OrthoNeuroSpine & Pain Institute
Buttock pain is literally a pain felt in the posterior. Since many of us have sedentary jobs and buttocks that may just be a few sizes too big, the soft tissue surrounding the ischial tuberosity bones is compressed. The ischial tuberosity is the swollen part or broadening of the bone in the frontal portion of the ischium, the lowest of the three major bones that make up each half of the pelvis. As the point of fusion of the ischium and the pubis, it is attached to various muscles and supports the weight of the body when one is sitting.
How does buttock pain develop?
When we sit down, our buttocks usually rest on the ischial tuberosity. The most common cause of pain at the cheek line in the buttock area is weakness in the structures that attack to the ischial tuberosity. Buttock pain and tenderness over the ischial tuberosity is known in traditional medical lingo as ischial bursitis. Bursitis is an inflammation of the bursa, the fluid-filled sacs that allow tendons and muscles to glide over the bones. True bursitis is not only extremely rare, but also so painful that any pressure on the involved bursa would have the affected individual literally “hit the ceiling.” In other words, most buttock pain is not true bursisits but, rather, is due to a ligament injury and/or weakness in the area.
Buttock pain is most commonly seen in athletes involved in kicking or sprinting sports. It can occur in isolation or it may be associated with low back or posterior thigh pain. Pain in this region may arise from a number of local structures or be referred from the lumbar spine or sacroiliac joint.
A deep, aching, diffuse pain, variable in site is an indication of referred pain. Buttock pain associated with low back pain suggests lumbar spine abnormality. Buttock pain associated with groin pain may suggest sacroiliac joint involvement. Pain that is easily localised and of a fairly constant nature, is more likely to be from the buttock itself.
Causes of buttock pain can range, but include such conditions as sciatica, piriformis syndrome (compression or irritation of the piriformis muscle), bursitis, strain, or arthritis. Injury of one or more of the gluteal muscles, especially the gluteus maximus (which is the body’s largest muscle) can cause buttock pain. Buttock pain may also be caused by disease or conditions of the nearby anatomy, such as the pelvis, tailbone, groin, or lower back.
Refered Lumbar Pain
Pain referred from the lumbar spine may be a result of abnormalities of the intervertebral disks and the apophyseal joints. Spondylolysis and spondylolisthesis may also cause buttock pain.
Sacroiliac Joint Dysfunction
Sacroiliac joint dysfunction may refer pain to the buttock. The sacroiliac joint is the articulation of the sacrum (at the base of the spine) with the pelvis. The most common presentation that we see is unilateral pain (although it can be bilateral). Clinically the patient has deep seated buttock pain, difficulty in negotiating stairs and problems rolling over in bed. With this condition there is often a rotation of the sacroiliac joint with one side of the pelvis being higher than the other resulting in a possible leg length discrepancy. This is often associated with instability of the low back and pelvis.
Treatment involves reduction of local inflammation and correction of the biomechanical dysfunctions present within and around the pelvis. Stretching and massage therapy are important to correct imbalances while a specific rehabilitation program is imperative to improve overall control of the lumbopelvic area.
The hamstring muscle group have an attachment from the buttock region. This attachment is a common site of a tendinopathy as a result of overuse. Treatment involves deep massage, stretching and correction of any biomechanical abnormalities with a structured rehabilitation program
What are the symptoms of buttock pain?
The symptoms of buttock pain are, plain and simple, “a pain in the butt.” Pain on the bottom of the buttock, especially when sitting, and possibly also while running, is typical. The pain may be achey, sore, stiff, dull, tight, throbbing or any combination of the above. The area may also be tender and sensitive to touch. Simple tasks such as putting on one’s socks may seem monumental. In extreme cases, sleep may be disturbed. Pain may also radiate from the buttock into the posterior leg. Buttock pain is worse first thing in the morning and/or increases as the day progresses.