According to the World Health Organization or the WHO, lower back pain affected 619 million people globally in 2020. That number is predicted to increase to 843 million by 2050. A large percentage of these cases are nonspecific, meaning they aren’t believed to be associated with another diagnosis or underlying disease, pathology, or tissue damage. Back pain can be caused or worsened by ligament or muscle sprains that often result from poor posture, lack of exercise, sudden awkward movements, improper lifting, and more.
The piriformis is one of the tiny and often overlooked muscles that can contribute to back pain. Lower back tension can arise from tightness in this muscle. Let’s look at what the piriformis is and the best stretches to provide some relief.
What is the piriformis muscle?
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The piriformismuscle is a flat muscle in your gluteal region or buttocks that helps you rotate your hip and turn your leg and foot outward. This pear-shaped muscle runs from your lower spine area through your buttocks to the top of your thighs. It’s one of the six short external thigh rotators that helps you shift your body weight to the opposite side when you’re walking.
A strong and flexible piriformis muscle can help prevent falls and injuries. Your sciatic nerve travels from your spinal cord and under or through your piriformis muscle, down the back of each leg, to your feet. Your sciatic nerve is the largest and longest nerve in your body.
What is piriformis syndrome?
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The sciatic nerve becomes irritated and inflamed when the piriformis muscle spasms, which can lead to piriformis syndrome. Piriformis syndrome involves pain, tingling, and numbness in the gluteal area and the back of the leg and foot on one or both sides.
What causes piriformis syndrome?
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Piriformis syndrome can be caused or worsened by several factors, including:
An acute injury that results in a sudden internal hip rotation
Inflammation, irritation, or overuse of the piriformis muscle
A compressed sciatic nerve
In some instances, people are born with an unusually formed piriformis muscle or sciatic nerve that contributes to this condition.
The problem with tight piriformis muscles
Having tight muscles from a lack of physical activity is known to be one of the contributing factors to piriformis syndrome. The right stretches and movements can help keep this tiny, overlooked muscle stronger and more supple to lower your risk of injury and issues like piriformis syndrome. Fitness and medical professionals point out that stretching and warming up properly before a workout can also help reduce the risk of piriformis syndrome.
What are the best piriformis stretches?
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The pigeon stretch is one of the best piriformis stretches.
Here’s how to do the pigeon stretch:
Start on your hands and knees in the tabletop pose.
Bring your left leg forward and under your chest. Bend your knee so the outside of your lower leg and foot are in contact with the ground.
Place both hands on the floor just in front of your bent leg.
Straighten your other leg back behind you.
Lower your body down and try to keep your pelvis square.
Hold the pose for a moment.
Return to the starting position.
Repeat on the other side.
Here are some more piriformis stretches to help relieve tension in your lower back:
From sciatica to piriformis syndrome, there are common culprits to buttock pain from sitting, Here, experts recommend how to handle them
Whether you’re dealing with a mega-commute, desk job, or just really loving your couch-time, if you’re like most people, you spend a lot of hours sitting down. One estimate in the International Journal of Behavioral Nutrition and Physical Activity looking at 54 countries found that adults spend nearly five hours every day sitting. As convenient as it may be, sitting is not doing your body any favours—particularly, your butt.
“Our bodies are not conditioned to be sitting for extended periods of time, and when we do, our gluteal muscles [the group that comprises the buttock area] begin to suffer,” says Ilan Danan, M.D., a sports neurologist and pain management specialist at the Centre for Sports Neurology and Pain Medicine at Cedars-Sinai Kerlan-Jobe Institute in Los Angeles. "With too much sitting, hip flexors begin to tighten over time, while gluteal muscles lengthen. Ultimately, this results in inefficient muscle activity with standing and walking.”
Even if you remember to take frequent breaks from sitting, you may still experience buttock weakness and pain from other issues. If you find that you're dealing with pain and difficulty whenever you've been sitting, here's a look at what may be going on.
Causes of Buttock Pain
To figure out what's causing your literal pain in the butt, you’ll want to consider your symptoms, as well as potential triggers and the intensity of your pain—for example, whether it's a dull ache or sharp and searing. With that in mind, here are four possible culprits, along with signs that may help with getting to the bottom of the issue.
