Pain in the gluteal muscle

Pain in the gluteal muscle is most often felt in m. gluteus maximus (large muscle), but can also be localized in m. piriformis - piriformis muscle and other structural components of the buttock. The causes of the pain symptom are varied and can be both independent signals of muscle damage and reflected pain in diseases of the internal organs, spine and vascular system.

What we mean by the buttock is one of the gluteal muscles, the gluteus maximus or the large gluteal muscle. Its functions are varied - it is responsible for hip extension when lifting up, for knee rotation, partly for walking upright, the muscle functions especially actively when running, jumping, squatting.

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Causes of pain in the gluteal muscle

The most common causes of pain in the gluteal muscle concern pathologies of the spinal column in the lumbosacral region. Such diseases make up about 75% of the causes that provoke pain in the buttocks area, and the nature of the pain is very similar to lumbago and rheumatic pathologies, which significantly complicates accurate diagnosis.

The main causes of pain in the gluteal muscle:

• Osteochondrosis of the lumbosacral region, radiculopathy, intervertebral hernia.
• Osteoarthritis of the hip joint.
• Diseases of the joints of the sacroiliac region (osteomyelitis of the femur or ilium).
• Injuries to the spine, sacrum, coccyx (muscle strain, hematoma, fracture).
• Compression of the sciatic nerve by the piriformis muscle (piriformis syndrome).
• Lumbago, when hypertonicity of the muscles of the lumbar region, as well as the hips and buttocks, occurs.
• Pathologies of the pelvic organs in women – adnexitis.
• Diseases of the rectum – proctitis, paraproctitis, hemorrhoids, perirectal abscess.
• Myalgia as a primary syndrome associated with infectious diseases and hypothermia.
• Myositis is an inflammatory process in the muscle tissue of the buttocks.
• Polymyositis.
• Various types of arthritis of the iliac joint, including psoriatic arthritis.
• Lumbar stenosis.
• Occlusion of the iliac artery or aorta.
• Tumors of the retroperitoneal region.
• Chronic gluteal muscle impingement syndrome.
• Malignant processes – lymphosarcoma, myeloma pathology, metastases of the iliac bone.
• Tuberculosis of bone.

Causes of pain in the gluteal muscle can also be secondary symptoms of such diseases:

• Fractures of the femoral neck.
• Inguinal hernia.
• Bursitis (trochanteric).
• False intermittent claudication.
• Tendinitis of the tendon belonging to the gluteus medius muscle.

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Symptoms of Gluteal Muscle Pain

The sensations and symptoms of pain in the gluteal muscle vary greatly in the descriptions of patients and can be as follows:

• The pain in the buttock appeared spontaneously, radiates to the back, then to the leg, and intensifies when getting up from a chair and when walking.
• The pain in the gluteal muscle prevents me from stepping on my foot; it is numb.
• The pain is felt in the middle of the buttock, it spreads down the entire leg, accompanied by a shooting pain in the lower back.
• The pain in my buttock has not subsided for a week now and gets worse when climbing stairs.
• The pain in the gluteal muscle is constant, does not subside when lying down, a feeling of pulling, spasmodic pain. The pain can be reduced by warming the buttock.

It is obvious that clinical manifestations, symptoms of pain in the gluteal muscle depend on the underlying cause, time of occurrence, and concomitant diseases. Here are several options for describing the symptoms of the following most common pathologies:

1. The most typical cause of pain in the buttocks is degenerative spinal disease, osteochondrosis. With such pathologies, the pain spreads along the surface of the buttock and radiates along the back of the thigh. The symptom intensifies with awkward movements, physical exertion and can subside at rest, in a lying position, with massage and warming up.
2. Stenosis, blockage of the aorta or iliac artery. The pain is intense during the first 30 minutes, so it can be considered paroxysmal. The pain gradually subsides on its own, without any treatment, but often recurs at night. In addition to pain in the gluteal muscle, stenosis is accompanied by weakness, pain in the leg, tingling and numbness of the foot, often partial lameness.
3. Piriformis syndrome. The clinical picture is characterized by pulling, dull pain, often accompanied by a burning sensation in the muscles of the buttock, sacrum and hip area. The pain subsides in a horizontal position, is activated by movement, especially during long walks. Symptoms of pain in the gluteal muscle can be radiating, radiating to the knee area, to the toes, disrupting normal gait.
4. Lumbago is characterized by severe, pulsating, shooting pain in the back, buttocks, thighs, and often the symptom radiates to the leg.
5. A purulent-inflammatory process in the bone tissue of the hip - osteomyelitis. Symptoms are characterized by sharp, acute pain, all movements are impaired, the pain does not subside even at rest, accompanied by fever, dizziness, nausea. Acute hematogenous osteomyelitis can provoke a comatose state.

Diagnosis of pain in the gluteal muscle

Diagnosis of pain in the gluteal muscle, first of all, should be differential, that is, its primary task is to exclude serious, life-threatening pathologies.

