No, I don’t mean a really bad boss or acquaintance.  I mean literally.

Buttock pain, medically called gluteal pain is a deep pain usually affecting one buttock.  It feels like a bruise and is quite bothersome.  It can make prolonged standing difficult, and even light walking.  Sitting is very uncomfortable.  Walking upstairs can make it hurt even more.

The pain is usually described to be in the cheek part (lower) of the buttock a couple of inches to the side and downwards, from the sacrum– the triangular bone at the base of your lower back that is connected to your pelvic bones on either side.  In some people, the pain continues down the back of the thigh to the calf, and sometimes the bottom of the foot.

In many cases, the patient cannot explain what caused the pain.  This type of problem usually is reported to have a gradual onset, getting progressively worse.

Sciatica, or pain down the sciatic nerve is usually the diagnosis.  The sciatic nerve is the largest nerve in the body.  It  forms from nerve roots that branch from the sides of the lower lumbar spine and sacrum.

However, the term “sciatica” describes a symptom and does not provide much clinical information.  Sciatica can be caused by a herniated disc that presses on a nerve root that partially forms the sciatic nerve; it can be caused by a pelvic tumor that encroaches upon the sciatic nerve, and it can be caused by a condition called piriformis syndrome.

Piriformis - Muscles of the Lower Extremity An...

Piriformis – Muscles of the Lower Extremity Anatomy Visual Atlas, page 8 (Photo credit: robswatski)

The piriformis muscle is one of the small muscles that connect your hip bone (femur head) to the side of the sacrum and is used to externally rotate the leg (turn outwards).  The sciatic nerve passes between the piriformis muscle and adjacent muscles before it descends down the leg.  If the piriformis muscle is in spasm, it can squeeze the sciatic nerve causing deep gluteal pain; the piriformis muscle itself can generate pain if it is inflamed.

Piriformis muscle spasm can be caused by a hard fall on your seat that puts the muscle in spasm.  It can also develop when the pelvis is uneven; i.e. one hip is higher than the other when standing.  This can cause uneven pull on the gluteal muscles, causing the hip rotators to spasm.

TREATMENT:

If the pain persists for over a month or is unrelenting, see your doctor so that a herniated disc can be ruled out (you may get an MRI of your low back).  Once that is ruled out, you can do a couple of things to make the pain go away:

1.  Check the level of your iliac crests while standing in front of a mirror.  Place your fingertips flat on top of your hip bones; see if one is higher than the other.  Sometimes if the unevenness is large, you can see the high side and low side simply by looking in the mirror, and focusing on your belt or skirt/pant top — it will not be parallel to the ground, one side will be higher.  If this is the case, try inserting a heel lift in the shoe on the  side of the “lower” pelvic bone.  This will help even out the pelvis and remove strain to the gluteal muscles.  You can purchase an “over the counter” heel lift at most drugstores like Walgreens or CVS.  Optionally, you can buy a pair of gel inserts for shoes, and use only one in the shoe on the side of the low iliac crest.  Make sure to wear the lifts for at least two weeks to see if they help.  Decreased pain or frequency of pain indicates that they are working.

2.  Slowly and gently stretch the painful piriformis muscle by lying on your back, raising the leg on the affected side and bending the knee.  Grab with both hands behind the knee and pull gently at a 45 degree angle relative to your body; you should feel a stretch in your gluteal muscle.  Hold the position for 30 seconds; repeat three times.  Finish by sitting on a frozen gel pack for 20 minutes.

You can also check out this system for relieving sciatica pain.

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