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1st Oct

2010

Buttock Pain- What Is It?

This is a question I often hear. My answer usually is, that only a thorough evaluation can determine its cause. Provided that sources other than from the musculoskeletal system have been ruled out, the lumbar spine (low back), sacroiliac joint and hip must be looked at, since either of these areas can produce pain in the buttocks. Sometimes problems in more than one area co-exist, especially in chronic cases. As an example, a low back disorder may produce increased muscle tension in hip muscles, which over time may cause tissue irritation in the hip joint, or its surrounding soft tissues.

The well trained clinician will take a thorough history, and perform a series of clinical tests, to differentiate between potential tissues involved, and to identify their location. Only then can an effective treatment regimen be prescribed.

Although taking medications, resting and applying ice may initially be helpful to reduce symptoms, such treatments do not address the source and cause of the pain, and therefore are ineffective in preventing its return, or often even in sufficiently decreasing the pain.

It should be pointed out that simply pressing on an area is the least accurate way of diagnosing a musculoskeletal problem. Typically we will find tightness in muscles with tender points in the area of pain. However, that does not mean that it is the muscle which is at fault, it simply means that the muscle is contracting as a result of the irritation, which is typically a reflex muscle guarding response.

When it comes to the buttocks, we often see such a guarding response of muscle groups such as the piriformis, or the gluteus medius. These muscles can easily be facilitated to contract by problems in the lower back or by irritation involving the sacroiliac joint or the hip.

For the person in pain, certain simple forms of self-assessment may give a clue as to the cause of the pain, although these signs are far from conclusive.

If the pain in the buttocks is stemming from the back, it may come on by bending the trunk forward or backwards or twisting the trunk in standing or sitting, during or after lifting, if coughing or sneezing, or if jarring the back such as driving over a bump. If there is also tingling or numbness in the leg, it may indicate that a nerve is being pinched and irritated in the back.

Sacroiliac pain is more common in women, during or after giving birth, in people younger than 40, in athletes and after traumatic events such as car accidents or falls. The pain may be more pronounced closer to the sacral bone than further out in the buttocks. The pain may increase with certain hip motions such as if sitting with legs crossed or with the foot placed on the opposite knee, and if standing with most weight on the leg or if taking long or quick steps. Without having a skilled clinician perform special tests, it is often quite difficult to diagnose most sacroiliac joint problems.

Buttock pain stemming from the hip is often accompanied by pain in the groin (but not always), and is usually reproduced by moving the hip in various directions, especially by pulling the knee up as far as possible and across the stomach or chest towards the opposite shoulder, or by fully twisting the leg. These movements may be somewhat restricted in mobility as compared to the opposite hip, especially if there is hip arthritis present. Again, sitting with the foot placed on the opposite knee may cause pain and be difficult to do. Squatting and walking stairs may be painful, and even regular walking and twisting with the foot planted. If there is much pain with pressure on the bump on the outside of the hip (trochanter), it may indicate trochanteric bursitis.

As with other musculoskeletal conditions, if the pain has not markedly improved after a few weeks, it is recommended to see your physician or physical therapist with orthopedic manual therapy training.

Best wishes for continued good health,

Gunnar

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