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Home Blog Pain in the Rear: Understanding Deep Gluteal Syndrome

Deep Gluteal Pain Syndrome

About Deep Gluteal Pain Syndrome

Deep Gluteal Syndrome (DGS) arises deep within the gluteal space, causing pain and/or numbness in the buttocks, at the back of the thigh, or in the hip region, and often radiating along the path of the sciatic nerve. DGS is not caused by disc herniation, but by entrapment of the sciatic nerve, inhibiting its ability to glide freely. Common sites of sciatic nerve entrapment are the piriformis muscle, the sciatic foramen and the ischial tunnel of the pelvis.

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Dr. Lev Kalika
Dr. Lev Kalika

Clinical director & DC RMSK

About Deep Gluteal Specialist Dr. Lev Kalika

Dr. Lev Kalika has been an active member of the International Society of Medical Shockwave) (ISMST) since 2007, and has performed over three thousand ESWT procedures. He is a world renowned expert in ultrasound guided dry needling and has published multiple peer-reviewed articles about ultrasound guided procedures.

He uses ultrasound guidance to perform dry needling, injection therapies and ESWT for deep gluteal syndrome treatment. Dr. Kalika has developed his own unique approach to gluteal pain, which is cardinally different from conventional deep gluteal physical therapy.

Dr. Kalika’s expertise makes NYDNRehab the clinic of choice for deep gluteal physical therapy in NYC.

Why Deep Gluteal Physical Therapy at NYDNRehab is Better than Conventional Deep Gluteal Syndrome Treatment

At NYDNRehab we take the guesswork out of diagnosis and treatment by leveraging the power of advanced technologies. We believe that what cannot be measured cannot be successfully treated. By accurately pinpointing the root cause of your condition and precisely measuring your response to treatment, we can accelerate your recovery and ensure that your condition is completely resolved.

In addition, we offer personalized one-on-one deep gluteal physical therapy designed for the individual patient. We recognize that no two conditions are identical, and that each patient is unique. By personalizing your treatment, you get the exact care you need for quick and successful results.

Deep Gluteal Pain Symptoms
and Causes

Symptoms

  • Deep buttock pain that runs down the back of the leg

  • Pain in the low back

  • Random shooting pains

  • Pain accompanied by tingling or numbness

  • Increased pain with hip flexion coupled with knee extension

  • Pain when walking uphill or climbing stairs

  • Pain that worsens at night

Causes

  • Tight or inflamed piriformis muscle

  • Excessive sitting

  • Driving

  • Overuse from sports or exercise

  • Being out of shape

  • Overweight or obesity

  • Injury from a fall or other trauma

We Use High-Tech Equipment for Optimal Results

We Use High-Tech Equipment for Optimal Results

GPS is an umbrella term that covers deep gluteal pain conditions with similar or overlapping symptoms. Because the lumbopelvic region houses a complex network of structures including muscles, bones, nerves, connective tissues and reproductive organs, all occupying a relatively small space, it is crucial for the various components to be able to glide smoothly without impediment from other structures.

When the sciatic nerve, the largest nerve in the body that innervates the lower extremities, becomes entrapped or impeded by other structures, interfering with its ability to glide among them, you may experience pain, discomfort and dysfunction anywhere along its path. Deep gluteal pain can sometimes mimic low back pain, leading to misdiagnosis and unsuccessful treatment.

The most common sites for sciatic nerve entrapment

  • piriformis muscle

  • sciatic foramen

  • ischial tunnel of the pelvis

The most common sites for sciatic nerve entrapment

At NYDNRehab, we use the highest resolution diagnostic ultrasonography to accurately identify the location and cause of deep gluteal pain. Ultrasound imaging allows us to view the sciatic nerve with the patient in motion, so we can observe its movement in the deep gluteal space. We are then able to devise a deep gluteal syndrome treatment plan designed to meet the specific needs of the individual patient.

In addition to ultrasound imaging, your diagnostic exam may include:

  • A thorough health history that reviews your past injuries, physical activities and lifestyle factors that may contribute to deep gluteal pain

  • A clinical exam that may include specially designed tests to rule out other causes of pain and dysfunction.

We Use Advanced Technologies and Innovative
Therapies for Optimal Treatment Results

In mild cases of deep gluteal syndrome, physical therapy alone may be enough to alleviate pain, but more advanced conditions made need additional treatment modalities such as:

We Use Advanced Technologies and Innovative Therapies for Optimal Treatment Results

  • Extracorporeal shockwave therapy (ESWT) to stimulate deep gluteal tendon healing.

  • Percutaneous neuromodulation to reduce pain and reboot the sciatic nerve.

  • Electromagnetic transduction therapy (EMTT) to reduce inflammation in the nerve and muscles.

  • Prolotherapy to improve sacroiliac joint stability and reduce shear forces on the nerve.

  • Ultrasound guided dry needling to release trigger points and deep gluteal fascia.

  • Steroid injections to treat extreme inflammatory reactions.

  • Sciatic nerve hydro dissection to reduce adhesions between the nerve and the fascia, and restore smooth gliding among bones and muscles.

