Buttock Pain: Causes of Pain in the Buttock and What Helps

What is buttock pain?

Buttock pain is pain in one or both buttocks: from the top of the buttock down to deep near the sitting bone. Often the cause is not in the bone itself, but in the gluteal muscles, the tendons and the bursae around the hip point, the sacrum or the hip joint. Those structures sit close together and their complaints look very much alike. That makes the cause of pain in the buttock hard to tell apart at first, and it asks for a careful examination. Most buttock pain is harmless and treatable.

You come to Embody Health Chiropractie without a referral; your first visit costs €39. After an extensive intake and physical examination you know straight away whether chiropractic care suits your complaint. Most Dutch health insurers (partially) reimburse chiropractic care from the supplementary package, without touching your deductible.

Across our three clinics in Alphen aan den Rijn, Amersfoort and Rotterdam we have guided more than 2500 people with complaints of the back, neck and joints over the past twelve years. Patients rate us on average 4.9 out of 5 stars on Google.

Where in the buttock does it hurt?

The signs and symptoms of buttock pain often point to the cause: the spot where it hurts says a lot. Pain high in the buttock, around the bone point on the outside, usually belongs to the tendons and the bursa there. Pain deep at the bottom, near the sitting bone, more often fits an overloaded attachment. And pain that runs from the buttock down into the leg belongs to an irritated nerve. Do you recognise one of these patterns?

• a nagging pain in the buttock that lingers and flares with certain movements
• pain when sitting on a hard chair, or when standing up afterwards
• pain when walking, climbing stairs or walking uphill
• a tender or tight gluteal (buttock) muscle that hurts when you press it
• pain on the outside of the hip that pulls towards the buttock
• radiating pain or tingling from the buttock into the leg

Pain in the buttock when sitting

Does it hurt to sit, especially on a hard chair? Then the complaint often sits at the attachment under the sitting bone, where the hamstring tendons anchor to the pelvis. Overload of that attachment gives a deep, nagging pain right there; sitting for a long time or pressing on a hard edge makes it worse. Rest and adjusted loading usually bring relief, and the complaint responds well to a calm build-up of load.

Pain in the buttock when walking

Walking puts more tension on the muscles and tendons around the hip, and on the bursa on the outside. Pain that increases with every step or on stairs often points to overload there. In that pattern the pain usually sits around the bone point of the hip and can travel along the side of the thigh, towards the buttock or the knee. Lying on the painful side, standing for a long time with the weight on one leg and walking uphill often make it worse.

Pain in the gluteal muscle

A painful gluteal muscle is common. Sometimes the muscle itself is overloaded or tight; sometimes there is more behind it. A well-known cause is piriformis syndrome: the piriformis muscle is a small muscle deep in the buttock, and it can trap the large nerve to the leg. That gives pain deep in the buttock, sometimes with tingling or numbness in the leg. The condition is not very common, but it is easily missed, because so many other conditions give the same complaints.

Causes of buttock pain

What can cause pain in the buttock? Usually it is a mix of overload, a poor posture and long periods of sitting or standing. The most common cause of buttock pain is overload of the gluteal muscles or the tendon attachment under the sitting bone. In practice we mainly see these causes:

• Overload of the gluteal muscles: one-sided loading, sport or a changed walking pattern can overload the muscles around the buttock and create muscle tension.
• Pain from the hip: wear or tendon problems in the hip joint are often felt in the buttock or in the groin.
• The pelvis and the sacroiliac (SI) joint: sacroiliac joint dysfunction — a disturbed movement of the pelvis or the SI joint — can create tension that is felt in the buttock.
• Overload of the attachment: tendons that anchor low at the sitting bone can become irritated; that gives deep pain exactly at that spot.
• An irritated nerve: when a nerve is trapped or irritated from the lower back, the pain can travel through the buttock into the leg.
• Bursitis: inflammation of the bursa on the outside of the hip gives pain when lying on your side and on stairs.

From the hip or the pelvis

The hip, the pelvis and the lower back work together in every step. When movement in the hip joint gets stuck, the pelvis takes over, and the other way around. That is why a complaint that starts in the hip can be felt as pain in the buttock. During your first visit we look at how they work together, so that we do not only treat the spot where it hurts. Pain that moves with the hip or with the lower back fits this pattern.

Pain in the buttock that travels into the leg

Does the pain not stay in the buttock, but run down the back of the leg, with tingling or numbness? Then a nerve is probably irritated. With sciatica the cause usually sits in the lower back, where a disc or a narrow opening presses on a nerve root. That is a different picture from pain out of the gluteal muscles or the joint, and it needs its own examination. You can read more about that on our page about sciatica.

First: rule out serious signals

Every first visit at Embody Health starts with a careful screening of the signals that need medical assessment. Most buttock pain is harmless and treatable, and we always screen first for the few signals that truly need attention. If the screening points to a serious cause, we refer you directly to your GP or an orthopedic specialist.

Buttock pain treatment at Embody Health

What does research show? Complaints on the outside of the hip and buttock, such as tendon and bursa problems around the hip point, respond well in most people to a conservative approach: adjusting the load, targeted exercises and manual therapy. Treatment options range from load adjustment and exercises to manual therapy, and in persistent cases a corticosteroid injection is sometimes considered for short-term pain relief. That matches what we see in practice. During your first visit we examine the mobility of the hip, the tension in the gluteal muscles and how the pelvis moves. With gentle, precise corrections we restore the movement of the joint and of the surrounding muscles and tendons. The goal is that sitting, walking and stairs become smoother again and that the pain settles.

Buttock and hip complaints often ask for more than one approach. We look at the mobility of the joint and the pelvis; physiotherapy (physical therapy) works with strength, condition and building up your load. When exercise therapy fits alongside the treatment, we align it with your physiotherapist, so that you do not follow two separate tracks.

Your first visit costs €39; a single follow-up treatment costs €65 and a consult in a recovery package €55. See what your health insurer covers and the fees.

What you can do yourself

Keep moving within a pain-free range. Walking and cycling keep the blood flow going and stop the muscles around the hip from stiffening; complete rest often makes the complaint stiffer. Break up long periods of sitting with short walks, and pick a chair in which your pelvis does not sink in. If you sit on a hard surface a lot, try a cushion or a softer seat. Stretching the gluteal muscles can relieve pain and reduce tension; a foam roller or a hard ball on the buttock can bring temporary relief, but do not push through if it hurts.

Do the complaints persist? Read more about pelvic and hip complaints or sciatica. Book a first visit and we will assess together whether chiropractic care suits your situation.