal hip rotation.

Other sources of buttocks pain that do not fall under the above categories include:

• Ischial bursitis
• Ischial apophysitis
• Adductor magnus tendinopathy

Advanced Treatment Options for Buttocks Pain

Once the exact source of your buttocks pain has been identified and confirmed, there are a plethora of therapeutic approaches available, including regenerative technologies, injection therapies and specialized physical therapy.

Prior to beginning physical therapy, you may need to resolve issues such as:

• Fascial densifications
• Myofascial trigger points
• Entrapped nerves
• Neurogenic inflammation
• Scar tissue and fascial adhesions
• Degenerated tendons

Your clinician may use regenerative technologies and orthobiologic injections to repair tissues, reduce inflammation, address myofascial issues, and release entrapped nerves.

Regenerative Therapies for Buttocks Pain

Focused Extracorporeal Shock Wave Therapy (ESWT)

Focused ESWT is an evidence-based approach to treating damaged tendon, muscle and bone tissue. This technology produces high frequency sound waves to stimulate the body’s own reparative mechanisms. It is especially effective for chronic degenerative tendon disorders and myofascial pain syndrome.

Myofascial Acoustic Compression Therapy (MyACT)

MyACT is a new type of focused shockwave technology whose higher frequency allows for precise neuro modulation under ultrasound guidance, with a special linear head for treating myofascial pain. MyACT transforms the mechanical energy of shockwaves into biochemical signals that precisely target damaged tissues, to stimulate the body’s own reparative mechanisms.

Extracorporeal Magnetic Transduction Therapy (EMTT)

EMTT transmits high energy magnetic pulses to targeted tissues that synchronize with the body’s own magnetic fields, triggering a regenerative response. EMTT waves can penetrate deep tissues to target difficult-to-reach tendons, muscles, bones and nerves.

Peripheral Magnetic Neuromodulation

Transcutaneous magnetic neuromodulation delivers high-intensity magnetic pulses to peripheral tissues, to stimulate neuroplasticity. This FDA-approved methodology is used to treat pain and regenerate nerve fibers, for enhanced motor control.

Neuralign S

Neuralign S is a therapeutic Motion Activated Stimulation technology that uses advanced sensors coupled with neuromuscular electrical stimulation. This breakthrough technology helps patients to recalibrate muscle actions, to optimize joint function. Neuralign S is revolutionizing the way shoulder injuries and rotator cuff tears are treated and rehabilitated.

Manual Therapy for Buttocks Pain

Stecco Myofascial Release

The Stecco method of fascial manipulation involves deep friction that heats up tissues and stimulates mechanical action. Stecco fascial manipulation is an evidence-based methodology for treating densified fascia, and breaking up scar tissue and adhesions. Stecco therapy is often used in conjunction with regenerative technologies. Patients often report immediate pain relief after a single Stecco session.

Injection Therapies for Buttocks Pain

Injection therapies use natural or neutral solutions to stimulate cellular repair by either nourishing or irritating the targeted cells. It is important to note that injection therapies are most effective when guided by high-resolution ultrasonography, to ensure that the needles precisely hit their target.

Platelet Rich Plasma (PRP)

PRP therapy uses a centrifuge to extract a high concentration of platelets from a sample of the patient’s own whole blood. When injected into damaged tissues, PRP releases biologically active factors to initiate the synthesis of new connective tissues and blood vessels.

Prolotherapy

Prolotherapy uses a biologically neutral solution to irritate stubborn tissues, triggering a regenerative response to grow new normal tendon, ligament and muscle fibers.

Interfascial Plane and Nerve Hydrodissection

Buttocks pain often stems from densified fascial tissues that have formed adhesions, entrapping nerves and blood vessels. Hydrodissection injects a saline solution into densified fascia to separate fascial layers and free up entrapped nerves and blood vessels. Hydrodissection is often used in conjunction with manual fascial manipulation.

Ultrasound Guided Dry Needling

Dry needling targets myofascial trigger points by inserting thin non-medicated needles to evoke a twitch response, relaxing contracted fibers and immediately relieving pain.

Get Advanced Treatment for Buttocks Pain in NYC

At NYDNRehab, we begin your therapy journey with high-resolution diagnostic ultrasonography, to get a clear picture of your condition. Once we identify the source of your buttocks pain, we pretreat your tissues to protect them from further injury. Only then will you be ready for specialized buttocks pain physical therapy.

Dr. Lev Kalika is an expert in diagnostic musculoskeletal ultrasonography and shockwave therapy. He has published multiple scientific papers on ultrasound guided procedures, and his research is frequently presented at medical conferences such as the International Society for Medical Shockwave (ISMS) Congress.

The clinic at NYDNRehab features an impressive array of technologies, including the most advanced high-resolution ultrasound equipment. We are one of the few clinics in Manhattan to offer regenerative therapies, orthobiologic injections, and personalized one-on-one physical therapy.