Buttock pain is a common complaint in a variety of populations, from young athletes to older
individuals. Buttock pain is a symptom of various possible causes, such as:

● Sciatica
● Piriformis Syndrome
● Spinal stenosis
● Gluteal muscle strain

All of the above causes can be treated through physiotherapy, and your physiotherapist will be
able to assess you to determine the cause of your buttock pain. Below are descriptions of these
causes and how they might present.

Sciatica is a general term describing compression of the sciatic nerve leading to pain over the
buttock and/or back of the leg. The sciatic nerve runs at the back of the pelvis, over the buttock
area, and down the back of the thigh. Compression might be caused by entrapment in the lower
back, or in the buttock area. Your physiotherapist will perform a variety of tests to determine
which it might be, and might refer you for a scan if needed.

Sciatica symptoms:
● Intense pain in the buttock area
● Pain may radiate down the back of the leg
● Sometimes associated back pain might be present
● Numbness, muscle weakness, sensation changes
● Tingling or burning sensation in the leg
● Gait abnormalities and difficulty walking normally

Piriformis syndrome causes buttock and/or hip pain, and can be closely associated with sciatica
symptoms. The piriformis muscle runs obliquely deep in the back of the pelvis and crosses over
the sciatic nerve. Abnormalities of the muscle can therefore lead to sciatica (see above
Sciatica). The muscle can either be injured or irritated. Women are more likely than men to
present with this syndrome, with a ratio of 6:1, due to anatomical differences in bone structure.
A large variation in anatomy of the sciatic nerve and the piriformis muscle also exists between
individuals. This variation is thought to lead to approximately 15% of piriformis syndrome cases.
The piriformis muscle functions to rotate the leg out (so the knee faces outwards), to lift the leg
sideways and to extend the leg backwards. Overuse of the muscle, due to weakness in other
muscles, unaccustomed exercise, or biomechanical abnormalities, leads to piriformis
dysfunction and causes irritation of the sciatic nerve that is in close approximation. Direct
pressure on the muscle and nerve over long periods can also lead to problems, and is referred
to as “wallet neuritis”, as sitting on your wallet in the back pocket or on hard surfaces is often the

Spinal stenosis is caused by degeneration in the lower back spinal structures, and is most
commonly seen due to aging. Degeneration leads to new bone formation in the area and
therefore narrowing of spaces between vertebrae occurs. Nerves and blood vessels run through
these spaces, and will become compressed or entrapped over time. The nerve compression
can lead to pain in the buttock, thigh or leg, causing difficulties walking or standing for long
periods of time. Pain can usually be relieved by bending forward or sitting down. Changes in
spinal structure can be seen on radiography, but often imaging findings do not correlate well
with symptoms.

Symptoms associated with spinal stenosis:
● Pain when extending the back (bending backwards)
● Pain with prolonged standing or walking
● Difficulty walking down stairs, easier to walk up stairs
● Relief when lying on the side, and not so much by lying on the back
● Change in posture of lower back (in avoidance of pain)
● Numbness and/or tingling the the leg/-s
● Weakness in the legs (almost half of patients experience this)
● Symptoms can be bilateral, although not always symmetrical
● Sometimes patients experience night cramps in the legs

Patients will be referred to a specialist for further investigation if the physiotherapist finds signs
of cauda equina or conus medullaris syndromes. These might include:
● Changes in bladder or bowel function
● Numbness of the sitting area (saddle anesthesia)
● Weakness or increased reflexes in both legs
● Failure to improve with rehabilitation

The gluteal muscles are a group of large muscles located over the buttock region. They are
important for stabilising the hip and pelvis and are also large force generating muscles used for
various movements. Muscle strains, trigger points, overuse injuries or compensatory
mechanisms might all lead to pathology of the gluteal muscles.

Common symptoms of gluteal muscle pain:
● Buttock pain
● Pain over the back and side of the thigh
● Pain when palpating the affected muscle
● Pain is exacerbated by walking, prolonged sitting, or prolonged standing
● Squatting and climbing stairs might cause pain
● Trigger points can be present in the affected muscle

Physiotherapy management:
Your physiotherapist will assess the gluteal muscles to determine the extent of the pathology of
the muscle. This will be followed by a variety of treatment techniques, depending on the initial
assessment findings. Some techniques that might be used include deep tissue massage, soft
tissue mobilisations, trigger point therapy, dry needling, retraining of movement patterns,
stability exercises, strengthening exercises, and stretching techniques