Surgery for buttock pain

Is surgery right for buttock pain?

For most people, surgery is not the first or main answer for buttock pain. Many common causes, like gluteal tendinopathy (greater trochanteric pain syndrome with tendon inflammation and wear), sacroiliac joint pain, deep gluteal syndrome (sciatic nerve compression), and proximal hamstring tendinopathy, improve with education, activity changes, and a structured exercise program. ^{1 2 3 4 5}

Surgery is usually only considered when:

• You have a clear structural problem, such as a significant gluteal tendon tear, that has not improved with high quality rehabilitation. ^{1 2 3}
• You have deep gluteal syndrome, where the sciatic nerve is trapped in the deep buttock, and symptoms remain severe despite targeted rehab and image guided injections. ^{7 16}
• You have well confirmed sacroiliac joint pain that stays very limiting even after good rehabilitation and interventional treatments like injections or radiofrequency ablation (this is a minimally invasive treatment that shrinks the nerves). ^{5 6}
• You have a rare but serious issue, such as infection, fracture, or cancer, affecting the pelvis or sacroiliac region. ^{13 14 15}

The choice to have surgery is always individual. It depends on your diagnosis, your goals, how long you have had symptoms, what you have already tried, and your overall health. A good plan involves shared decision making with your surgeon or pain specialist so you understand likely benefits, risks, and non surgical options before deciding. ^{2 5 7}

Common surgical options for buttock pain

Not everyone with buttock pain will hear about surgery. When it is discussed, it is usually targeted to a specific cause.

• Gluteal tendon repair or reconstruction For a small group of people with confirmed partial or full thickness tears of the gluteus medius or minimus that have not improved with a long course of education and exercise, surgeons may repair or reconstruct the tendon, sometimes with an arthroscopy (minimally invasive surgical technique using small holes and a camera). This aims to restore tendon function and reduce pain on the outer hip and buttock. ^{1 3 5}
• Arthroscopic treatment for deep gluteal syndromeIn deep gluteal syndrome, the sciatic nerve is compressed by muscles or fibrous bands in the deep buttock. When symptoms are severe and persistent and imaging and tests strongly support the diagnosis, arthroscopic surgery can be used to release the nerve and remove tight tissues around it in specialist centers. ^{7 16}
• Sacroiliac joint procedures For carefully selected people with confirmed sacroiliac joint pain who do not respond to rehabilitation and image guided injections, options may include radiofrequency ablation of small nerve branches or, rarely, minimally invasive sacroiliac joint fusion using implants (plates and screws). These procedures aim to reduce pain coming from the joint itself. ^{5 6}
• Surgery for proximal hamstring tendinopathy (less common) In rare cases of long standing proximal hamstring tendinopathy with clear structural damage and failure of prolonged rehab, surgery may involve debridement of damaged tissue and repair of the tendon at the sit bone. Evidence is still evolving, and this is usually a last resort. ^{4 11}

Your care team will recommend these procedures only if there is a clear match between your symptoms, imaging, and exam findings, and only after non surgical care has been fully explored.

What to expect during recovery

Recovery after surgery for buttock pain depends on the procedure and your starting health and strength. There is no single timeline, but some general patterns are common. ^{1 2 4 5 7 11 16} 

Right after surgery (days to early weeks)

• You will likely use crutches or a walking aid at first to protect the surgical area and follow weight bearing limits from your surgeon.
• Pain, swelling, and bruising around the hip or buttock are normal. You will receive a plan for pain relief, ice, and comfortable sitting or lying positions.
• You may be advised to avoid certain positions, such as deep hip flexion or crossing your legs, while tissues begin to heal. ^{2 4 7}

Early rehab phase (first several weeks)

• Physical therapy usually starts with gentle range of motion, light muscle activation, and postural changes to reduce compression on healing tendons or the nerve. ^{2 4 5}
• After gluteal tendon repair, loading of the tendon is carefully increased over time to protect the repair while preventing stiffness and weakness. ^{1 3}
• After surgery for deep gluteal syndrome, early rehab focuses on restoring hip movement and nerve friendly positions without aggressive stretching of the sciatic nerve.^{7 16}

