Throwing this question out to the social-media masses is sure to bring out the cyber “comedians” among us, but the truth is when you really do have butt pain, it’s no laughing matter. So we’re glad you came here to ask because we actually do see many patients in our clinic with this problem.
There are a number of issues that can cause butt pain, but the root causes we most often discover are hamstrings tendinopathy, a pinched low-back nerve, or sacroiliac joint syndrome. Let’s take a look at each of these individually.
Hamstrings Tendinopathy
The hamstrings are actually a collection of large muscles at the back of the thigh. At the top, in the basic anatomy, they attach by the tendons to the butt bone (i.e., the ischial tuberosity). The muscles reach vertically down the upper leg, and end just below the knee. Overworked hamstrings can become tight, while underworked hamstrings may stiffen, but because it is such a large muscle group, it’s usually obvious when something is wrong with the hamstrings.
When the problem is in the hamstrings tendons that attach at the butt bone, this often presents as butt pain. Hamstrings tendinopathy can result from trauma or degeneration of the tendon due to wear and tear.
If you have been diagnosed with hamstrings tendinopathy, conservative treatment, such as rest or physical therapy (PT), are often sufficient. Steroid injections are ill-advised for tendon issues as they are toxic to your stem cells (your body’s repairmen). If, however, the pain worsens or the tendon refuses to heal with conservative therapies, a precise injection of high-dose platelet-rich plasma can help wake up the local stem cells so they can start repairing.
Pinched Low-Back Nerve
Nerves that branch off the low back supply the butt, hip, and leg, all the way down to the toes. So when a nerve becomes pinched in the low back, this can cause pain, numbness, or other irritations anywhere along its supply chain. In addition, your butt pain could be due to a pinched nerve in your low back, and you may not even feel any pain or discomfort in your back.
So what causes the pinched nerve? More often than not, it’s a problem in a low-back disc (e.g., disc bulge or herniation), the facet joints in the spine (e.g., arthritis), or the foramen, the channel the bundle of nerves are threaded through (e.g., foraminal stenosis). Obviously, in this case, treating the pinched nerve in the low back is the key to eliminating the butt pain.
Again, steroids should be avoided (see above). Surgery for pinched low-back nerves, in the majority of cases, should also be avoided. If conservative measures or PT fail to provide relief and address the pinched nerve, a precise X-ray–guided injection of platelet growth factors can typically help.
Sacroiliac Joint Syndrome
The sacroiliac (SI) joint lives between the tailbone and the back of the hip in the lower back. With SI joint syndrome, the pain is typically located at the dimples of Venus (if you watch the brief video below, you can see the location of these structures). Pain from SI joint syndrome often radiates into the butt, groin, and/or side of the hip. Injuries to the SI joint can occur with childbirth or a traumatic accident, such as a fall.
Steroid shots, again, are a bad idea for treating SI joint syndrome. It’s also best to stay away from SI fusion surgery as it eliminates needed movement and shock absorption in the SI joint and overloads the lower back and hip joints. PT or chiropractic treatments may help, but if these fail, a precise image-guided injection of high-dose platelet rich plasma (HD-PRP) or high-dose stem cells (HD-BMC) should be able to address your SI joint syndrome. Prolotherapy is another option.
If you have butt pain that doesn’t seem to be easing up or is getting worse, it’s a good idea to have it checked by a regenerative medicine physician. Leaving something like a pinched nerve, tendon injury, or SI joint injury unaddressed may only lead to further problems later.
A Deeper Dive Into the Conditions Associated with Butt Pain
Degenerative Scoliosis
Degenerative Scoliosis, also known as Adult-onset Scoliosis, is a medical condition that involves a side bending in the spine. The bending can be mild, moderate, or severe with side-bending to either the right or the left. The term degenerative means generalized wear and tear and is common as we get older. Degenerative scoliosis is the curvature of the spine that occurs as a result of degeneration of the discs, small joints, and building blocks. The Degenerative Scoliosis curve is often located in the low back and forms a ‘C” shape. There is a convex and a concave side. The convex side is the open side where it curves outward.
