How to diagnose and
treat buttock pain

How do clinicians diagnose buttock pain?

Clinicians start by listening to your story. They will ask exactly where you feel the pain, whether it is more to the side of the hip, deep in the buttock, low near the dimples of the back, or at the sit bone. They will ask what brings it on, such as lying on your side, sitting, walking, stairs, running, or bending forward, and what helps it settle.³ They may also ask about training changes, recent injuries, pregnancy, heavy lifting, or long periods of sitting.^{1 4 5}

A careful physical exam helps narrow down the source. Your clinician may:

• Press gently over the outer side of your hip to see if there is a tender spot over the greater trochanter (bone at the outer side of the hip), which fits gluteal tendinopathy or greater trochanteric pain syndrome (excessive friction and inflammation of the soft tissues).^{1 3}
• Press over the sit bone and test hamstring loading if they suspect proximal hamstring tendinopathy.^{4 11}
• Ask you to point with one finger to the area just below the back dimples, which can suggest sacroiliac joint pain (the joint that connects the spine and the pelvic bone) if that reproduces your main symptoms.^{5 6}
• Check how your pain responds to standing on one leg, climbing a step, lying on your side, or moving from sitting to standing. These movements can show how the hip and pelvis handle load.^{1 3 5}

If deep gluteal syndrome or sciatic nerve compression at the buttock is suspected, your clinician will ask about sciatica like pain that starts in the buttock and runs down the back of the thigh, often worse with sitting or positions where the hip is bent and rotated.^{3 7} They may use positions that bend and rotate the hip to see if these reproduce your symptoms and test for tingling or numbness in the leg.^{3 7 16}

Because buttock pain can come from the lumbar spine, the hip joint, the sacroiliac joint, or nearby nerves, most clinicians will also check your lower back and hip range of motion, strength, and basic nerve function. This helps tell the difference between local tendon or joint problems, referred pain from the back, and more serious nerve compression.^{1 5 13}

Imaging is used selectively. For many people with typical gluteal tendinopathy, a diagnosis can be made based on history and exam without an immediate scan.^{1 3} An ultrasound or MRI may be ordered if symptoms are not improving, if a tendon tear is suspected, or if another condition needs to be ruled out.^{1 3 8} MRI or ultrasound can also help stage proximal hamstring tendinopathy or confirm ischiofemoral impingement (compression of soft tissues between superior part of thigh bone and pelvic bone) when the diagnosis is unclear.^{4 9 11}

For sacroiliac joint pain, imaging is not very good at showing simple mechanical pain, so clinicians often use a cluster of manual tests and sometimes an image guided injection of local anesthetic into the sacroiliac joint to confirm that it is the main pain source.^{5 6} If inflammatory or infectious sacroiliitis is suspected, MRI and blood tests are important.^{5 14 15}

Red flag symptoms such as new bladder or bowel problems, numbness in the saddle area, severe weakness, fever, or unexplained weight loss will prompt urgent assessment for conditions like cauda equina syndrome (compression of spine neural roots), infection, or malignancy.^{13 14 15}

Clinical insight

Buttock pain was often labeled as “trochanteric bursitis” This pain was mainly with rest and steroid injections. Newer research shows that the main problem in greater trochanteric pain syndrome (GTPS) is usually the gluteal tendons themselves.^1,2,3 This has shifted best practice toward education and exercise as first line care, with injections used more as a short term support rather than the main solution.^1,2,8

What are the treatment options for buttock pain?

Treatment for buttock pain depends on the main diagnosis, but most plans focus on education, activity changes, and progressive strengthening of the hip and trunk. Injections and surgery are usually reserved for persistent cases with a clear structural problem after high quality conservative care.^{1 2 4 5 7}

Education and activity modification

• For gluteal tendinopathy, reducing positions that compress the outer hip, such as lying on the sore side, crossing your legs, or “hanging” on one hip while standing, can ease pain.^{1 2 3} A pillow between the knees or lying on the opposite side with a cushion under the top leg can help at night.^{1 3}
• For deep gluteal syndrome, limiting long periods of sitting, especially on hard chairs, and avoiding strong figure four or twisting positions can reduce nerve irritation.^{3 7 16} Simple changes like standing up regularly and adjusting seat height can also help.^{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 reduce strain on the joint.^{5 6}
• For proximal hamstring tendinopathy, using a cushion or cut out seat, taking breaks from prolonged sitting, and avoiding sudden spikes in sprinting or hill running are often helpful.^{4 11}

Exercise based rehabilitation

In gluteal tendinopathy, a large randomized clinical trial showed that education plus specific hip abductor strengthening led to better global improvement and satisfaction at 52 weeks than corticosteroid injection or a wait and see approach.^{1 2} Programs typically include:

• Progressive strengthening of the hip abductor and extensor muscles
• Trunk and pelvic control exercises
• Movement retraining to reduce hip collapse inward and pelvic drop during walking and running^{1 2 3 8}

