Do You Have A Pain In the Butt?

Running should normally not be painful. However, eventually all of us will experience some form of discomfort,
hopefully only temporary, with the activity. It most commonly
will be in the leg, shin or knee, or the foot or ankle. Occasionally the runner might get pain in the buttocks—hence
pain in the butt. The buttock is the area at the back of the pelvis, which is covered by the gluteus maximus muscle,
“the glutes.” There are also some other deeper muscles and tissues that can become inflamed or injured during
activities such as running and other active sports. These include the short muscles responsible for the turning in
or turning out of the hip.These “rotators” include the superior and inferior glamelli, the obturators, the quadratus
femoris, and the piriformis muscle (Figure 1).

Figure 1: Back view of pelvis and hip joint.

Buttock pain can be due to several other causes besides the

piriformis or other rotator muscles. These include hamstring
injuries, hip conditions, lower spinal problems, and referred pain
from either lower in the kinetic chain or higher up in the spine.
The cause can be muscular weakness, unbalanced conditions,
or more serious pathological diseases. Muscle tears or pulls are
a common cause of acute injuries in this area. The piriformis
syndrome is not usually an acute injury—the symptoms develop
slowly over time. A bursa is a space often containing fluid which
serves to lubricate an area of high friction
as when a muscle or tendon moves near a bony prominence.
There are several bursae in the area of the hip and pelvis in the
buttock region. These bursae may become inflamed for reasons
related to overuse, injuries, or anatomical variations. Some of
these inflamed bursae do in fact respond to antiinflammatory
medications.

The typical complaint from someone with piriformis syndrome will be pain and tenderness in the area of the back of
the hip deep in the buttock region. The pain and symptoms may begin with the first step of running and persist
throughout the run. It usually does not get worse with activity but just continues to nag the runner. Pain may not be
severe enough to curtail the run completely, but the runner may slow down her pace and cadence. The diagnosis is
most obvious with acute painful tenderness on close palpation or feeling of the area in the buttocks. To confirm the
location of the tenderness, place your fingers over the tender area and push hard while rotating your hip. You may be
able to feel the tender area of the muscle deep in your buttock. (A word of caution— perform this maneuver in the
privacy of your Running Room store or in your home, not in public!) As with any inflammatory
condition it is especially helpful to know what caused it so that effective treatment can be introduced. Repetitive
movements to a susceptible tissue are probably the most common
theory for most injuries. The tissue may have been rendered susceptible due to a recent injury, from a muscle tear or
pull, from a loss or gain in body weight and associated weakening of essential muscles. The true diagnosis may only
be achieved after a period of excluding other conditions through careful physical examination or other investigations
(such as x-rays, blood test, electrical studies).

The pain from piriformis syndrome will often be exacerbated from prolonged sitting, especially in soft chairs such
as car seats and couches. The pain usually is better when you lie down or walk around. As the piriformis muscle is
intimately associated with the sciatic nerve, there may be some radiation of the pain down the leg as seen in sciatica
conditions. Usually the sciatic nerve lies adjacent to the piriformis muscle, but in approximately 15 percent of
individuals the sciatic nerve actually penetrates the piriformis muscle as it exits the pelvis to provide the nerve supply
to the rest of the leg.

Treatment: