From the Guidelines
Musculoskeletal buttock pain is commonly caused by several conditions, including piriformis syndrome, sacroiliac joint dysfunction, hamstring tendinopathy or strain, gluteal muscle strains or tears, bursitis, and referred pain from lumbar spine issues or hip osteoarthritis. These conditions can result from various factors such as mechanical problems, injuries, age-associated changes, or inflammatory diseases 1. The management of musculoskeletal conditions, including buttock pain, requires integrated, coordinated, multidisciplinary, and multiprofessional care focused on the individual's needs, which can be provided in primary care or secondary care with specialist expertise and facilities 1.
Some key causes of musculoskeletal buttock pain include:
- Piriformis syndrome, which occurs when the piriformis muscle irritates or compresses the sciatic nerve, often due to muscle spasm or tightness
- Sacroiliac joint dysfunction, involving inflammation or misalignment of the joint connecting the sacrum to the ilium, frequently triggered by pregnancy, falls, or repetitive stress
- Hamstring tendinopathy or strain, affecting the tendons connecting hamstring muscles to the ischial tuberosity, typically from overuse or sudden movements
- Gluteal muscle strains or tears, happening during activities requiring rapid acceleration or deceleration
- Bursitis, involving inflammation of fluid-filled sacs that cushion muscles and tendons, particularly the ischiogluteal bursa, often from prolonged sitting on hard surfaces
- Referred pain from lumbar spine issues like herniated discs or facet joint arthritis, which can manifest in the buttocks
- Hip osteoarthritis, causing pain that radiates to the buttock region
Treatment typically involves rest, physical therapy, anti-inflammatory medications, and addressing underlying biomechanical issues. For example, ibuprofen (400-800mg three times daily with food) can be used to manage pain and inflammation, along with proper footwear and exercise modifications to address biomechanical issues 1. It is essential to identify and manage musculoskeletal conditions in a timely manner to reduce the burden on the individual and society, as they are the most common causes of physical disability and have an enormous socioeconomic cost 1.
From the Research
Causes of Musculoskeletal Buttock Pain
The causes of musculoskeletal buttock pain can be diverse and complex. Some of the potential causes include:
- Referred pain from the lumbar spine and sacroiliac joint 2
- Hamstring origin tendinopathy 2
- Myofascial pain 3, 2
- Ischiogluteal bursitis 2
- Gluteal pathology, including neuromas 2
- Piriformis syndrome, which can be caused by intrinsic pathology of the piriformis muscle, such as myofascial pain, anatomical variations, hypertrophy, and myositis ossificans, or by trauma to the pelvis or buttock 3, 4
- Sacroiliac joint pain, which can be caused by trauma, pregnancy, or certain athletic activities 5
- Leg length discrepancy, which can cause piriformis syndrome 4
- Peripheral nerve sheath tumors, which can cause persistent and debilitating buttock pain 2
Diagnosis and Treatment
Diagnosing the cause of musculoskeletal buttock pain can be challenging due to the complex anatomy and multiple potential causes. A thorough history and physical examination, as well as diagnostic tests such as MRI and fluoroscopically guided injections, may be necessary to determine the underlying cause of the pain 3, 2, 5. Treatment options may include conservative management, such as physical therapy and anti-inflammatory medications, as well as more invasive procedures, such as surgical arthrodesis or tumor removal 3, 2, 5.