Buttock pain includes all sorts of different problems with different ways to get the diagnosis and different treatments. Some of the more common things are as follows:
Buttock in active people
Trapped nerves in the back
A pinched nerve in the back can cause pain radiating down into the buttock. It is caused by a slipped disc (prolapsed intervertebral disc) in the back. There is often a dull aching pain which can change throughout the day. There may be some sensations of numbness or pins and needles. Sometimes the pain can radiate down the back of the leg and we call this sciatica.
Rarely there can be a weakness in the leg, and even problems passing water. This is a serious sign and needs immediate attention.
The diagnosis is usually obvious following an examination and listening to your story but sometimes we would get an MRI scan to confirm it.
This is not really a problem that I can deal with, other than helping get the right diagnosis as often people will spend years having physiotherapy for buttock pain when the problem is actually in the back. Treatment can be physiotherapy, injections, or even surgery.
Pain in the sit bones
There are two quite common causes of pain in the region of your bottom where you sit (we call these bones the ischial tuberosities). These are proximal hamstrings tendinopathy and ischio-gluteal bursitis. Both of these cause sitting pain.
Proximal hamstrings tendinopathy
This is inflammation and tearing where the hamstring muscles join onto your pelvis. It is one of the most common causes of pain in this region, particularly in sportspeople. I see this a lot in runners and cyclists and have had it a bit myself. Typically, these people have tight hamstrings anyway, then they develop pain with sport that builds up and builds up through a session.
I can usually make the diagnosis following a gentle examination and listening to your story but sometimes we would get an MRI scan to confirm it.
Fortunately, there are really good treatment options in the form of physiotherapy, shockwave therapy and rarely injection therapy. Surgery is not required for this condition.
Ischio Gluteal Bursitis (Weavers Bottom!)
The alternative problem in this area has this complicated name. This is where the body makes a little sac of fluid called a bursa from prolonged sitting on hard surfaces. I had it when I was rowing for hours every day at Oxford. It can be really uncomfortable to sit down and you’ll always be hunting for a cushion.
The diagnosis can be confirmed with an MRI scan or ultrasound scan and a really good treatment option is an image guided injection into the sac of fluid to calm things down.
Frequently asked questions
No, hip arthritis very rarely causes pain at the back of the hip or the buttock. It causes groin pain. The things described above are the common causes of buttock pain. Come for an appointment and I can take a look and hopefully get you fixed and free of pain.
Yes, probably. Sitting pain is one of the most common complaints for proximal hamstrings tendinopathy.