Ischial Bursitis
Bursitis is the general medical term for painful swelling around joints and other tissues. Although it's most common in the shoulder, elbows, and knees, it can affect the hips and butt, too, according to Cleveland Clinic. Buttocks-specific painful swelling is called ischial bursitis, and symptoms include:
Deep ache rather than shooting pain
Pain that worsens with movement or stretching
Tenderness and swelling in lower part of the buttocks
Warmness (to the touch) in the swollen areas
Sciatica
There are several muscles in the hips and buttocks that allow you to extend your hip and turn your leg outward—these are called external rotator muscles, says George Eldayre, M.D., a specialist in primary care sports medicine at Orlando Health and Jewett Orthopaedic Institute in Orlando, FL. "These muscles are closely related to the sciatic nerve," Dr. Eldayrie says. "So if there are issues with these muscles or excessive pressure in the area, you can get radiating pain along that nerve—a condition called sciatica."
Other sciatica symptoms include:
Difficulty walking on your toes or bending your foot
Loss of sensation or numbness
Pain typically only on one side of the body
Pain when lifting the leg straight up when lying down
Shooting pain originating in the spine and radiating down the back of the leg
Weak reflexes
Piriformis Syndrome
Your piriformis muscle is located at the centre of either side of your hips and stretches horizontally across to your legs. Because of its proximity to your sciatic nerve, tightness in this muscle can cause compression and inflammation, resulting in piriformis syndrome, with symptoms like:
Burning sensation in the buttocks or hips
Difficulty walking up stairs
Inflammation in the front of the hips
Muscle spasms in the hips and buttocks
Numbness and tingling
Pain that worsens after sitting for long periods of time
Gluteal Medius Tendinopathy
Known informally as "dead butt syndrome," or "gluteal amnesia," this condition happens when your gluteal muscles are unable to support your pelvis and spine, according to Jhankhana Jani, D.P.T., doctor of physical therapy at Providence Saint John's Health Centre's Performance Therapy in Santa Monica, CA. She says symptoms include:
Feeling of poor lumbar spine and pelvis support, so your whole midsection feels unstable
Imbalance while walking
Tightness in the hips
Weakness in the gluteal muscles
In addition to these difficulties, people who have tight hips, arthritis in the spine, or chronic lower back issues like herniated discs can have pain in the buttocks when sitting, Dr. Eldayrie notes. "With problems like those, posture changes may cause excessive pressure to the discs, and that can radiate pain into the buttocks and the legs," he says. "Even limited flexibility of the hips can cause some discomfort with sitting for long periods of time."
Treatment for Buttock Pain
Addressing pain while sitting depends largely on the cause. For example, with sciatica, treatment usually involves over-the-counter pain relievers as well as ice and heat therapy. Alleviating pain from piriformis syndrome can include medication that relaxes the muscles, steroid injections, and physical therapy that strengthens piriformis muscles specifically. One notable difference is that bed rest is not recommended for sciatica, while it does help with piriformis syndrome.
For "dead butt syndrome," Dr. Jani says the best treatment is taking breaks throughout the day from sitting, and performing exercises that strengthen the gluteal and hip muscles on a regular basis.
Because buttock pain can be brought on by several issues, getting the proper diagnosis is invaluable for the right treatment, says Dr. Eldayrie. "Particularly if pain doesn't resolve on its own with stretching, or you're experiencing hip or low back problems, getting an evaluation is helpful for restoring mobility and activity," he adds.
If you only have occasional buttock pain or it isn’t disruptive to your everyday life, treatment may be as easy as changing your chair, says Renee Urban, P.T., a physical therapist at Atlantic Rehab in Livingston, NJ. "Pain may be due to seating position and it can be fixed with postural correction," she adds. "If that's the cause, then the pain should be remedied right away."
When to See a Doctor About Buttock Pain
If your butt pain doesn't improve with postural changes like choosing a different chair, or it continues even after you've gotten up and moved around for a while, there may be a deeper issue going on, says Dr. Eldayrie.
Particularly if you’re experiencing other symptoms along with the pain such as numbness, tingling, or weakness in the legs, it’s worth an appointment with your doctor. "In general, if pain with sitting comes on quickly and frequently, and doesn't resolve on its own with a change in lifestyle habits, then the problem should be evaluated by a physician," Dr. Eldayrie says.
Wallet-induced chronic sciatic nerve constriction causes lower extremity pain, tingling, and burning sensation. Pyriformis muscle stretching may help
Wallet neuritis is an example of extra-spinal tunnel neuropathy concerning sciatic nerve.
