“It’s a pain in my @$$!”

Author: Brooke Carmen, PT, DPT: Doctor of Physical Therapy and Blog Contributor.  Loves fun informational gems.  Fitness addict and wannabe foodie. Emphasizes patient-specific treatment style and promotes goal-oriented care. Learn more about Brooke on here.

Did you know you can get physical therapy for butt pain?  It’s true.  Let’s talk about some common pains in the booty!

Buttock pain can be several differential diagnosis.  When I say “differential diagnosis,” I am talking about different things that can be causing your pain, whether that is muscular, bony, ligamentous, or nerve-related.

A common “pain in the butt” I see is something called a LUMBAR RADICULAR REFERRAL which is commonly referred to as “sciatica.”  You have nerve roots in your back that bunch up into a cat’s cradle-looking thing called a plexus that then forms the sciatic nerve.  This nerve is a beast.  It’s the biggest one in our body.  If a nerve gets irritated in the back, it can send a signal down this big sciatic nerve.  Sometimes the pain can cross your knee down to your foot.  Generally, people that see me with this have a “burning,” “sharp, shooting,” or “tingling” sensation in their buttock or leg.

Another diagnosis I come across is PIRIFORMIS SYNDROME.  This one is not nearly as common as a lumbar radicular referral, but presents very similar.  The piriformis is a rotator of your hip, one of six major.  Sometimes this muscle can become hypertonic, or “angry” and overactive.  It can put pressure on the sciatic nerve, causing buttock pain or symptoms down your leg.




A GLUTEAL TENDINOPATHY can be a real pain in the butt!  Your glutes are muscles in your buttocks.  There are three total:  the maximus, medius, and minimus.  They work to rotate your hip in, out, out to the side, and straight backwards.  Sometimes when they are overworked, you can get tiny (really, really tiny) tears in them and develop irritation.  Just having tender glutes won’t diagnosis this one.  It can be a silent diagnosis that stays quiet during activity, then annoys you when resting.  Don’t confuse this with delayed muscular soreness (DOMS).  That’s that “good pain” you get after doing a bunch of squats, lunges, and/or bridges 1-2 days ago.

I mentioned a lumbar radicular referral.  When I say “radicular,” I’m talking about nerve, specifically nerve roots.  Nerve roots follow these things called dermatomal patterns.  I’ll get to that in another blog.  Google it for now.  There are also LUMBAR REFERRALS in general.  These are pathologies that come from the back, but present like pain in the buttock region.  Structures that cause this type of pain can include facet joints (joints between segments in your back), discs (which can be a cause of radicular pain, too), and trigger points (a suspected irritation or “knot” like symptom in a muscle that refers pain to another place) to name a few.

These are just a few pains that I come across in the bum region.  There could be others!  You want to make sure you don’t have RED FLAGS with some of these conditions.  A red flag is something that would warrant immediate medical concern, like loss of bowel or bladder or numbness and paresthesia (tingling, abnormal sensations) in groin or pubic regions.

If you think you have a pain in your butt that sounds like one of these, contact us. However, I can’t address all pains in the butt, like in-laws or a downtown parking ticket ;). Although, keep in mind, some of those stresses can increase the musculoskeletal buttock pain that you may already feel.