Buttock pain: symptoms and relief

Shin pain is pain along the front or inner edge of your lower leg that often gets worse with walking or running. It can make exercise and movement uncomfortable or hard to keep up with.

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Living with buttock pain

Buttock pain can show up in many ways. You might feel a sharp twinge when you stand up, a deep ache when you sit for too long, or a pulling pain where your hamstring (back thigh muscle) meets your pelvis when you run or bend forward. Some people feel pain on the side of the hip when lying on that side, or a burning ache that runs from the buttock down the back of the thigh.

Because the buttock region is where your lower back, hips, and pelvis all meet, problems in any of these areas can be felt there.

Did you know?

Gluteal tendinopathy is not just “hip bursitis.” Research shows that the main problem in greater trochanteric pain syndrome is usually the gluteal tendons themselves, with or without bursitis. This is why education and specific hip strengthening outperform a single corticosteroid injection at one year.^{1 2 3}

What are the symptoms of buttock pain?

People with buttock pain often notice:

Aching, sharp, or burning pain in one or both buttocks
Pain when sitting for a long time, especially on harder surfaces
Pain when lying on the affected side in bed
Pain when standing on one leg, walking up hills or stairs, or doing single leg exercises
A sore, tender spot on the outer side of the hip over the bony bump (greater trochanter), often called gluteal tendinopathy or greater trochanteric pain syndrome^{1 3}
Deep buttock pain that may travel into the back of the thigh, sometimes with tingling or numbness, especially when sitting or with hip flexion, seen in deep gluteal syndrome^{3 7}
Pain low down near the dimples at the back of the pelvis, often one sided, that worsens with standing up, walking, or turning in bed, typical of sacroiliac joint pain^{5 6}
Pain where the hamstring attaches at the sit bone, worse with running, lunging, bending at the hip, or sitting on firm chairs, common in proximal hamstring tendinopathy (tendon disease)^{4 11}
Discomfort with long strides or positions where the hip is extended behind you, sometimes seen in ischiofemoral impingement (this is the entrapment of soft tissues caused by narrowing of the space between thigh bone and pelvic bone)⁹
Sleep disturbance, difficulty finding a comfortable position, or needing to change posture often because of pain

Red flag symptoms such as new bladder or bowel changes, fever, or rapidly worsening weakness need urgent medical review and are described below.

Clinical insight

For years, many adults with outer hip or buttock pain were told they had “trochanteric bursitis” and were offered rest or repeated injections. High quality evidence has changed this view. Gluteal tendinopathy is now understood as a tendon and load problem, where compressive postures and under trained hip abductors play a major role.^1,2,3,8 As a result, best practice is to start with education to reduce compressive positions, then build tendon capacity with a structured strengthening program rather than relying on short term injections.

What causes buttock pain?

Buttock pain has many possible causes. Some come from tendons and muscles around the hip, some from joints like the sacroiliac joint, and some from nerves or referred pain that starts in the lower back or hip joint and is felt in the buttock area. Understanding the main source helps guide the best treatment.

Common causes and risk factors of buttock pain

Gluteal tendinopathy / greater trochanteric pain syndrome (GTPS)

Irritation or degeneration of the buttock’s gluteus medius and minimus tendons where they attach on the outer hip. It is now understood as a tendon problem present for some people either with or without bursitis.^{1 2} This is the inflammation of the bursae, which is a fluid-filled sac that acts like a cushion.
More common in women aged 40 to 60, people who stand a lot, side sleep, cross their legs often, or have hip abductor weakness. Training spikes or changes in walking or running can also contribute.^{2 8}

Deep gluteal syndrome (DGS)

Non spinal entrapment of the sciatic nerve in the deep buttock, often involving the piriformis or other small hip rotator muscles.^{3 7}
Prolonged sitting, hip flexion, or repeated twisting can aggravate symptoms. It is an under recognised cause of “sciatica” when spine imaging is normal.