Strengthening and return to function (months)

• As healing progresses, exercises focus more on hip and trunk strength, balance, and functional tasks like sit to stand, stairs, and single leg activities.^{2 4 5 11}
• For sacroiliac joint procedures, lumbopelvic stabilization and hip strength are key to support the joint and reduce strain.^{5 6}
• Return to running, sport, or heavy work is usually gradual and guided by strength, control, and symptom response, not just time on the calendar.

Long term recovery and possible risks

Many people notice improvements in pain and function over months, but full recovery can take time, especially when pain has been present for a long period before surgery. Possible risks and complications include:

• Infection or delayed wound healing
• Bleeding and blood clots
• Ongoing pain, stiffness, or tenderness
• Weakness of hip abductors or extensors
• Numbness or altered sensation near the incision
• Incomplete relief of symptoms or recurrence, especially in deep gluteal syndrome and sacroiliac joint pain ^{4 5 7 16}

Your surgeon and physical therapist can give you a timeline tailored to your surgery, work, and activity goals and help you plan for a safe, steady return to the things you care about.

Can surgery be avoided?

Often, yes. Many buttock pain conditions improve with non surgical care when you have a clear diagnosis and stick with a well designed plan.

Key conservative options include:

• Education and load management for gluteal tendinopathy A large trial showed that education plus specific hip strengthening led to better one year outcomes than a single corticosteroid injection or a “wait and see” approach for gluteal tendinopathy. ^{1 2} Reducing compressive positions, such as side lying on the sore hip, crossing your legs, or “hanging” on one hip, is a big part of this. ^{2 3 8}
• Progressive strengthening for tendons For both gluteal tendinopathy and proximal hamstring tendinopathy, programs that build tendon and muscle capacity through progressive loading, along with trunk control, are central to recovery. Many people improve over months without ever needing surgery. ^{2 4 8 11 12}
• Multimodal rehab for sacroiliac joint pain For sacroiliac joint pain, a combination of education, lumbopelvic stabilization, hip strengthening, and graded return to activity is first line. Injections and more invasive procedures are reserved for those who do not respond after a thorough rehab program. ^{5 6}
• Targeted care for deep gluteal syndrome For deep gluteal syndrome, a trial of posture changes, hip and gluteal strengthening, and neural friendly exercises, sometimes combined with image guided injections, can help some people avoid or delay surgery. ^{7 16}

There is also growing evidence that fully remote, exercise based digital care can achieve similar improvements in pain and function as conventional face to face physical therapy in other joint and spine conditions, with good adherence and safety. ^{17 18} This suggests that, when well designed, digital programs can deliver guideline based rehabilitation for many buttock related problems in a way that fits into daily life.

If surgery is on the table, it is usually best to first complete a structured, well supported course of conservative care unless there is a clear emergency or severe structural problem that demands earlier intervention.

How Sword can support you before and after surgery

Physical therapy can play an important role in preparing for surgery, supporting recovery, and, in some cases, helping people manage symptoms without surgery. Sword offers physical therapy programs designed to support you at different points along that journey.

Sword supports recovery before and after surgery, with care designed to fit into your life. You receive high-quality physical therapy at home, guided by licensed clinicians and supported by smart technology.

• Care that adapts as your body and recovery needs change
• Licensed physical therapists guiding your care at every stage
• Non-invasive, evidence-based physical therapy programs

Support for preparation, recovery, and long-term movement health

Clinical insight

Deep gluteal syndrome reminds us that not all “sciatica” comes from the spine. In some people, the sciatic nerve is compressed in the deep buttock by muscles or fibrous bands, and spine imaging may be normal. ^{7 16} Recognising this pattern can help direct care toward targeted hip and neural interface rehab and, where needed, specialist injections or surgery, instead of unnecessary lumbar procedures.