Causes and Treatment of Buttocks Pain

Human buttocks have been celebrated in art for centuries, encased in tight-fitting jeans for decades and been the buzz of social media since its inception. A well-defined derriere epitomizes the perfect fusion of form and function, providing both symmetry and stability for the human body.

The powerful muscles of your buttocks make it possible for you to walk, run, jump and climb. And of course, your backside provides a comfy cushion for sitting, except when you experience sharp or stabbing buttocks pain. Because of the important role the buttocks play among the highly complex structures of the lumbo-pelvic region, a sharp pain in the gluteus can signal a number of potential problems.

The buttocks are composed of many structures and cover a large area of your body, which means there can be many causes of buttocks pain. During sports and other physical activities, the pelvic region is responsible for translating large force loads between the upper and lower body, with the powerful buttocks muscles and other structures playing prime roles in providing stability and producing movement.

• The gluteus maximus is the large prominent muscle that defines the buttocks. The GM is the largest, most powerful muscle in your body, working against gravity to help you run, climb and jump, and playing a key role in keeping your trunk erect while standing and moving. It lies atop additional layers of muscle and covers the hip and sacroiliac (SI) joints. A weak gluteus maximus can cause multiple problems in gait and posture.
• The gluteus medius and minimus muscles, along with several smaller muscles, work with the GM to act as a base of support for your hips and pelvis. They also stabilize the head of your femur in your hip socket, work to rotate your hip joint, and help draw your leg backward and to the side. All the gluteal muscles play key roles in standing, walking, running and other physical activities.
• The piriformis muscle is found near the top of your hip joint and next to your sciatic nerve. It is a flat band-like muscle that stabilizes the hip and pelvic region and plays a key role in lower body movements. A healthy piriformis muscle can help protect the sciatic nerve and improve its function.
• The sacroiliac joints are situated on either side of your lower spine, connecting the sacrum, or base of your spine, to the ilium at the top of your pelvis. The SI joints support your upper body weight and distribute it across the pelvis. They also act as shock absorbers to reduce impact pressure on your spine during physical activities.

Buttocks pain can manifest in a number of different ways, depending on its underlying source. Some common symptoms of buttock pain include:

• pain, tingling or numbness in the buttocks and down the leg
• pain in one side of your lower back and buttock
• pain that begins in the buttock and radiates to the lower hip, groin or upper thigh
• pain that worsens when sitting, standing, sleeping, walking or climbing stairs
• tenderness or aching in the buttock
• difficulty sitting
• pain that worsens the longer you sit
• pain that only happens when walking or doing physical activities

Because of the involvement of the buttocks in almost everything you do, getting to the source of pain and eliminating it is paramount.

Buttock pain can be caused by a number of problems in the pelvic region. It may indicate a problem in one of the sacroiliac joints, in the lumbar spine (lower back), pelvic muscles or any of the other structures that make up the lumbo-pelvic complex.

Some of the most common causes of buttock pain for healthy active adults include:

• Deep gluteal syndrome: Sitting can compress muscles, skin and blood vessels and place pressure on nerves, sending severe pain signals to your brain. Deep gluteal syndrome shares symptoms similar to other types of buttocks pain, and it is often non-responsive to rest and home remedies.
• Piriformis syndrome: This painful syndrome often occurs in runners and athletes, and involves a small muscle near the sciatic nerve. Symptoms are similar to those of sciatic nerve pain, including pain, tingling and numbness in the buttock and down the leg. Consequently, the condition is often misdiagnosed, delaying healing and recovery.
• SI joint dysfunction: Because your sacroiliac joints attach your spine to your pelvis, they can easily become damaged during vigorous physical activity. SI joint pain usually begins in the low back and buttock, sometimes radiating to the hip, groin or upper thigh. Pain is usually one-sided, but it can affect both sides. SI pain often gets worse when sitting, standing, sleeping, walking or climbing stairs.
• Sciatica: Compression of the sciatic nerve causes pain on one side of the low back that often radiates down the leg, causing pain, tingling, numbness and muscle weakness along its path. A variety of factors may contribute to sciatica, including sitting, poor posture, deficient body mechanics and overuse during sports and exercise.
• Lumbar disc problems: The discs that lie between the vertebrae in the lower back can become inflamed and bulge out of their normal location, placing pressure on the nerves that descend to the lower body, including the buttocks. Nerve compression can be very painful and debilitating.
• Trauma: A traumatic injury during sports or from a fall can result in bruises or fractures of bony structures. This in turn can cause inflammation, scar tissue and the formation of painful myofascial trigger points in the fascia surrounding the buttocks.

Accurate diagnosis is key to identifying the source of your buttocks pain and devising the most effective treatment plan. A knowledgeable and experienced physical therapist will not only help you eliminate your pain, but teach you strategies for avoiding pain in the future.

Your diagnosis should be based on:

• A detailed review of your health history
• A clinical exam that includes testing for mobility and range of motion
• A gait analysis to identify harmful patterns of walking and running
• Ultrasound imaging to view the structures of the pelvic region in motion

Use of pain medication and anti-inflammatories may mask your symptoms, but in most cases, buttocks pain will not go away on its own. It is important to see a specialist who can accurately diagnose your pain and develop a treatment plan to eliminate the underlying cause of pain.