Sacroiliac (SI) joint complex pain

Pain from the joint between the sacrum and the iliac bones in the pelvis, often felt as low back or buttock pain.
Risk factors include pregnancy related laxity, falls or twisting injuries, repeated heavy lifting, leg length differences, and extra load on the SI joint after lumbar spine fusion.^{5 6}

Proximal hamstring tendinopathy (PHT)

Overload of the hamstring tendon where it attaches at the sit bone, typically from sprinting, hill running, or repeated bending and straightening of the hip.
Prolonged sitting and sudden training increases can worsen symptoms.^{4 11}

Ischiofemoral impingement

Narrowing of the space between the lesser trochanter (part of the thigh bone)and the ischium (part of the pelvic bone) that compresses the quadratus femoris muscle.
More often seen in middle aged women and can cause deep buttock or groin pain with longer steps or hip extension.⁹

Cluneal neuralgia

Irritation or entrapment of small nerves that supply the skin over the buttock, which can mimic sacroiliac or gluteal tendon pain. ¹⁰

Because pain from the lumbar spine, hip joint, pelvis, or even internal organs can be felt in the buttock, a careful assessment is important to rule out referred pain and serious causes. ^{1 5 13}

Did you know?

Exercise plus education can beat injections long term. In a large trial, people with gluteal tendinopathy who received education and targeted exercise had better global improvement and were more satisfied at 52 weeks than those who had a steroid injection alone.^{1 2}

When should I see a doctor?

Most buttock pain from tendons or joints improves with simple changes and guided exercise. However, some signs could mean a more serious problem that needs urgent medical review.

Seek a doctor right away if you notice:

New problems controlling your bladder or bowels, difficulty starting urination, or leaking when you did not before
Numbness around your groin or inner thighs (saddle area)
Rapidly worsening weakness or numbness in both legs
Severe back or buttock pain with these nerve symptoms, which can suggest cauda equina syndrome (compression of the nerve roots at the bottom of your spinal cord). Note that pain like this needs emergency assessment¹³
Fever, feeling systemically unwell, and very severe buttock or sacroiliac pain, which can signal infection^{14 15}
A recent significant fall, accident, or possible fracture in the pelvis or hip
Unexplained weight loss, night sweats, or history of cancer with new persistent buttock pain

You should book an appointment with a health professional if:

Buttock pain has lasted more than 4 to 6 weeks and is not improving
Pain keeps you from sleeping, working, or doing your usual activities
You have leg pain, tingling, or weakness along with buttock pain
You are unsure whether your pain is from the hip, back, or sacroiliac joint

How is buttock pain treated?

Education and activity modification

For gluteal tendinopathy, reducing positions that compress the outer hip, such as lying on the sore side, crossing legs, or “hanging” on the hip while standing, can ease pain.^{1 2}
For deep gluteal syndrome, limiting long periods of sitting or hip flexion and avoiding prolonged twisting or figure four positions can reduce nerve irritation.^{7 16}
For sacroiliac joint pain, learning safer ways to move between sitting, standing, and lifting, and spreading loads more evenly through both legs, can help.⁵

Exercise based rehabilitation

In gluteal tendinopathy, a strong research trial found that education plus specific hip abductor strengthening led to better long term outcomes than corticosteroid injection or a “wait and see” approach.^{1 2}
Programs usually include hip abductor and extensor strengthening, trunk control, and movement retraining to reduce hip adduction and pelvic drop during walking and running.^{2 8}
Proximal hamstring tendinopathy is a painful overuse injury causing deep buttock pain at the "sit bone". In this case, a progressive tendon loading with hip dominant and knee dominant exercises, along with lumbopelvic control and gradual return to running, is helpful. Sitting tolerance can be addressed and improved with cushions and posture changes.^{4 11}
For sacroiliac joint pain, guidelines support multimodal rehabilitation, including specific stabilization, hip and gluteal strengthening, and graded return to functional tasks.^{5 6}

Medications

Short courses of pain relief or non steroidal anti inflammatory drugs can help in the short term.
For cases where buttock pain is part of lumbar radicular pain (pain radiating down the leg), national guidance advises against routine use of gabapentinoids, benzodiazepines, or long term opioids (drug classes) for sciatica.¹³