General, standard algorithm for examining patients with pain in the buttocks and thighs after collecting anamnesis:

Method of examination	Objective of the survey
Visual inspection	Determining the specifics of pain – intensity, character, duration, dependence on position, etc. Determination of muscle tone of the buttocks and lower back Examination of motor activity, sensitivity Biomechanical tests aimed at clarifying the area of muscle damage
X-ray	Identifying possible spinal injuries Determination of displacement of intervertebral discs or vertebrae Determination of possible congenital anatomical abnormalities in the structure of the spine and pelvis Exclusion of a possible tumor process in the spine Detection of osteoporosis, osteochondrosis
Computer tomography	CT scans perform tasks similar to X-rays, but with more detailed visual results (cross-sectional and three-dimensional sections of the spine)
MRI – magnetic resonance imaging	Allows to identify abnormalities in the soft tissues surrounding the spine and joints
Isotope contrast scintigraphy	Detects metastases, abscesses, osteomyelitis, non-union of the vertebral arches
OAC, urine analysis	To exclude or confirm an inflammatory process, rheumatism
ENMG - electroneuromyography	Determines muscle tone, innervation disorders in compression syndrome
Ultrasound of the hip joint, puncture	Prescribed strictly according to indications for the tumor process

The stages that are included in the standard diagnosis of pain in the gluteal muscle are carried out in the following sequence:

• Conversation with the patient.
• Inspection.
• Palpation of muscle tissue, manual diagnostics.
• Determination of the volume of active and passive movements.
• Biomechanical tests, muscle testing, physical tests (Trendelenburg test, Thomas test, Rob Patrick test and others).
• The stabilometry method is the determination of the ratio of tonic and clonic reflex muscle contractions.
• Examination of areas near the buttocks.
• X-ray.
• Electromyography.

Other examination methods can be prescribed based on the results of previous actions.

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Treatment for gluteal muscle pain

Most often, treatment of pain in the gluteal muscle is the correction of the primary disease that formed the muscular-tonic syndrome. If the source of the pain impulse is blocked, the reflex tonic pain subsides and regresses. If pain in the gluteal muscle is an independent symptom and at the same time a source of pain, treatment is carried out using local and general effects:

• Rest and immobilization of the spine.
• Therapeutic stretching.
• Massage the affected muscle.
• Warming compresses.
• Warming physiotherapy procedures.
• Manual therapy.
• Local application of NSAIDs – non-steroidal anti-inflammatory drugs.
• Prescribing muscle relaxants in tablet form.
• Post-isometric relaxation (PIR) may be prescribed.
• Correction of excess body weight.
• Physiotherapy exercises.

If the pain symptom is caused by a serious spinal pathology, radicular syndrome, novocaine blockades may be prescribed.

In summary, treatment of gluteal muscle pain depends on the etiology and pathogenetic mechanisms of the underlying disease that provokes the symptom. Therapeutic tactics should be determined not only by the intensity of pain and the rate of development of the process, but also aimed at relieving pain and neutralizing its relapses. Unfortunately, muscle pain in the gluteal, pelvic, and lumbar regions is often treated symptomatically, without taking into account serious consequences and complications, including the possibility of chronic pain syndrome. The most progressive therapeutic complexes are prescribed after a thorough examination and exclusion of threatening pathologies; treatment includes many drug methods (based on anti-inflammatory nonsteroidal drugs, glucocorticoids, vasoactive and antioxidant agents), as well as non-drug methods, including the so-called traditional methods. The leaders in non-drug therapy are massages, manual post-isometric relaxation (muscle stretching) and physiotherapy.

Surgical treatment of pain in the gluteal muscle is practically not used; such measures are rarely needed in the case of ineffective long-term treatment of elderly patients with hip joint damage.

Preventing Gluteal Muscle Pain

Preventive measures to prevent the development of pain in the buttocks are similar to actions to prevent diseases of the spine and surrounding soft tissues. In general, it can be noted that the advice concerns well-known truths - a healthy lifestyle, physical activity, which are familiar to almost everyone, but few adhere to them.

Prevention of pain in the gluteal muscle, recommendations:

• Regular fitness and sports activities. Systematically performed exercises allow you to strengthen muscle tissue in general, buttock muscles in particular.
• When maintaining static postures due to the work process (working in the office, sitting at a desk), it is necessary to do warm-ups every 20-30 minutes. Changing postures, walking, bending help restore blood flow, provide nutrition to muscle tissue, and reduce the risk of venous congestion.
• If you have spinal diseases, it is necessary to comprehensively treat the underlying pathology and minimize the load on the lumbosacral region.
• The pelvic area of the buttocks should not be exposed to hypothermia. This primarily concerns the fair sex, who neglect the weather forecasters and prefer short skirts and other fashionable novelties that do not correspond to the weather conditions.
• At the first painful sensations, you should not treat your buttocks and lower back on your own. It would be more appropriate to consult a doctor, identify the true cause of the pain and use specific treatment methods. Self-medication can transform acute pain into a chronic, sluggish and difficult to treat disease.

Pain in the gluteal muscle is not a disease, but a symptom indicating many different pathologies and conditions. Some of them are treated quite quickly and easily, others require longer therapy, but in any case, only a doctor can determine the severity of damage to the muscle of such an important area of the body for a person. That is why the main advice on preventing muscle pain in the buttock is as follows: timely medical examination, diagnostics is the key to successful treatment and the return of normal motor activity.