Buttock pain is a common problem seen in the physiotherapy clinic. The buttock area
has a complex anatomy and there are numerous sources, both local and referred, that can cause pain in this region. It is important to determine the exact source of the pain to ensure effective management of the problem.
The gluteal muscles originate and insert in this region. Overuse injuries (tendinopathy) of the gluteal tendon, acute tears, bursitis and trigger points can cause pain in this area. Pain from these injuries is often reproduced by a contraction or stretch of the muscle. The pain is often aggravated by increasing loads.
The sciatic nerve starts its journey into the lower limb through the buttock area. The nerve is made up of a combination of the 5 lower lumbar nerve roots. Injury to a disc or facet joint in the lower back can refer pain into this area without any associated back pain. This pain is often associated with neurological symptoms such as pins and needles and numbness, but can also present as a deep ache or sharp pain in the buttock.
The sacro-iliac joint (SIJ) is involved in transferring load between the lumbar spine and 
the lower limbs. It is supported by numerous strong ligaments which can be strained through an injury or abnormal postural loads. Pain from the SIJ is common during and after pregnancies. This pain is often worse with standing on one leg and lying on the back.
The hip joint can refer pain into the buttock area and groin. Hip osteo and inflammatory arthritis, joint infection, stress fracture of the femoral neck, hip impingement, osteoporosis and fractures can all contribute to buttock pain. Some of these injuries require urgent medical attention and need to be identified early. Sudden onset of buttock pain in young people can often involve the hip joint. It is important to investigate for Perthes disease or a slipped femoral epiphysis in this age group.
The pelvic floor muscles make up the floor of the abdominal core. As with any muscle in the body, they are prone to weakness and tightness. Trigger points from an over tight pelvic floor or an asymmetric floor, can cause significant pain in this area.
Due to the various potential sources of buttock pain, accurate diagnosis of the source of the pain as well as the reason for the tissue becoming painful is pivotal in effectively treating and resolving the injury. Incorrect diagnosis often results in ineffective management, a protracted period of injury and obvious frustration.
