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 or sciatic nerve-related injuries.
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.
- Pain may be a sudden sharp pain.
- Or maybe more of an ache in the lower back which radiates into the buttocks.
Sacroiliac joint pain may have a number of causes including traumatic impact, poor biomechanics, inflammatory disease or pregnancy.
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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.
- Symptoms include pain in the buttocks.
- Pain may radiate down into the back of the thigh and even into the calf muscles.
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Hamstring tendinitis is inflammation or degeneration of one of the hamstring tendons at the point it attaches to the pelvis.
- 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.
- Stretching the hamstrings is likely to be painful. In particularly chronic cases the sciatic nerve becomes irritated causing sciatic pain.
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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.
- The bursa can become painful and inflamed with symptoms almost identical to Hamstring tendonitis.
- Pain is located at the top of the back of your thigh, just below the crease of the buttock.
- Stretching the hamstring muscles may be painful.
- It can occur with a hamstring strain or tendon injury.
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Prolapsed disc (slipped disc)
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. Symptoms include:
- Back pain.
- Leg pain.
- Neural (nerve) related symptoms.
- Bowel and bladder problems.
Treatment may involve rest and exercises or surgery may be required in some cases.
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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.
- Sudden pain, usually during a powerful, explosive movement.
- Pain at the back of the pelvis in the crease of your buttock.
- You will feel weakness and pain when doing certain movements such as sprinting, squatting or jumping.
- Bruising and swelling are likely.
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Myofascial pain or trigger points in the Gluteus medius and/or 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 obvious low back pain present. Many problems could cause this to happen including:
- Prolapsed or ‘Slipped’ discs
- 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 used to identify if the sciatic nerve causing buttock pain.
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A contusion of the buttocks is bleeding in the muscles caused by a direct impact or trauma. This can be from a fall, or being hit in the area by a hard blunt object such as a ball or even an opponent. Symptoms include:
- Pain in the buttock at the time of impact.
- Obvious tenderness when pressing into the muscles or sitting down.
- 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.
Chronic compartment syndrome occurs when a muscle swells up too big for the sheath that surrounds it.
- Symptoms consist of pain in the muscle, 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 and buttock, particularly following a muscle strain or previous injury.
Stress fracture of the sacrum
Stress fractures of the sacrum are rare and most likely to affect female long-distance runners. Symptoms include:
- 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:
- Infections of bone and joint.