What should I do if I'm an adult with no significant medical history and I fell on my buttocks, now experiencing pain in my buttocks and thigh, especially when walking and running?

Buttock and Thigh Pain After Fall: Immediate Management

After a fall on the buttocks causing pain with walking and running, you should immediately rest from aggravating activities, apply ice for the first 48-72 hours, and monitor for red flag symptoms that would require urgent medical evaluation.

Red Flags Requiring Immediate Medical Attention

You need urgent evaluation if you experience any of the following:

• Inability to bear weight or walk – suggests possible fracture or severe soft tissue injury 1
• Night pain that wakes you from sleep – may indicate stress fracture or other serious pathology 1, 2
• Progressive neurologic symptoms – numbness, tingling, or weakness radiating down the leg suggests nerve injury requiring urgent assessment 3
• Severe pain at rest that doesn't improve with position changes – concerning for fracture or vascular injury 4
• Loss of bowel or bladder control – indicates cauda equina syndrome requiring emergency surgery 3

Initial Self-Management (First 48-72 Hours)

If no red flags are present, begin conservative management:

• Rest from aggravating activities – avoid running, prolonged walking, and sitting on hard surfaces 4
• Ice application – 15-20 minutes every 2-3 hours for the first 48-72 hours to reduce inflammation 4
• Pain monitoring – any increase in pain suggests you're overloading the injured tissues and should further reduce activity 4
• Avoid prolonged sitting – sitting increases pressure on the buttock and can aggravate soft tissue injuries 5, 6

Most Likely Diagnoses After Buttock Fall

Soft Tissue Contusion (Most Common)

• Pain characteristics: Localized buttock pain, worse with direct pressure and sitting, improves gradually over days to weeks 7
• Expected recovery: Most contusions improve significantly within 1-2 weeks with rest and ice 4

Piriformis Syndrome (Post-Traumatic)

• Pain characteristics: Buttock pain with radiation down the posterior thigh, worse with prolonged sitting, pain with hip flexion/adduction/internal rotation 5, 6, 7
• Key features: Tenderness over the sciatic notch, pain reproduced by flexing, adducting, and internally rotating the hip 6, 7
• Timeline: Symptoms may persist beyond 2-4 weeks if this is the diagnosis 7

Proximal Hamstring Injury

• Pain characteristics: Buttock pain radiating to posterior thigh, weakness with hip extension, pain with sitting ("sit pain") 8
• Key features: Pain at the ischial tuberosity (sit bone), worse with stretching the hamstring 8

Sacral or Hip Fracture (Less Common but Serious)

• Pain characteristics: Severe pain, inability to bear weight, night pain, no improvement with rest 1, 2
• Risk factors: Older adults, osteoporosis, high-impact fall 4

When to Seek Medical Evaluation

Seek evaluation within 24-48 hours if:

• Pain is severe and not improving with rest and ice 4
• You cannot walk normally or have significant limping 1
• Bruising is extensive or rapidly expanding 7
• Pain radiates significantly down the leg 5, 6

Seek evaluation within 1-2 weeks if:

• Pain persists beyond 2 weeks despite conservative management 4, 7
• You cannot return to normal walking by 1-2 weeks 4
• Pain with sitting becomes the predominant symptom 5, 6

Gradual Return to Activity

Once acute pain improves (typically 3-7 days for simple contusion):

• Begin with walking – start with short distances (5-10 minutes) on flat surfaces, monitoring for pain 4
• Progress distance before speed – increase walking duration by no more than 10% per week before attempting faster walking or running 4
• Use pain as your guide – any pain during or after activity means you've progressed too quickly and should reduce activity level 4
• Introduce running gradually – begin with 30-60 second running intervals interspersed with 60 seconds of walking, only after you can walk 30 minutes pain-free 4
• Allow rest days – exercise on alternate days initially to allow tissue recovery and adaptation 4

Physical Therapy Considerations

If pain persists beyond 2 weeks, physical therapy should focus on:

• Stretching the piriformis muscle – if piriformis syndrome is suspected, this is a mainstay of conservative treatment 6
• Hamstring flexibility – gentle progressive stretching if proximal hamstring injury is present 8
• Hip strengthening – particularly hip abductors and external rotators to reduce compensatory stress 4
• Gradual loading progression – systematic increase in weight-bearing activities 4

Critical Pitfalls to Avoid

• Don't ignore persistent sitting pain – this is a hallmark of piriformis syndrome or proximal hamstring pathology and won't resolve without specific treatment 5, 6
• Don't progress activity too quickly – bone and soft tissue need adequate time to adapt to increasing loads 4
• Don't assume it's "just a bruise" if pain persists beyond 2-3 weeks – post-traumatic piriformis syndrome can develop after blunt buttock trauma and requires specific diagnosis and treatment 7
• Don't sit through the pain – prolonged sitting aggravates most buttock injuries and delays healing 5, 6

Diagnostic Testing if Symptoms Persist

If conservative management fails after 4-6 weeks:

• Plain radiographs first – AP pelvis and lateral hip views to exclude fracture, arthritis, or bone pathology 1, 3
• MRI if radiographs normal – to evaluate soft tissues including piriformis muscle, hamstring tendons, and sciatic nerve 3
• Consider EMG/nerve conduction studies – if radicular symptoms are present, to confirm nerve compression 6, 7