"Pain in the bum?" Common causes of buttock pain (Posterior Hip Pain)

Common causes of buttock pain (Posterior Hip Pain)

Pain in the buttock region, also known as posterior hip, is commonly treated in the Physiotherapy treatment room. Although we have used a Pun in the title, it is actually no laughing matter, and anyone who has had buttock pain will tell you how uncomfortable it can be!

The common assumption is that all buttock pain arises from a muscle called the Piriformis, which we will describe below, but will also discuss other common causes for the pain.

Piriformis Syndrome

The Piriformis is a small , flat muscle located deep in the buttock (underneath the gluts). Interestingly, in about 85% of people the sciatic nerve runs next to the muscle, but in 15-17% of us the sciatic nerve pierces through the muscle, which may be why some people are more susceptible to piriformis syndrome.It is aggravated by sitting, pressure on the buttock region (e.g. a wallet in your back pocket), driving and walking up hill.The pain can be situated locally in the buttock or can also refer down the leg (in the pattern of the sciatic nerve).

Proximal Hamstring Tendinopathy

The hamstring muscle attaches to the sitting bone by a tendon, called the Proximal Hamstring, or High hamstring. The pain is normally in the lower buttock region and worse when sitting, bending forwards, walking up hill or stretching the hamstring muscle. This pain can sometimes start after increased running, up hill running or being new to the sport. The proximal hamstring can also become problematic after long periods of sitting or driving.

Glut medius tendinopathy/Bursitis

There are 3 Glut muscles! Gluteus minimus, medius and maximus! Gluteus medius sits at the side / back of the hip and is responsible for stabilising the pelvis when we stand, walk and run. Like the hamstring tendon, the Glut medius tendon can get aggravated by increasing exercise too quickly, standing with hip ‘hanging’ over to side, lying on your side sitting with your legs crossed and walking. Again, stretching the buttock region can make this pain worse, so it is best to get advice about the best exercises for this problem.

Sciatica

Most people have heard about sciatica and how painful it can be! The sciatic nerve comes from the lower back and goes down the leg through the buttock muscle. An irritated sciatic nerve can therefore give you buttock pain. This pain can be achy but tends to be more sharp, burning and/or shooting in nature. Some people may also experience pins and needles or numbness in the buttock or further down the leg. This pain can be worse with sitting, bending forwards and driving.

Lower back pain with buttock pain

The muscles, joints and discs in the lower back can all refer pain into the buttock region. Therefore you may feel the pain in your buttock but it could be coming from elsewhere. A bit like when tooth ache makes your whole face ache! In this case, lower back exercises and physiotherapy treatment to the lower back can be very effective in helping to resolve the pain.

Could it be something else?

Although very rare, buttock pain can sometimes refer from other areas of the body such as the prostate or other organs. Therefore if you have pain but it does not seem to fit a classic pattern then make sure you visit your GP or Physiotherapist who can help you with a diagnosis.

We can provide assessment and treatment to help you with your hip/buttock pain at LMC Physiotherapy in Rugby & Coventry so please don’t suffer in silence!

Thanks for reading.