Injections and procedures

For gluteal tendinopathy, corticosteroid injection can reduce pain in the short term but has worse global outcomes at 1 year than education plus exercise.^{1 2}Shockwave therapy has mixed evidence and is best seen as an adjunct to a good rehab plan. Platelet-rich plasma (PRP) injections can help to reduce the pain.⁹
For sacroiliac joint pain, image guided steroid injections and radiofrequency ablation of nerve branches (a minimally invasive technique that shrinks nerves) may help in carefully selected people who have not improved with rehabilitation. This is best reserved for those with a well-confirmed diagnosis.^{5 6}
For deep gluteal syndrome, image guided injections around the surrounding piriformis and obturator internus muscles or the sciatic nerve can be used as both diagnostic and therapeutic tools. Surgical decompression is reserved for clear, persistent cases in specialist centers. ^{7 16}

Surgery

Surgery is usually considered only when there is a confirmed structural problem such as a significant gluteal tendon tear, persistent deep gluteal syndrome with clear imaging and test findings, or sacroiliac joint pain that has not responded to rehabilitation and interventional care.^{5 7 16}

Recovery times vary. Many people with gluteal tendinopathy notice meaningful improvement within 8 to 12 weeks, with further gains over a year if they keep up their exercises.^{1 2}Hamstring tendinopathy can take several months or longer, especially if symptoms have been present for a long time.^{4 11}Sacroiliac and deep gluteal pain often need sustained, multi layered support and sometimes procedures.^{5 7}

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Footnotes

Brunker P, et al. Greater trochanteric pain syndrome: review of diagnosis and management. Br J Gen Pract. 2017;67(663):479-480.

Mellor R, Bennell K, Grimaldi A, et al. Education plus exercise versus corticosteroid injection versus wait and see for gluteal tendinopathy: randomised clinical trial. BMJ. 2018;361:k1662.

International Society for Hip Preservation (ISHA). Physiotherapy agreement on assessment and treatment of GTPS. J Hip Preserv Surg. 2023;10(1):48-56.

Woodley SJ, et al. Proximal hamstring tendinopathy: systematic review of interventions. Int J Sports Phys Ther. 2021;16(2):305-333.

McCormick ZL, Cohen SP, et al. Sacroiliac joint complex pain: multispecialty consensus guideline. Pain Med. 2025; pnaf136.

Manchikanti L, et al. Systematic evaluation of prevalence and diagnostic accuracy of SI joint interventions. Pain Physician. 2012;15:E305-E344.

van der Windt A, et al. Deep gluteal syndrome (editorial). Br J Gen Pract. 2019;69(687):485.

Grimaldi A, Mellor R, Nicolson P, et al. Education plus exercise is cost effective for gluteal tendinopathy versus corticosteroid injection and wait and see. Physiotherapy. 2022;114:1-11.

Orthopedic Reviews Editorial Group. Cluneal neuralgia: an under recognised source of low back and buttock pain. Orthopedic Reviews.

Rich A, Ford J, Cook J, Hahne A. Physiotherapy vs shockwave for proximal hamstring tendinopathy: randomised controlled trial. Am J Sports Med. 2025; epub ahead of print.

Korakakis V, Whiteley R, Tzavara A, Malliaropoulos N. ESWT in common lower limb tendinopathies including GTPS and PHT: systematic review. Br J Sports Med. 2018;52(6):387-395.

National Institute for Health and Care Excellence (NICE). Low back pain and sciatica in over 16s: assessment and management (NG59). 2016-2024.

Feki W, et al. Infectious sacroiliitis: diagnostic contribution of CT/MRI and long term follow up. Eur Spine J. 2025;34:4758-4765.

Biondi NL, et al. Radiological insights into sacroiliitis. Clin Pract. 2024;14(1):106-121.

Sun G, Fu W, Li Q, Yin Y. Arthroscopic treatment of deep gluteal syndrome and peri operative ultrasound utility. BMC Musculoskelet Disord. 2023;24:742.