Often buttock pain is related to or as a result of an injury elsewhere such as the lower back.
Pain usually develops gradually over time but can also occur suddenly in the case of muscle strains.
On this page:
- Sacroiliac joint pain
- Hamstring origin tendinopathy
- Ischiogluteal bursitis
- Myofascial pain
- Referred pain
- Piriformis syndrome
- Compartment syndrome
- Avulsion fractures
- Stress fracture of the sacrum
Sacroiliac joint pain
The Sacroiliac joint is located at the bottom and just to the side of the back. The joint can become inflamed and painful, causing either a sharp pain or an ache in the lower back which can spread to the buttocks. The pain can be caused by a traumatic impact, poor biomechanics, inflammatory disease or from hormonal changes, such as pregnancy.
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Hamstring origin tendinopathy
Hamstring tendinitis is inflammation or degeneration of one of the hamstring tendons as it attaches to the Ischial tuberosity at the top of the thigh. It may follow a tear of the hamstring tendon which hasn’t properly healed or simply develop through overuse. Pain may come on gradually, especially after activity, and stretching the hamstrings is likely to be painful. In particularly chronic cases adhesions or stick bits may develop, irritating the sciatic nerve, although this is thought to be rare.
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Ischiogluteal bursitis is inflammation of the bursa that lies between the ischial tuberosity and the tendon of a hamstring muscle. A bursa helps movement between the tendon and the bone so when this becomes inflamed it can be painful. It can occur with a hamstring or tendon injury, which have similar symptoms to Ischiogluteal bursitis.
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Myofascial pain or trigger points in the Gluteus medius and Piriformis muscles can cause pain in the buttock area. A trigger point is a tiny localized knot in the muscle. It will cause pain in the buttock or lower back which may spread to other areas. Movement around the hip will be difficult, but this can be helped by stretching and massage.
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Referred buttock pain (from the Lower back)
Pain in the buttocks may be referred from problems in the lower back, even if there is no low back pain present. Many problems could cause this to happen including Prolapsed or ‘Slipped’ discs or nerve impingement from the joints in the spine. Symptoms include a diffuse or deep aching in the buttock which can vary from mild to severe. The slump test is one test a professional therapist would use to identify if sciatic nerve tension or impingement is contributing to buttock pain. Read more on:
Bruised buttocks or a contusion of the buttocks is bleeding in the muscles caused by a direct impact to the area. This can be from a fall or being hit in the area by a hard blunt object such as a hardball. There will be pain and tenderness at the point of impact. Read more on the ways you can treat this injury.
Symptoms include pain in the buttock at the time of impact. Obvious tenderness when pressing into the muscles or sitting down will be felt. Bruising may appear and pain and stiffness may be felt when stretching and contracting the buttock muscles during exercise.
Treatment involves rest and applying the PRICE principles. Apply ice or cold therapy products regularly for 15 minutes to ease the pain, bleeding, and swelling. Once comfortable to do so, start gently stretching the glute muscles. Sports massage can help to relax the muscles and disperse waste products, but should not be performed within 72 hours of injury due to possibly increasing blood flow.
Once pain-free to stretch and everyday movements, strengthening exercises can be performed to ensure there is still full strength in the glutes.
Piriformis syndrome causes pain in the buttock which may radiate down the leg. It is due to the sciatic nerve being impinged by a tight piriformis muscle deep in the buttocks. Overuse and tight adductor muscles can cause the nerve to be impinged and make the buttock painful. Resting, icing and stretching can help ease the pain, with strengthening exercises helping once the pain has gone.
Read more on Piriformis syndrome.
A herniated disc is sometimes also known as a slipped disc or prolapsed disc. It can occur anywhere in the spine although is most common in the lower back and can manifest itself with a number of symptoms including back pain, leg pain, neural symptoms as well as bowel and bladder problems. Treatment may involve rest and exercises or surgery may be required in some cases.
Chronic compartment syndrome occurs when a muscle swells up too big for the sheath that surrounds it, causing pain, especially during exercise when the muscles expand due to blood flow. This is very rare but may happen in muscles at the back of the thigh causing pain in the back of the thigh and buttock, particularly following a muscles strain or previous injury.
Hamstring/Pelvic avulsion fracture
A pelvic avulsion fracture is where the tendon comes away from the bone, often taking a piece of bone with it. This most commonly occurs at the ischial tuberosity where the hamstrings attach, or the anterior inferior iliac spine, AIIS, at the front where the Rectus Femoris attaches. Pain can be caused by explosive movements, and the location of the pain indicates what kind of avulsion fracture it is.
Symptoms include sudden pain during a powerful, explosive movement. Pain at the back of the pelvis in the crease of the buttock may be an ischial tuberosity avulsion fracture and pain at the bony part on the front of the hip may be an anterior superior iliac spine avulsion fracture, ASIS. The athlete will feel weakness and pain when doing certain movements which place a load on the affected tendon. Bruising and swelling are likely.
Treatment: If this injury is suspected, seek medical attention as soon as possible. Rest the area as much as possible. Apply ice regularly for the first 2-3 days to ease pain and inflammation. An X-ray will help confirm the diagnosis. Generally, the treatment for a pelvic avulsion fracture is rest. They tend to heal on their own in 4-6 weeks.
In some cases, surgery may be performed to re-attach the bone and tendon to the pelvis. This is mainly reserved for large fractures of where the fracture is displaced considerably. Following the rest period, a gradual rehabilitation programme can be commenced which aims to regain full strength and movement at the hip.
Stress fracture of the sacrum
Stress fractures of the sacrum are rare and most likely to affect female long-distance runners. Symptoms of vague low back or buttock pain on one side which is made worse with weight-bearing activities such as running. A specific tender point may be felt on the bone itself. Treatment involves rest or non-weight bearing exercise until paid goes, usually a couple of weeks. Then a gradual return to training is important rather than going straight back into full training.
Be aware of:
There are a number of conditions which although rare may be overlooked when diagnosing buttock pain. These include Spondyloarthropathies, tumors, and infections of bone and joint.