Buttock Pain vs. Low Back Pain: Critical Distinctions
No, buttock pain is not the same as low back pain—they represent distinct anatomical regions and often have different underlying causes, though they can coexist or overlap in certain spinal conditions.
Anatomical and Clinical Definitions
Low back pain is defined by the American College of Physicians as "pain occurring primarily in the back with no signs of a serious underlying condition, spinal stenosis, radiculopathy, or another specific spinal cause" when nonspecific 1
Buttock pain is anatomically defined as pain in the region between the iliac crest and buttock crease, which is distinct from the lumbar spine region 2
Patients with sacroiliac joint-mediated pain (a common buttock pain source) rarely report pain above L5 and typically localize their pain to the area around the posterior superior iliac spine, not the lumbar spine itself 3
Key Clinical Evidence for Distinction
Buttock pain should be considered an independent symptom, not simply an extension of low back pain or leg pain. Recent prospective data demonstrates:
In 321 patients with lumbar disc herniation, 75.4% presented with buttock pain as a distinct symptom 2
Buttock pain was not related to back pain intensity or radiating leg pain patterns, establishing it as an independent clinical entity 2
Buttock pain responded to targeted treatment (endoscopic discectomy) similarly to radicular leg pain, with 91.2% resolution at 1-year follow-up, further supporting its distinct pathophysiology 2
Common Causes of Buttock Pain (Not Low Back Pain)
Radiculopathy from nerve root compression: Buttock pain was more common in contained disc herniations (85.8%) versus uncontained (69.7%), and in patients with intact annulus (86.7%) versus ruptured annulus (68.7%) 2
Sacroiliac joint dysfunction: Accounts for approximately 15% of lower back and buttock pain cases, with pain localized around the posterior superior iliac spine 3
Piriformis syndrome: May constitute up to 5% of cases presenting with buttock and leg pain, characterized by buttock tenderness and pain with hip flexion, adduction, and internal rotation 4
Facet joint pathology: Though selective nerve root blocks show superior results compared to facet blocks for buttock pain in spinal stenosis patients, suggesting radiculopathy is the primary mechanism 5
Clinical Pitfalls to Avoid
Do not assume buttock pain is simply referred low back pain—it often represents radicular pain from nerve root compression at L3-S1 levels 2
Do not overlook isolated buttock pain without leg symptoms—rare cases of L5 nerve root compression can manifest exclusively as upper buttock pain without radiculopathy 6
Imaging findings (MRI, CT, bone scans) of the sacroiliac joint cannot reliably determine if it's the pain source; controlled analgesic injections are the most important diagnostic tool 3
Diagnostic Approach
When evaluating buttock pain in the context of potential lumbar pathology, perform a straight leg raise test (91% sensitivity for disc herniation causing nerve root compression) and assess for sciatica below the knee 7
Consider L5/S1 transforaminal injection with local anesthetic to confirm nerve root origin when isolated buttock pain is present without clear radicular symptoms 6
Selective nerve root blocks demonstrate superior outcomes compared to facet joint blocks for buttock pain in degenerative spinal disease, with significantly better results at day 1, week 2, and week 6 post-procedure 5