Buttock and Piriformis Pain

A deep, nagging ache in one buttock.

Worse after sitting for a long time, or driving. Sometimes it spreads down the back of the thigh. You can press a spot that reproduces it exactly.

This is a good target for heat, with one important caveat about what else can cause it.

What’s in there

Under the large gluteal muscles sits a group of smaller ones, including the piriformis, which runs from the sacrum to the top of the thigh bone.

The sciatic nerve passes close by, and in some people through the glute muscle. Rare, but it happens.

Buttock pain can come from these muscles being overworked or tight, from the sacroiliac joint, from the hip, or referred from the lower back. Pain further out on the side of the hip is usually gluteal tendinopathy; right at the tailbone, coccyx pain. They overlap, which is why self-diagnosis here is unreliable.

A word on “piriformis syndrome”: it’s a contested diagnosis.

Many people labelled with it have pain coming from the lumbar spine. That doesn’t change what you do at home much, but it’s why a proper assessment is useful if it persists.

Heat and release

The buttock is thick, well-padded muscle, so it takes heat well.

1. Heat, 15–20 minutes. Lie on your side with the pad over the buttock, cover on, lowest setting.
2. Then pressure. Sit on a tennis or lacrosse ball, find the tender spot, hold 30–60 seconds, breathing normally. See muscle knots: heat first, then a massage ball.
3. Then stretch and move. The two below, then a walk.

Ease off the ball if the pain shoots down your leg. That’s a nerve being provoked, not a muscle being released. See sciatica and heat.

Two stretches and one strengthener

1. Figure-four stretch. Lying on your back, cross the sore ankle over the opposite knee, then draw that thigh towards you. Hold 30 seconds, 3 times.
2. Knee across body. Lying down, draw the bent knee across towards the opposite shoulder. Hold 30 seconds. Tight hamstrings often come with this.
3. Glute bridges. On your back, knees bent, lift the hips and lower slowly. 10–15 times. Weak glutes are a common reason the deeper muscles get overloaded, and strengthening usually helps more than stretching alone.

What keeps it going

• Long stretches of sitting, especially in a car. See long flights and long drives and sitting back pain.
• Sitting on a wallet or phone in a back pocket
• A jump in running or hill work. See IT band and runner’s knee.
• Weak hip muscles doing a job they’re not conditioned for

See a doctor or physio if…

• You have numbness around the groin or buttocks, or trouble controlling your bladder or bowels. Go to A&E.
• Pain, numbness or weakness runs down the leg below the knee. See sciatica: can a heating pad help?
• You have a fever, unexplained weight loss, or a cancer history
• The pain started after a fall, or you can’t bear weight
• It’s constant and doesn’t change with position or movement
• It hasn’t improved after three or four weeks

Clinically reviewed by: Nigel Chua (Hand Occupational Therapist) & Louise Yow (Physiotherapist). This article is general information, not a diagnosis. electricheatpad.com sells electric heat pads.