  • Deep gluteal physical therapy to correct muscle imbalances, improve hip and pelvic stability, and restore pain-free movement

Preventing Deep Gluteal Pain Syndrome

Staying physically active is key to maintaining stability and mobility in the hip and lumbopelvic region. Avoid overtraining, and give your muscles time to rest and recover between workouts. Include stretching as part of your workout routine to avoid overly tight piriformis muscles and fascia.

If you spend most of your time sitting or driving, begin a regular fitness regimen to offset the negative effects of sedentary activities.

Preventing Deep Gluteal Pain Syndrome

Get Pain-Free Deep Gluteal Syndrome Treatment
that Really Works

Pain and dysfunction are not normal, and you don’t have to live with them. At NYDNRehab, we offer conservative and non-invasive treatment plans, tailored to the individual patient. Personalized one-on-one treatment ensures that you get the results you came for, in the least amount of time possible. We know that physical therapy is time consuming, and we believe that time should not be wasted. Contact NYDNRehab today, and get rid of your deep gluteal pain so you can get back to doing the things you love.

Clinical Case Studies
NYDNRehab

Case Study: Resolving Chronic Sit Bone Pain in a Female Runner

Our patient is a 45 year-old female runner complaining of left sit bone pain when running and sitting. She has a history of proximal hamstring tendinopathy, and had been treated with plasma injections about 5 years prior, along with physical therapy. Her pain was initially resolved by the injections, and she continued to run.

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    Deep gluteal syndrome, formerly referred to as piriformis syndrome, is an overuse syndrome characterized by buttock pain accompanied by symptoms of sciatica. The condition is often caused by the sciatic nerve becoming entrapped and impinged around the piriformis muscle in the sub-gluteal space.

    Pain-in-the-Rear-Understanding-Deep-Gluteal-Syndrome

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    About the Author

    Dr. Lev Kalika is a world-recognized expert in musculoskeletal ultrasonography, with 20+ years of clinical experience in advanced rehabilitative medicine. In addition to operating his clinical practice in Manhattan, he regularly publishes peer-reviewed research on ultrasound-guided therapies and procedures.

    Dr. Kalika is an esteemed member of the International Society for Medical Shockwave Treatment ((SMST), and the only clinician in New York certified by the ISMST to perform extracorporeal shockwave therapy. He is also an active member of the American Institute of Ultrasound in Medicine (AIUM), and has developed his own unique approach to dynamic functional and fascial ultrasonography.

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      Physical therapy and rehab can be time consuming,
      and a faulty diagnosis can make treatment a total waste of time.

      Failure to accurately diagnose a condition in its early stages can lead to chronic
      problems and sometimes devastating results

      Diagnostic musculoskeletal sonography (MSUS) provides the perfect tool for the rehab practitioner. Yet many doctors and physical therapists have no experience with MSUS, are unaware of its advantages, and have no idea how to use it as a diagnostic tool.

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      Below is a prime example of how ultrasound can take the guesswork out of diagnosis.

      Learn more »
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      Accurate Diagnosis Is the ONLY way to
      Successful Treatment
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      A bad physical therapy experience is one of the primary causes of unnecessary surgery

      At NYDNR, we believe in
      medical innovation

      We have equipped our clinic with the latest research-grade technology to arrive at objective and accurate diagnoses, and to objectively measure our patients’ progress.

      • С.A.R.E.N.
      • Kineo
      • Proteus shoulder arm recovery
      • Zebris
      • Manuthera 242
      • ESWT
      • Vertimax
      • Ankle Stabilizing Device
      • Blood Flow Restriction
      С.A.R.E.N. С.A.R.E.N. Kineo Kineo
      Proteus shoulder atm recovery Proteus shoulder atm recovery Zebris Zebris
      Manuthera 242 Manuthera 242 ESWT ESWT
      Vertimax Vertimax Ankle Stabilizing Device Ankle Stabilizing Device Blood Flow Restriction Blood Flow Restriction Training
      • Aplio i800
      • Vibration Platform
      • Sensa mat
      • Force Plate
      • Fascial Gun
      • ShooTools Slider
      • Redcord
      • Cryo Therapy
      • Skier's Edge
      Aplio i800 Aplio i800 Vibration Platform Vibration Platform Sensa mat Sensa mat
      Force Plate Force Plate Fascial Gun Fascial Gun ShooTools Slider ShooTools Slider
      Redcord Redcord Cryo Therapy Cryo Therapy Skier's Edge Skier's Edge

      Most importantly,

      we are the only facility in the US

      where structural medical diagnosis is reflected in functional treatment, and vice versa.

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      In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

      Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

      The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

      Dynamic ultrasonography examination demonstrating
      the full thickness tear and already occurring muscle atrophy
      due to misdiagnosis and not referring the patient
      to proper diagnostic workup

      Demonstration of how very small muscle defect is made and revealed
      to be a complete tear with muscle contraction
      under diagnostic sonography (not possible with MRI)

      image

      Complete tear of rectus femoris
      with large hematoma (blood)

      image

      Separation of muscle ends due to tear elicited
      on dynamic sonography examination

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