In daily practice we often encounter patients who are suffering from ‘buttock pain’. A large majority of these patient have been diagnosed or self-diagnosed with piriformis syndrome or sacroiliac joint dysfunction often commenting that their ‘pelvis is out of place, mal-aligned and rotated’. Buttock pain, however, has several potential sources that includes structures at the back of the hip, pelvis and lumbar spine (lower back). These structures may include nerves, soft tissues (ligaments, tendons, bursae) and the joints.

All too often that buttock pain is labelled without thorough assessment and consideration of the surrounding structures. A thorough knowledge of anatomical structures coupled with clinical experience helps to identify dysfunctional movement patterns providing early diagnosis allowing targeted treatment and reducing recovery time.

This blog briefly looks at common causes of buttock pain, pain location and clinical features.

Figure 1- Common areas of buttock pain referral
Original images supplied by Image by gpointstudio on Freepik

Key features of lumbar spine buttock pain

  1. Symptoms often associated with low back pain that refers into the buttocks and further down the leg
  2. Pain may be felt below the knee and into the foot
  3. Patients may complain of Low back stiffness
  4. Can be associated with nerve pain – such as pins and needles, altered sensation, weakness, heaviness
  5. Symptoms often aggravated with lifting, carrying, pelvic movements, bending forward, backward or flexing to the side and through prolonged standing
  6. Further information on back pain here

Key Features of Hip buttock pain

  1. Pain in the mid buttock region is often found with pain at the front of the hip around the groin
  2. Symptoms can be referred to the knee and the outside of the shin
  3. Patients may have a medical history of hip osteoarthritis
  4. Hip stiffness and reduced movement is common for example difficulty putting socks on
  5. Walking pattern may be affected for example you may be walking with a limp
  6. Symptoms are often aggravated with sitting in low chairs, squatting, pain is often initially experienced on walking after rest but improves with distance (start-up pain) and discomfort on the impact phase of walking as your heel strikes the floor
  7. Further information on hip pain here

Key Features of sacroiliac joint pain

  1. Pain located in the small dimple area either side of the low back with pain on placing weight through the leg such as standing and walking
  2. Often associated with pubic and or groin pain
  3. Patients often find it difficult standing on one leg
  4. The leg may feel heavy to lift
  5. Symptoms are often aggravated with transferring weight from leg to leg, sustained sitting, lifting weight, rolling in bed and on the stairs
  6. Often associated with pregnancy, history of falls, impacts, trauma and people with hypermobility

Key features of piriformis syndrome

  1. Pain located around the sciatic notch (see figure 1)
  2. Often symptoms are very similar to low back pain such as buttock pain, altered sensation, paraesthesia – tingling / burning / itching.
  3. Symptoms aggravated with sitting, prolonged walking, squatting, and placing the muscle under a stretch – such as moving the affected leg across the body
  4. Symptoms are not characterised by neurological deficits – this means no muscle weakness, no numbness, and no loss of reflexes in the affected leg

This blog helps to explore some of the potential sources of buttock pain. Buttock pain when seen in clinical practice requires a comprehensive assessment that involves taking a thorough history and physical examination to consider different sources of symptoms experienced. Should you have any questions and or struggling to manage your buttock pain please do not hesitate to contact the practice and ask for Duncan Townsend.

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