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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.

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