Pressure increases in sitting position and result in pressure increases the injury to sciatic nerve.
It is reversible if diagnosed early and corrective measures are taken
The internet is rife with tips and interesting insights on health and unheard concerns that may occur due to everyday habits which may be as small as even carrying a wallet in the back pocket.
Recently, Dr Sudhir Kumar, a neurologist took to Twitter to share an incident of a 30-year-old patient who consulted him for “severe, sharp pain” from the right buttock to the leg and foot for three months continuously. Highlighting the details of the case he wrote, “Pain was more while sitting and lesser while standing or walking. The pain increased on lying down,” he wrote in the thread — ‘How a valuable possession slowly damaged a young man’s nerve’.
Dr Jyoti Bala Sharma, a director of Neurology at Fortis Hospital Noida told News9, “This is a common problem as a result of pressure on the sciatic nerve. Pressure increases in the sitting position and results in pressure increase injury to the sciatic nerve. This is also known as Wallet Sciatica.”
She suggested that the treatment is not to keep the wallet in the back pocket. She further said, “It is reversible if diagnosed early and corrective measures are taken.”
While mentioning the way they ruled out the cause of pain in the patient Dr Kumar went on to write, after being evaluated elsewhere, an MRI spine ruled out slipped disc and nerve compression in the lower back region. Nerve conduction studies had shown severe damage to the right sciatic nerve but no cause for sciatic nerve damage was obvious, he noted.
The other disease-causing similar problem is the lumbar slipped disc or joint problem of the sacroiliac joint. Can be differentiated by an MRI of the Lumbar spine which will be normal in wallet sciatica, said Dr Bala.
According to PubMed, wallet neuritis is an example of extra-spinal tunnel neuropathy concerning the sciatic nerve. Its clinical appearance often gets confused with sciatica of lumbar spine origin. Wallet-induced chronic sciatic nerve constriction produces gluteal and ipsilateral lower extremity pain, tingling, and burning sensation. It was Lutz, who first described credit-card wallet sciatica in an Attorney, and surfaced in the Journal of American Medical
Association, however, the condition has not been well-studied in various other occupations. Long-standing use of a rear pocket wallet may compress and sensitize the ipsilateral sciatic nerve, generating features resembling lumbago sciatica; thereby, remains a source of patients’ misery and diagnostic illusion for pain physicians as well.
Dr Kumar mentioned in his tweet thread that there was no cause for sciatic nerve damage was obvious. Moreover, on detailed enquiry, the patient informed that he always carried a “fat wallet” in his right back pocket, which remained in his pocket while he sat in the office during work (10 hours a day). Now, I could guess the cause. The cause was “fat wallet” syndrome,” he added. The wallet compresses the pyriformis muscle, through which the sciatic nerve passes, thereby compressing the sciatic nerve. The wallet can also cause direct compression of sciatic nerve branches.
As a treatment of this, the expert “did not order any investigations” he said. Rather he advised the patient to remove the wallet from the back pocket while sitting. Pyriformis muscle stretching exercises were also taught to him. One month later, he was much better. Pain score had reduced from 7/10 to 1/10 on the visual analogue scale, explained Dr Kumar.
Buttock pain can have several causes, including injuries, overuse conditions, and nerve compression. Because buttock pain can significantly impact your ability to sit, stand, or walk, it is important to determine the underlying cause, receive appropriate treatment, and prevent your condition from getting worse.
This article will discuss common causes of buttock pain, how it is diagnosed, treatment options, and when to see a healthcare provider.
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Causes
Different causes of buttock pain can produce varied symptoms, including shooting, burning, numbness, tingling, or aching sensations. Some causes of buttock pain will come on all of a sudden while others can develop gradually over time.
Osteoarthritis
Osteoarthritis, also called degenerative joint disease, is a condition that causes pain, stiffness, and inflammation of joints from the breakdown of cartilage. Osteoarthritis tends to develop over time from the wear and tear that comes with aging but can also develop faster after an injury.
Osteoarthritis can affect any joint, including the hip. Osteoarthritis of the hip can cause a dull, aching pain in the groin, side of the hip, or back of the buttocks that can make walking difficult.
Sciatica
Sciatica is a general term that refers to compression of the sciatic nerve, the largest nerve in the body that runs from the lumbar spine of the low back down the back of the leg. Compression of the sciatic nerve can cause pain, tingling, numbness, and weakness in the buttock, back of the thigh, and/or below the knee.
