Stop being a pain in the ass” I mean literally…

18th Nov, 2019

Buttock pain

Do you have localised deep buttock pain with or without:

  1. Radiating leg pain behind your thigh (i.e. pain going down your legs),
  2. Low back pain,
  3. Paraesthesia (i.e. pricking/ pins and needles/ tingling)?

🤔 If you’ve experienced one or more of the above symptoms, do any of the following activities trigger them?

  1. Prolonged sitting in front of your computer/ desk
  2. Sitting with legs crossed
  3. Activities that require forward bending or put you in a slumped-type posture e.g. driving, gardening, walking uphill or going up the stairs etc.
  4. Dynamic activities that work your buttock muscles e.g. cycling on road bike in a high seated position, running uphill etc.
  5. After a buttock massage and/or buttock exercises

Well if so…you may just be experiencing Deep Gluteal (buttock) Syndrome (DGS)!

It is defined as: “buttock pain and dysaesthesia (i.e. any abnormal sensation) associated with sciatic nerve compression within the deep gluteal space”.

It encompasses the following conditions:

  1. Piriformis Syndrome
  2. Gemelli-Obturator Internus Syndrome
  3. Ischial Tunnel Syndrome

Hold up…what are these fancy big names for my buttock pain?!

Compression of the sciatic nerve by the piriformis muscle (one of your buttock muscles that facilitate rotation and sideways movement of your hip) was the first of such conditions to be described, which led to the term ‘piriformis syndrome’. This term was replaced by an umbrella term ‘deep gluteal syndrome’, as other musculoskeletal structures (besides the piriformis) have shown to cause pain that radiates down your leg i.e. sciatica.

As there are multiple potential sites and structures where the sciatic nerve can get entrapped or irritated, the above conditions are termed based on the different anatomical regions the sciatic nerve passes through.

Let’s get to the buttom of it (no pun intended!)

Where is the buttock pain coming from? There are three possible locations where the sciatic nerve can be compressed, and they can be classified into 3 zones:

Zone 1: Greater sciatic foramen

The piriformis muscle may be involved due to enlargement or individual structural variation.

Zone 2: Posterior hip i.e. back of your hip

The relationship between the Gemellus-Obturator Internus Complex (a fancy name describing a region in our buttock) and our hip joint structure.

Zone 3: Ischial Tunnel

You may experience pain at your butt crease behind the hip-thigh bone, which could be related to a problem at the upper part of your hamstring tendon (near your sit bone), or an impingement (i.e. compression) of the muscles between your butt crease and sit bone.

What a buttload of information…so can I get rid of this pain in my ass 🤬? Can Physiotherapy help with my buttock pain?

Fret not! Physiotherapists at PhysioX can help you get to the BOTTOM of your buttock pain!

From our mini anatomy lesson earlier, we can appreciate the complexity of your buttock pain. Firstly, let’s assess and diagnose it so that we can treat your buttock pain! 🤓

We may need to address your posture and advise you on load management during specific tasks or sports, to minimise your exposure to sustained stretch, compression and friction between your nerve and buttock muscles. To allow your pain to settle, you may have to avoid or reduce hills, stairs, or prolonged sitting positions initially.

Your Physiotherapist will then be able to curate an individualised exercise plan to optimise the health of your soft tissues around the sciatic nerve. For example, we may introduce nerve mobilization and movement retraining exercises. You will be progressing gradually with increased loads and functional exercises targeting control of your buttock muscles.

Manual therapy may also be utilised to complement your exercise program if deemed necessary by your therapist. Applying pressure deep into your buttock must be done with caution due to potential irritation and inflammation of the sciatic nerve. However, we should err on the side of caution when it comes to aggressive pressure into the deep buttock in view of potential irritation or inflammation to the sciatic nerve.

What are some exercises for your buttock pain?

Wall squats

Double leg squats

Single leg heel raise

Calf stretch

Why are you sitting on it?! Wait no more and get rid of that pain in your ass!

Book now or give us a call to schedule an appointment to see our Physiotherapist who will be able to partner you to recovery as we address your buttock pain!

DISCLAIMER: These advice and exercises should not replace the need for a consultation with a Physiotherapist especially if your condition doesn’t improve. Therapeutic exercise should be carefully selected to suit your condition.

Ref:

Dr Grimaldi, A. (2021, April 15). Getting to the bottom of buttock pain – Part 2. Dr Alison Grimaldi. https://dralisongrimaldi.com/blog/getting-to-the-bottom-of-buttock-pain-part-2/.

Hopayian, K., & Heathcote, J. (2019). Deep gluteal syndrome: an overlooked cause of sciatica.

Martin, H. D., Reddy, M., & Gómez-Hoyos, J. (2015). Deep gluteal syndrome. Journal of hip preservation surgery, 2(2), 99-107.

Schröder, R. G., Martin, R. R., Bobb, V. L., Khoury, A. N., Palmer, I. J., & Martin, H. D. (2016). Outcomes of non-operative management of deep gluteal syndrome—a case series of six patients. J Musculoskelet Disord Treat, 2(2).

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