I can’t hit a ball more than 200 yards. I have no butt. You need a butt if you’re going to hit a golf ball.
Dennis Quad, American actor and producer
Buttock pain is most commonly seen in athletes involved in kicking or sprinting sports. It can occur in isolation or it may be associated with low back or posterior thigh pain. Buttock pain or injuries such as pressure sores are also common in wheelchair athletes. Diagnosis of buttock pain can be difficult, as pain may arise from a number of local structures in the buttock or can be referred from the lumbar spine or sacroiliac joint (SIJ). The causes of buttock pain are shown in Table 27.1. The anatomy of the buttock region is shown in Figure 27.1.
Causes of buttock pain
|Favorite Table|Download (.pdf) Table 27.1
Causes of buttock pain
|Common||Less common||Not to be missed |
• Lumbar spine
• Sacroiliac joint
Hamstring origin tendinopathy
Quadratus femoris injuries
• Muscle strain
Fibrous adhesions around sciatic nerve
Prolapsed intervertebral disk (Chapter 26)
Chronic compartment syndrome of the posterior thigh
Stress fracture of the sacrum
Proximal hamstring origin avulsion
• Ischial tuberosity (children)
Gluteus medius tendinopathy (Chapter 28)
• Ankylosing spondylitis
• Reiter’s syndrome (reactive arthritis)
• Psoriatic arthritis
• Arthritis associated with inflammatory bowel disease
Bone and joint infection
Anatomy of the buttocks
(a) Surface anatomy
(b) Muscles of the buttock: superficial (left) and deep (right)
When assessing a patient with buttock pain, the clinician should attempt to determine whether the pain is local or referred. Clues can be obtained from the nature and location of the athlete’s pain. Examination may then identify which of the local or the potential pain-referring structures are causing the buttock pain. Investigation is of limited usefulness in the assessment of the patient with buttock pain.
A deep aching diffuse pain that 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 or hip involvement.
When the patient is easily able to localize pain of a fairly constant nature, the source is more likely to be in the buttock region itself. Pain constantly localized to the ischial tuberosity is usually due to either tendinopathy at the origin of the hamstring muscles or ischiogluteal bursitis. Pain and tenderness more proximally situated and medial to the greater trochanter may be from the piriformis muscle.