Sciatica nerve compression can result from a variety of different causes, including bulging or herniated disks, spinal stenosis, direct nerve injury, or muscle tightness.
Piriformis Syndrome
Piriformis syndrome is a condition characterized by an overly tight piriformis muscle in the back of the hip. Because the piriformis muscle most commonly overlays the sciatic nerve, tightness of the piriformis can cause compression of the sciatic nerve, resulting in buttock pain that radiates down the leg.
Symptoms of piriformis syndrome present or significantly worsen when sitting for extended periods of time due to constant pressure on the piriformis muscle.
Sacroiliac Joint Dysfunction
The sacroiliac joint is the joint that forms between your sacrum and both sides of your pelvis at the base of your spine. While very little movement occurs in the sacroiliac joints compared to other joints of the body, the sacroiliac joints can become stressed or shifted out of normal alignment from pregnancy and childbirth, injury to the spine or pelvis, muscle imbalances, or uneven leg lengths.
Sacroiliac joint dysfunction causes a deep joint pain directly at the sacroiliac joint pain at the upper portion of the buttocks. Standing, walking, and climbing stairs all tend to worsen sacroiliac joint pain.
Hamstring Tendonitis
Tendonitis refers to inflammation of a tendon, connective tissue that attaches muscles to bones, from overuse of the associated muscle without proper rest. Hamstring tendonitis can occur from overuse of the hamstrings muscles in the back of the thigh that commonly occurs with long distance running, repetitive weightlifting, and field-based sports.
The hamstring tendons attach to the ischial tuberosities of the pelvis, the hard bony prominences that you can feel at the bottom of your buttocks when you sit. With hamstring tendonitis, pain can develop at these bony areas and deep at the bottom of your buttocks.
Trochanteric Bursitis
Bursae are small, fluid-filled sacs that lay in between tendons and bones to decrease friction and irritation at tendons from rubbing over bones. With repeated contraction or overuse of the muscles associated with the tendons, the underlying bursae can become inflamed and irritated, resulting in bursitis.
Trochanteric bursitis occurs at the side of the hip where the femur (thigh bone) joins with the hip. Symptoms of trochanteric bursitis include pain, tenderness, swelling, and muscle weakness at the side of the hip and/or buttocks.
Coccydynia
Coccydynia, or coccyx (tailbone) pain, often results from a fall on your buttocks and landing directly on your tailbone. Injuring your tailbone can cause a tailbone fracture or bruise to the connective tissue around your tailbone, causing significant pain and discomfort, especially when sitting on firm surfaces.
Haemorrhoids
Hemorrhoids result from swollen and inflamed blood vessels around the rectum, causing pain, burning, itchiness, and sometimes bleeding during bowel movements. Haemorrhoids are often caused by straining during bowel movements, chronic constipation or diarrhoea, or pregnancy.
When to See a Healthcare Provider
If your buttock pain persists longer than a week, especially if you did not injure your hip or leg, contact your healthcare provider.
The presence of certain signs and symptoms should also prompt you to schedule a visit to see a healthcare provider. These include:
Your pain significantly impacts your ability to walk, stand, or sit for extended periods of time.
You cannot move your hip without causing pain.
You experience burning, numbness, tingling, or weakness in your hip or leg.
You have pain and/or difficulty passing bowel movements.
You have unusual symptoms such as fever, fatigue, or unexplained weight loss.
Diagnosis
To diagnose the cause of your buttock pain, a healthcare provider will perform a physical exam and ask you about your medical history, including how and when your symptoms began.
Depending on the nature of your condition, your healthcare provider may recommend imaging tests to determine the underlying cause of your buttock pain.
Medical History
During your visit with your healthcare provider, you will review your medical history. This will include going over any medical conditions you have and discussing how and when your buttock pain began.
Your healthcare provider will also ask you questions about your condition, which may include:
Are you experiencing any other symptoms besides pain, such as tingling, numbness, swelling, burning, or muscle weakness?
Has the pain been getting worse over time?
Does the pain occur or worsen with different positions, such as sitting, standing, or bending?
Did you injure or previously injure your hip or back?
Are you having any problems passing bowel movements?
Be sure to tell your healthcare provider if you recently had an infection or experience unusual symptoms like fever, fatigue, or unexplained weight loss as these factors may point to an atypical systemic condition causing your buttock pain.
