Buttock pain may arise from a number of local structures in the buttock or can be referred from the lumbar spine or sacroiliac joint (SIJ), which happens quite commonly. Trigger points are common sources of referred pain to both the buttock and posterior thigh. A deep, aching, diffuse pain, which is variable in site, is an indication of referred pain. Buttock pain associated with low back pain suggests lumbar spine abnormality. Buttock pain associated with groin pain may suggest SIJ involvement.
When pain is localized in a precise area in the buttock, the source is more likely to be in the buttock region itself. Pain constantly localized to the ischial tuberosity area (the bone in your pelvis in which you sit on) is usually due to either tendinopathy at the origin of the hamstring muscles or ischiogluteal bursitis (inflammation of a bursa in the gluteal area). Pain and tenderness more proximally situated (higher up and located more on the inside of the hip joint) may be from a muscle in the buttock area called piriformis. The gluteus medius and piriformis muscles are two of the most common sites at which trigger points develop, and commonly the cause of pain is shortening of these muscles. Occasionally, this may lead to a sciatica-like symptom, with pain radiating down the leg. This is because the sciatic nerve runs underneath the piriformis muscle, and if this muscle is tight, it may compress/pressurize the nerve, causing radiation of pain down the leg where the nerve runs through. This condition is called “piriformis syndrome” (piriformis impingement). Physiotherapy treatment in these cases involves stretches of the muscles, electrotherapeutic modalities and soft tissue therapy (massage, soft tissue release) to the tender area in the piriformis muscle. Stretching and soft tissue therapy are also useful in correcting pelvic/SIJ imbalance (especially of the hip flexor muscles).
Core stability training and a rehabilitation exercise program to improve the overall control of the lumbopelvic area will also form part of the rehabilitation process. Low back mobilization or manipulation techniques to restore full mobility to stiff intervertebral segments may also be used if buttock pain is thought to be referred from the lumbar spine. Soft tissue therapy and dry needling may be used to treat chronic muscle thickening both around the lumbar vertebrae and in the gluteal region.
See also - Jaw Pain, Shoulder, Elbow & Forearm, Wrist & Hand, Pelvic Pain, Hip & Groin, Thigh, Knee, Shin, Foot, Head & Neck, Upper Back/Thoracic Spine, Lower Back, Buttocks, Calf & Achillies Tendon, Ankle