Read More About Degenerative ScoliosisEhlers-Danlos Syndrome (EDS)
Disorders that affect and weaken the connective tissues such as tendons and ligaments. It is a hereditary disorder which means you are born with it. EDS has many different signs and symptoms which can vary significantly depending upon the type of EDS and its severity. It most commonly affects the skin, joints, and blood vessels. Joints are typically hypermobile with excessive joint range of motion because of a defect in collagen formation. In most cases Ehlers-Danlos syndrome is inherited. That is to say that you are born with it. The two main ways EDS is inherited are: autosomal dominant inheritance and autosomal recessive inheritance…
Read More About Ehlers-Danlos Syndrome (EDS)Gluteal Tendinopathy
Tendinopathy is a group of tendon disorders. The most common form of Tendinopathy is Tendinosis (1). Tendinosis is a degenerative condition that is characterized by collagen degeneration and micro-trauma in the tendon due to repetitive overloading. Gluteal Tendinopathy is a clinical condition in which there is moderate to severe debilitating pain due to injury of the Gluteal tendons. It is the most common Tendinopathy in the lower leg (2) and is more common in women (3). In most cases, physical examination alone is sufficient to diagnose Gluteal Tendinopathy. If symptoms continue despite conservative care, other studies may be warranted which include ultrasound and MRI.
Read More About Gluteal TendinopathyHamstrings Tendinopathy
Hamstring tendinopathy, a condition that causes pain and tenderness in the hamstring tendons, represents a common but often misunderstood musculoskeletal issue. It typically occurs in athletes and individuals engaged in high-intensity activities but isn’t limited to them. This condition, including its more specific form, high hamstring tendinopathy, can significantly impact daily and athletic performance, making understanding its nuances critical.
Read More About Hamstrings TendinopathyHip Labral / Labrum tear
A tear in the hip labrum can cause a number of different symptoms. The most common is anterior hip or groin pain which may radiate down to the level of the knee (3). Pain develops gradually and typically is dull in character made worse with walking, pivoting and running. Hip labral tears are easily seen on MRI. Unfortunately, it’s importance as a source of pain must be questioned. Why? Research has demonstrated that many patients with no hip pain have labral tears on MRI (4-5). In one study, Duthon et al demonstrated that 69% of patients without hip pain had labral tears.
Read More About Hip Labral / Labrum tearHip Ligament Injuries
Ligaments are connective tissue structures that connect bone to bone. They help provide stability for joints such as the hip. There are four main hip ligaments that help to keep the hip in its natural socket. If these ligaments are injured, then they may cause pain directly. Most often, they cause the hip to become unstable, leading to more stress and injury to other parts of the hip such as the labrum, cartilage, and/or bone.
Read More About Hip Ligament InjuriesPinched Nerves in the Back
We talk a lot about leg pain stemming from a pinched or irritated nerve in the lower back. And, indeed, that’s what our physicians are traditionally taught in medical school—a pinched nerve in the lumbar spine typically presents as a symptom in the leg. However, what if you have some butt pain but no pain or other symptoms in the leg? Does this mean it couldn’t be a pinched nerve? Not so fast. Turns out a pinched low back nerve doesn’t always have to be accompanied by leg symptoms. Let’s start by taking a look at how the back is structured.
Read More About Pinched Nerves in the BackSpinal Instability
Spinal instability is a condition that occurs when the spinal column is not able to maintain its normal alignment and function under normal loads. It can be caused by various factors such as trauma, degenerative changes, infections, tumors, or congenital abnormalities. In a stable spine, the bones, discs, ligaments, and muscles work together to support and protect the spinal cord and nerve roots. However, in an unstable spine, the structures that support the spine may be damaged or weakened. This can lead to abnormal movement and excessive stress on the spinal cord and nerves. In most cases, bone and joint problems…
Read More About Spinal InstabilityTorn Discs
The spinal discs are shock absorbers that live at each level between the vertebral bones (1). They have a tough outer annulus part and a soft inner gel part (nucleus pulposis). The outer covering can get damaged which can sometimes be seen on MRI and other times requires additional testing to identify. These tears are called: a torn disc, a disc tear, an annular tear, and when seen on MRI a “High-Intensity Zone” or HIZ. They can cause pain, mostly through ingrown nerves. There are torn disc findings that can be seen on MRI (HIZ) and these can be either asymptomatic (i.e. not painful) or…
Read More About Torn Discs