Physical Examination
After reviewing your symptoms and medical history, your healthcare provider will perform a physical exam to look at your buttocks and surrounding areas, including your hips and spine. Your healthcare provider will inspect and touch your buttock and thigh muscles and move your hips and legs to see if your motion is restricted and/or painful.
During your physical exam, your healthcare provider will look for signs of:
Redness
Swelling
Tenderness
Bruising
Numbness
Abnormal joint alignment
Imaging
Imaging methods may be used to examine the structures in and around your spine, hip, and sacroiliac joints to check for damage. X-rays are typically performed first to check for signs of arthritis or broken bones.
If an injury to a tendon or ligament is suspected, you may have an MRI (magnetic resonance imaging) performed to check for a sprain, tear, tendinitis, or bursitis. An MRI may also be used to examine your spine to check for irregularities, such as spinal stenosis, bulging or herniated disks, and nerve root compression.
Nerve Conduction Study
A nerve conduction test may be performed to examine the functioning of your nerves if your healthcare provider suspects nerve compression or damage is causing your buttock pain. During this test, you will have electrodes applied to your skin while small electrical shocks are administered. This test will measure how fast your nerves transmit signals to assess abnormal nerve functioning.
Treatment
Treatment options for buttock pain will vary depending on the underlying cause and severity of your symptoms. Many causes of buttock pain can be managed conservatively with medication, physical therapy, and at-home treatments, although surgery may be needed for serious or chronic injuries.
Lifestyle Treatment Options
Simple at-home methods can be used to help manage buttock pain. These include:
Ice or heat for pain relief
Topical pain-relieving creams or gels
Gentle stretching of your hip muscles
Resting from aggravating activities such as running, vigorous exercise, or prolonged standing, sitting, or walking
Using a specialized seat cushion to relieve pressure from your rectal/tailbone area
Dietary changes to improve your bowel movement regularity
Medications
If needed, medications can be used to help reduce your pain levels. Pain medication can be taken by mouth, such as over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) or stronger prescription-strength opioids, or delivered through a steroid injection into your hip or spine.
Physical Therapy
Physical therapy is very important for treating many causes of buttock pain. A physical therapist will create an individualized exercise program for you to help stretch overly tight muscles and improve your strength to help correct muscle imbalances.
A physical therapist may also perform manual treatments and administer therapy that include heat, ice, or electrical stimulation to help reduce your pain intensity.
Surgery
For significant causes of buttock pain due to spinal problems such as spinal stenosis or herniated disks that cause ongoing pain and limit your ability to comfortably stand and walk, surgery may be an option. Surgery is only considered, however, after trying other treatment methods for several weeks or months.
Spinal surgical procedures that can help decrease nerve compression and buttock pain from spinal disorders include foraminotomies to enlarge the area around one of the bones in the spine, laminectomies to create space by removing bone spurs and tissue in the spine, and spinal fusions to permanently connect two or more vertebrae in your spine.
Prevention
Most causes of buttock pain are due to physical issues resulting from overuse, muscle imbalances, or joint problems that develop over time. Exercising regularly and strengthening muscle groups around your buttocks such as your glutes, hamstrings, and abdominals can help decrease the risk of injury.
Whenever starting a new exercise program or an increase in physical activity, start off slowly to allow your body to adjust to the increase in physical demands and check with your doctor to make sure that you are healthy enough to exercise.
Summary
Buttock pain can result from a variety of different causes, including osteoarthritis, sciatica, piriformis syndrome, sacroiliac joint dysfunction, hamstring tendonitis, trochanteric bursitis, coccydynia, and haemorrhoids.
Most causes of buttock pain can be addressed with at-home treatments, physical therapy, and medication, if needed. Some severe or ongoing causes of buttock pain resulting from spinal problems like spinal stenosis or herniated discs may require surgery if symptoms fail to improve with conservative treatment options.
Limiting repetitive strain to your hips, correcting muscle imbalances, and resting from aggravating activities, especially if your buttocks are already hurting, can help prevent symptoms from developing or worsening.
A Word From Verywell
While buttock pain can often be treated and managed at home, see your healthcare provider if you have been experiencing buttock pain that lasts longer than one week.
Unaddressed causes of buttock pain can significantly impact your ability to sit, stand, or walk, and are best treated early to prevent permanent damage.
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