Buttock Pain

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Many of the conditions discussed under “Low Back Pain” can also cause pain in your buttock area.

Piriformis Syndrome

Piriformis syndrome is a general term to describe pain arising from the deep gluteal region. It is not really a specific diagnosis, since it is not always possible to establish whether the piriformis muscle is indeed causing your symptoms. The piriformis muscle is a flat muscle that lies deep within the buttock area. One of your largest nerves, the sciatic nerve, runs over, through, or beneath this muscle, as it exits your pelvis along its path to your leg. Piriformis syndrome is thought to be caused by compression on the sciatic nerve by the piriformis muscle. This compression irritates the nerve, causing pain in the buttock area. Pain can also spread to your lower back, outer hip, thigh, calf or foot. You may have difficulty doing daily activities such as walking, sitting, standing, turning in bed or getting into and out of your car.

It is important to rule out any other potential causes for your pain. We always evaluate your unique situation. This will include obtaining your history of the onset, nature and progression of your symptoms, as well as a thorough physical assessment. We may perform various tests to distinguish between different body structures.

To treat your pain, we may use electrotherapy, mobilisation techniques, massage, taping and heat application. Tight muscles can be released with dry needling, myofascial techniques and therapeutic exercises. We will also educate you, where needed, on lifestyle modifications to help manage your symptoms. We encourage you to engage in regular physical activity, and will develop an exercise program for you. Lower back, pelvic and hip strengthening exercises are very important in the management of piriformis syndrome.

Hamstring injuries Strains/Tears

“Pulling” a hamstring can result in sudden pain, often accompanied by a tearing sensation or even a popping sound. The pain is generally located at the back of your thigh and/or at your gluteal crease. This type of injury typically happens when your hamstring muscle contracts rapidly or when it is stretched excessively at the end of its range e.g. during running, sprinting or doing the splits. Hamstring strains or tears are common in sports that involve acceleration movements like sprinting, jumping or kicking, as well as those that require maximal hamstring length such as skiing or gymnastics. Hamstring strains are the most common injuries in football.

The severity of strains/tears are graded, with a grade I tear being a minor partial tear, and a grade III tear is a complete tear. With more severe injuries, you may also have bruising and swelling at the back of your thigh. The hamstring muscle group consists of 3 muscles, which all originate from your sitting bone (the ischial tuberosity), stretching down the back of your thigh and attaching again just below your knee.

Buttock Pain

This means that the hamstring muscle group acts to move and control both your hip and your knee joints. Sudden, forceful movements with your leg stretched forward and your knee straight, stretches the hamstring muscle group to its limit, which may result in injury.

The first 48 hours after a hamstring injury are vital. During this time, you need to follow the RICE regime to manage any pain and swelling, to prevent further muscle damage, and to protect the injured area. It is important to contact your physiotherapist during this time, so that we can guide you on the Rest, Ice, Compression and Elevation phase. We also help manage your pain and inflammation with modalities such as ultrasound, electrotherapy, or laser.

After this acute phase, early movement is crucial as this will prevent loss of movement and strength of your leg. At Just Physio, we will assess the extent of your injury and develop a personalised rehabilitation plan to allow you to recover fully. Many people do not get the appropriate treatment, or fail to follow up and complete their rehabilitation programs. That is exactly why the recurrence rate is so extremely high. The greatest risk factor for another hamstring injury is a previous hamstring injury. The primary aim of our treatment is to help you restore full function of your leg such that you can return to your sport or other daily activities with minimal risk of injuring your hamstring again.

Your rehabilitation program will be progressed over a course of 12 weeks. During the first few weeks, we aim to protect the healing muscle and reduce any loss of motion or strength. We will teach you early exercises that are appropriate at this time, as well as treat any additional symptoms of pain, swelling or nerve irritation. Following this phase, we will gradually increase the amount of movement and load while monitoring your pain and other symptoms. Each patient’s rehabilitation program is adjusted according to their progress and symptom response. Finally, we guide you back to your sporting and other activities, and ensure that you are able to do so pain-free!

Tendinopathy

Pain at the back of your thigh or deep in your gluteal crease that starts gradually and becomes worse over time is most likely tendinopathy of your hamstring muscle. This type of pain is typically brought on at the start of activity, but becomes less as you continue the activity. However, the pain may be worse and linger after you stop the activity. The type of activities usually associated with symptoms include sitting, squatting, lunging, running, or any other activity where your hip is flexed or your body is leaning forward. You may also feel stiff in the morning or after sitting for a long time.

Most people only seek help after suffering from progressive symptoms for a long time. This makes the diagnosis of hamstring tendinopathy challenging, as other surrounding structures may also be adding to your symptoms by then. At Just Physio, we always take your full history and do a comprehensive assessment to determine the cause of your symptoms.

Buttock Pain

Our treatments aim to address the problem, and not simply manage your symptoms.

Tendons need to work, and with tendinopathy, the worst thing you can possibly do is to avoid movement. Our treatment will be aimed at progressively working or loading your tendon while monitoring your pain response. Some pain is expected but should not last longer than a day. The exercise program is the most crucial part of the management of a tendinopathy and we develop a plan specific to your needs. During this time we will also consider additional treatment techniques to address any other problems such as muscle spasm, persistent pain, or chronic inflammation. This may include ultrasound, electrotherapy, dry needling, and soft tissue release. We will also assess for, and address any potential contributing factors to your injury such as weakness of your core, poor hip/pelvic stability, muscle imbalances, etc.

Bursitis

Rarely, does the bursa covering your sitting bone (the ischial bursa) become inflamed, causing bursitis. A bursa is a fluid-filled sac that serves to protect joints and other body tissues. It does this by allowing smooth movement and preventing friction as these body parts move in relation to one another. Damage or irritation of the bursa will result in inflammation and thus pain. Direct trauma such as falling directly onto your sitting bone on a hard surface can cause an acute bursa injury.

The bursa can also become inflamed when it is exposed to repeated minor trauma such as when you sit for long periods of time especially on a hard surface. Pain will develop gradually. Typically, it will feel like a dull ache in the buttock that may radiate down the side of your leg. Your symptoms will be worse when you walk, run, climb the stairs, or sit for a long time. If you have tight or overworked glute or hamstring muscles, they can increase the pressure on the bursa.

Physiotherapy is effective in treating bursitis. Initially, we can assist in identifying any factors that are contributing to your problem, and help to address these. To reduce the pain and inflammation, we may use ultrasound, electrotherapy, mobilisation techniques, soft tissue release techniques, and therapeutic exercises.

Bursitis does not generally resolve on its own unless the cause of the problem is addressed. Long-standing bursitis can lead to thickening of the tissue, which can restrict your hip movements, and ultimately cause problems with your daily functioning. It is better to seek help sooner than later.

Pelvic Fractures

Falls or car accidents often cause pelvic fractures. Pelvic fractures are usually treated without surgery, and physiotherapy is crucial in the recovery period. Stable, undisplaced fractures usually require a day or so of rest but it is vital to start with early, gentle movement soon. This is where we can help you perform your daily activities with as little pain as possible. We will teach you how to balance activity and rest, how to get into and out of your bed, show you how to use an assistive walking device if needed, help to maintain your pelvic/hip movement, etc. Before starting with rehabilitation, we will make sure to discuss the extent of your injury with your doctor.

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