Treatment of Buttock Muscle Strain
For a patient with a buttock muscle strain, immediately initiate rest from pain-provoking activities, apply ice and water mixture for 20-30 minutes 3-4 times daily, and begin early mobilization within pain limits while avoiding complete immobilization beyond the initial healing phase. 1
Immediate Management (First 48-72 Hours)
Activity Modification
- Stop all activities that reproduce pain immediately, as pain serves as the primary guide for activity restriction and continuing painful activities causes ongoing tissue damage. 1
- Avoid complete immobilization beyond what is needed for initial pain control, as prolonged rest impairs muscle regeneration and promotes fibrosis. 1
Ice Application Protocol
- Apply ice and water mixture surrounded by a damp cloth for 20-30 minutes, 3-4 times daily, as this method provides superior tissue cooling compared to gel packs or ice alone and improves pain scores at weeks 1,2, and 4 after injury. 1
- Never place ice directly on skin to prevent cold injury—always use a barrier cloth. 1
- Ice application is effective for decreasing pain in acute soft tissue injuries. 2
Pharmacologic Management
First-Line Analgesics
- Use NSAIDs for short-term pain relief (ibuprofen, naproxen, or diclofenac), as they are effective for acute musculoskeletal pain. 1
- Topical NSAIDs eliminate gastrointestinal hemorrhage risk while providing equivalent analgesia to oral formulations and should be considered, especially in patients with GI risk factors. 1
- Topical capsaicin may be used to temporarily relieve minor muscle aches and pains due to strains. 3
Muscle Relaxants (Short-Term Use Only)
- For acute muscle spasm, consider cyclobenzaprine 5 mg three times daily or baclofen 10-30 mg/day for 2-4 days maximum. 1
- Avoid muscle relaxants entirely in elderly patients due to fall risk. 1
Medications to Avoid
- Avoid opioids, as they carry overuse risk without superior efficacy for musculoskeletal injuries. 1
- Do not use corticosteroid injections into muscle tissue, as deleterious effects on healing are well-documented. 1
Rehabilitation Protocol
Early Mobilization (Begin Within 48-72 Hours)
- Start gentle range-of-motion exercises within 48-72 hours after injury to restore flexibility while preventing joint contractures. 1
- Progress to eccentric strengthening exercises, as eccentric exercises have proven beneficial for muscle healing. 1
- Physical therapy should begin early in the recovery process to optimize outcomes. 1, 4
Specific Exercises for Buttock Muscles
- Gluteal squeezes: Squeeze buttocks muscles tightly, hold for 6-7 seconds, then slowly relax; rest 2-3 seconds between repetitions. 5
- Perform 5-7 repetitions, 3-5 times daily (before getting out of bed, before climbing stairs, and before going to sleep). 5
- Never hold breath during exercises. 5
Progressive Strengthening
- As pain subsides, advance to more challenging exercises including standing hip extensions and closed-chain exercises. 5
- Low-impact aerobic activities (walking, swimming, aquatic exercise) can be incorporated once acute pain resolves. 5
Interventions Without Proven Benefit
Avoid the following modalities, as they have no proven benefit for muscle strain recovery:
Red Flags Requiring Urgent Medical Evaluation
Seek immediate medical attention if any of the following are present:
- Obvious deformity or visible bone protrusion 1
- Severe swelling suggesting fracture 1
- Inability to bear weight or move the extremity 1
- Signs of vascular compromise (pallor, coolness, absent pulses) 1
Expected Recovery Timeline
- Most muscle strains heal with conservative management within 2-6 weeks. 4
- The long-term outcome after muscle strain injury is usually excellent with appropriate treatment. 4
- Complications are few when proper rehabilitation protocols are followed. 4