In proximal hamstring tendinopathy, care focuses on progressive tendon loading using hip dominant and knee dominant exercises, along with lumbopelvic control and a gradual return to running and sport. Sitting tolerance is improved by using cushions, adjusting posture, and pacing how long you sit at a time. ^{4 11}

For sacroiliac joint pain, consensus guidelines support multimodal rehabilitation, including specific stabilization exercises, hip and gluteal strengthening, and graded return to functional tasks like lifting, stairs, and work activities. ^{5 11}

For deep gluteal syndrome, conservative programs often include hip rotator and gluteal strengthening, gentle nerve friendly mobility, and sitting and posture changes. The quality of evidence is lower, but a time limited trial of these strategies is usually recommended before more invasive options.^{7 16}

Medications

Short courses of simple pain relief or non steroidal anti inflammatory drugs can help reduce pain while you start activity and exercise based care, as long as they are safe with your other health conditions.^{1 5} When buttock pain is part of lumbar radicular pain (pain that goes down the leg), national guidance advises against routine use of gabapentinoids, benzodiazepines, or long term opioids (drug classes) for sciatica because the benefit is limited and risks can be significant.¹³

Injections and procedures

• In gluteal tendinopathy, corticosteroid injections can provide short term pain relief but have worse global outcomes at one year than education plus exercise.^{1 2} Shockwave therapy has mixed evidence and is best seen as an add on to a strong rehabilitation plan rather than a stand alone fix.¹²
• For sacroiliac joint pain, image guided steroid injections and radiofrequency ablation of nerve branches may help selected people who have not improved with rehabilitation and have a well confirmed diagnosis based on clinical tests and diagnostic blocks. This is a minimally invasive treatment that shrinks the nerves to help reduce symptoms.^{5 6}
• In deep gluteal syndrome, image guided injections around the piriformis muscle, the obturator internus muscle, or the sciatic nerve, can be used both to help diagnosis and to calm symptoms. Surgical decompression of the nerve is usually reserved for clear, persistent cases in specialist centers.^{7 16}

Clinical insight

Education plus exercise can beat injections in the long term. In a large trial comparing three approaches for gluteal tendinopathy, people who received education and targeted exercise had better global improvement and were more satisfied at 52 weeks than those who received only a corticosteroid injection or a wait and see plan. This supports the idea that building tendon capacity and changing everyday habits creates more lasting benefits than short term pain relief alone.^{1 2 8}

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} Proximal hamstring surgery or advanced procedures are reserved for the small group who remain very limited after a long period of high quality rehabilitation.^{4 11 12}

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 3} Proximal 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 steady, multi layered support and sometimes injections or procedures.^{5 7 16}

Sword's approach

Sword Health helps people manage pain and movement issues with expert-guided AI care you can use from home. Our model combines clinical support with modern technology, designed to work around your life.

Sword makes recovery easier and more accessible. You get high-quality care at home, guided by clinicians and supported by smart technology.

• Care that adapts to your progress in real time
• Licensed experts guiding every step
• Simple, non-invasive, evidence-based programs
• Proven results for pain relief, movement, and satisfaction

How can I find pain relief?

Once serious causes have been ruled out, many people can start with simple steps at home to reduce pain and protect the area while it heals.

• Adjust your sleeping position. If lying on your side triggers pain, try lying on the other side with a pillow between your knees, or partly on your back with support under your thighs. This reduces compression on sore gluteal tendons and the sacroiliac region. ^{1 3 5}
• Break up long periods of sitting. Standing up and walking for a few minutes every 30 to 60 minutes can ease pressure on the deep gluteal space and hamstring tendons. Using a soft cushion or seat wedge can also help if sitting is unavoidable.^{4 7 11}
• Start gentle hip and trunk strengthening. Simple exercises such as bridges, side lying hip lifts in a comfortable range, and supported squats can gradually build support around the hips and pelvis.^{1 2 4 5} Over time, these can progress to single leg tasks if your pain allows.
• Watch for sudden load spikes. If you walk, run, or do classes, try to build up distance or intensity gradually instead of jumping to new levels quickly. This protects both gluteal and hamstring tendons.^{2 4 8 11}
• Use medicine carefully. Over the counter pain relief or anti inflammatory medicines can be useful in the short term, but they should support a good rehab plan, not replace it.^{1 5} If buttock pain is linked with sciatica, it is important to follow guidance about avoiding certain nerve pain medicines and long term opioids.¹³

You should contact a clinician if buttock pain has lasted more than 4 to 6 weeks and is not improving, if it is stopping you from sleeping, working, or being active, or if you have leg pain, tingling, or weakness along with buttock pain.^{5 13} Seek urgent care if you notice new bladder or bowel changes, numbness in the saddle area, high fever with severe buttock pain, or a sudden major change in strength or feeling in your legs.^{13 14 15}