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what are the causes of butt pain?

“Prevalence of piriformis syndrome was 6.25%. Piriformis syndrome is one of the differential diagnoses of low back/buttock pain with Sciatica. Individuals of all activity levels can be affected. Females are more affected than males. Causes are overuse, prolonged sitting, trauma, and vigorous massage.”From the abstract of a 2013 study from the Indian Medical Society called Prevalence of Piriformis Syndrome Among the Cases of Low Back / Buttock Pain with Sciatica: A Prospective Study

Butt pain.  We’ve all had it at one time or another.  Maybe you sat too long on a hard chair.  Or maybe you fell on your rear end on the ice — or while playing sports or roller skating.  Or maybe you were like me and got your hind end SPANKED on a fairly regular basis as a child.  These are all causes of butt pain — but not the kind of butt pain that we will be discussing today.  Today I want to address a few of the potential diagnoses in people who end up with debilitating buttock pain.

  • SCIATICA:  Firstly, I want you to understand that SCIATICA is not so much a diagnosis as it is a symptom of an underlying problem.  In the same way that it is not really helpful to go to the doctor with a headache, which he then miraculously diagnoses as a “headache,” it is none too helpful to have a doctor tell you that your problem is Sciatica.  There is always an underlying cause of Sciatica.  Truth be known, there are lots of causes of Sciatica.  Pinch or irritate one of the nerves that comes from your low back / pelvis area and you could easily end up with Sciatica, as it’s a very common problem.  And one of the most common causes of Sciatica is……….
  • PIRIFORMIS SYNDROME:  Despite the fact that many people have never heard of it, according to a 2005 study done at UCLA’s Mount Sinai Medical School in Los Angeles, PIRIFORMIS SYNDROME is the most common cause of Sciatica and Buttock Pain (40% as opposed to the 6.25% touted above).   Although the incidence probably falls somewhere in the middle, when severe, this poorly understood problem can destroy one’s will to live (HERE).  By the way, the large discrepancy between the two numbers likely has to do with the fact that Piriformis Syndrome is usually misdiagnosed as…….
  • DISC PROBLEMS:  These can be in the form of things like DEGENERATIVE JOINT DISEASE, SPINAL STENOSIS, or HERNIATED DISCS.  The problems with disc diagnoses come into focus once you begin to grasp the concept of ASYMPTOMATIC DISC HERNIATIONS. Because all of these diagnoses have the ability to cause Sciatica, they all have the ability to cause severe buttock pain as well.  HERE is a simple test for helping to differentiate between Disc problems and Piriformis Syndrome.  Far from foolproof, but definitely a start.
  • CUTANEOUS NERVE ENTRAPMENTS: This is an ultra common problem that I feel is way too often being diagnosed as Piriformis Syndrome (which also helps account for the 35% discrepancy discussed a moment ago).  When CUTANEOUS NERVES (superficial nerves) become “entrapped” in FIBROTIC FASCIA, it can cause pain.  Although this is super common to find just about anywhere, it is ultra common in the areas around the hip / buttock (HERE).
  • SACROILIAC (SI) PAIN:  You can find your SI joints by feeling for the two bony knobs of bone on either side of your spine at your belt line.  I wrote an article awhile back on differentiating SI problems from Piriformis Syndrome (hint: it can often be difficult to do).  To understand a little bit more about SI pain and its relationship to Piriformis Syndrome, go HERE.
  • BURSITIS:  The ischial tuberosity (the butt-bone that you sit on, often referred to as the “sits” bone) has a BURSA on it.  If it gets inflamed it is known as WEAVER’S BOTTOM.  In similar fashion to people with PS, these folks cannot sit down unless maybe they are sitting on a pillow or cushion of some sort.
  • TENDINOSIS:  Although TENDINOSIS can happen at any muscle tendon in the body, it is not terribly rare to have HAMSTRING TENDINOSIS.  And because the hamstrings attach to the ischial tuberosity (the butt-bone), the pain is frequently felt in the region of the lower buttocks.  If these are bad enough, they will be seen with MRI.  People with hardcore tendinosis of the upper hamstring cannot sit down without major discomfort.  Tendinosis can also occur in the piriformis or any of the other hip rotator cuff muscles.
  • TAIL BONE PAIN:  This is pain that can be felt in the Sacrum (the triangular bone that the lowest spinal vertebrae sits on), or it can be in the tail bone (the coccyx — the tip; just above the anus).  Although this is frequently the result of a fall or even having a baby, there are many cases of “Coccydinia” that have unknown origins.
  • TRAUMA:  Fall on your butt, and you are likely to end up with a bruise — or even a broken tail bone (super common).  I have seen many of these type of injuries result in both SCAR TISSUE and TRIGGER POINTS that can lead to buttock or hip pain, which, by the way, commonly manifests in the HIP FLEXORS as well. 
  • OTHERS:  Truth be known, there are a number of other causes of Pain in the Butt (CANCER, tumors, INFECTIONS, WEIRD NEUROLOGICAL CONDITIONS, labral tears, FAI, pelvic floor issues, etc, etc, etc).  The really cool thing is that……

Most buttock pain, whether chronic or acute, can be dealt with using conservative methods (without DRUGS, surgeries, or EXPENSIVE TESTS).  CHIROPRACTIC ADJUSTMENTS, understanding INFLAMMATORY CONDITIONS, TISSUE REMODELING, LASER THERAPY, CORE STRENGTH, or SPINAL DECOMPRESSION THERAPY will change most of these conditions.


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