Buttock Nerve Pain (Sciatica, Cluneal Neuralgia, Gluteal Neuralgia)

 
buttock pain, nerve pain, Pain Relief, pelvic pain, Physiotherapy

Buttock Nerve Pain – The Upper & Lower Buttock Regions (Including Sciatica, Piriformis Syndrome, Deep Gluteal Syndrome, Cluneal Neuralgia, Gluteal Neuralgia)

Buttock Nerve Pain can include Sciatica, Piriformis Syndrome, Deep Gluteal Syndrome, Cluneal Neuralgia, Gluteal Neuralgia.

Pain through the buttock and extending into the legs may develop due to a problem along the pathway of a peripheral nerve, outside the spine. Pain related to a nerve is called “Neuralgia”. You can read more about hip pain from a nerve (neuralgia) in our previous blog. 

Nerves of the upper and lower buttock regions. SCNs: Superior Cluneal Nerves, MCNs: Middle Cluneal Nerves; ICNs: Inferior Cluneal Nerves; SGN: Superior Gluteal Nerve; IGN: Inferior Gluteal Nerve; PFCN: Posterior Femoral Cutaneous Nerve. The large yellow nerve pictured is the Sciatic Nerve.

Which Nerves May Be Involved With Your Buttock Pain?

Nerves that pass through or supply the buttock region include:

  • the sciatic nerve
  • the cluneal nerves – superior, middle and inferior
  • the gluteal nerves – these are motor nerves that serve muscles and not the skin.
    • superior gluteal nerve – serves the gluteus medius, minimus and tensor fascia lata (TFL) muscles
    • inferior gluteal nerve – serves the gluteus maximus muscle
  • the posterior femoral cutaneous nerve – provides nerve supply to a large area of skin of the back of the thigh.

Nerve Related Pain / Neuralgia in the Buttock Region

The Sciatic Nerve and “Sciatica”

The term “sciatica” is often used incorrectly in reference to any pain felt in the area running from the back, down into the leg. See our section on “back-related hip pain” to read more about radicular pain associated with irritation of the nerve roots as they exit the spine. The sciatic nerve does not exit the spine as a single nerve.  Nerve roots from the lower levels of the lumbar spine (lower back) and sacrum (tailbone) join together in the pelvis. Here they form a thick, cord-like structure, called “the sciatic nerve”.  This large nerve exits the inner pelvis via the greater sciatic notch and runs through the buttock and down the back of the thigh.

Figure 2: View of the back of the pelvis demonstrating the relationship between the sciatic nerve and the bony and muscular structures. The light-yellow areas of the nerve indicate that these parts are on the other side of the structures you can see, that is, inside the pelvis, under the piriformis muscle and within the hamstring muscles.

The sciatic nerve can sometimes be compressed, irritated or entrapped as it runs through the soft tissues of the buttock.  Traditionally, sciatic pain (neuralgia) generated from issues within the buttock has been termed “Piriformis Syndrome” (see the picture above to view the piriformis muscle and the sciatic nerve). This was based on a finding that in about 20% of the population, all or part of the sciatic nerve runs through the piriformis muscle.

Compression of the nerve within the piriformis muscle was thought to be the problem in all cases of nerve related buttock and leg pain that could not be associated with a problem in the back. It is now thought that this is the case in only a relatively small number of cases and that this condition has been over-diagnosed. So much so, that some believe it does not exist at all.

The term “Deep Gluteal Syndrome” has been suggested recently as an alternative term to piriformis syndrome. It refers to any irritation of the sciatic nerve in the deep gluteal space, beneath the gluteus maximus muscle. In this space, the sciatic nerve may be compressed or irritated at the level of the piriformis, as it runs over the deep external rotator muscles or by fibrous bands anywhere along its path through the buttock. The nerve can also be irritated as it leaves the pelvis to head down into the thigh. Here it runs through a tunnel (ischial tunnel), between the outer side of the sitting bone (ischial tuberosity) and the upper thigh bone (femur) (See picture above). In this tunnel it may be squeezed between the bones or irritated by unhealthy hamstring tendons (tendinopathy).

Feel that your buttock pain may be related to the sciatic nerve? Check out our FIRST FREE LESSON as part of our in depth self-help course, discussing symptoms and demonstrating tests you can try yourself at home – click here to find out if you have this condition and what to do about it!

Purchase your own self help program “Recovering from Piriformis Syndrome, Deep Gluteal Syndrome or Hip Related Sciatica” Read more here.

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Cluneal Nerve Neuralgia

Of the cluneal nerves, the superior and inferior are more likely to be at risk of compression. The superior cluneal nerve branches run from the spine, over the top of the back of the pelvis and down into the buttock. They usually run through fibrous tunnels as they cross the top edge of the pelvis. This is where the small nerves may become compressed or irritated. This is usually associated with a fairly localised area of pain in the upper buttock, in the region of its skin supply (see picture below).

The inferior cluneal nerve branches run across the lower buttock, right over the sitting bone (ischial tuberosity).  They can be compressed and irritated by a hard fall onto the bottom or sitting for prolonged periods on a hard surface, particularly if you don’t have much gluteal muscle bulk to cushion the bone. Again, associated symptoms are usually fairly localised to the area of skin supply (see picture above). Sometimes the nearby posterior femoral cutaneous nerve can also be affected. Symptoms may then extend into the back of the thigh (see picture above for region of this nerve supply).

The regions of skin served by the cluneal nerves of the buttock and the posterior femoral cutaneous nerve that supplies sensation to the skin of the back of the thigh.

Gluteal Nerve Neuralgia

The gluteal nerves do not have a sensory supply to the skin, but gluteal neuralgia may be felt as a deep buttock pain, sometimes like a cramping feeling. These nerves provide important motor supply (the ability to make the muscles work/contract) to the gluteal muscles and the Tensor Fascia Lata (TFL) muscle at the side of the hip. Damage to these nerves may alter your ability to stand on one leg, walk without a limp, climb stairs, and lift the leg out to the side or behind you. The nerves may be irritated or compressed as they pass out into the back of the pelvis and run through the soft tissues of the buttock. Very occasionally, these nerves may also be damaged by surgery, such as a posterior approach Total Hip Replacement (where the scar is at the back of the hip).

Need Help? How Can A Hip Pain Professional Help?

Your Hip Pain Professional can:

  • perform specific tests in the clinic to see if nerve involvement is likely
  • provide treatments and give you exercises that may improve the health or movement of the nerve
  • help improve health of the muscles and tendons beside the nerve (this may be the source of nerve irritation)
  • review the positions you spend time in and activities you perform daily and provide strategies when performing these tasks that might help protect the nerve, thus reducing your symptoms. This may include changing your sitting or lying posture, or changing stretches or strength exercises that you have been performing that may be contributing to the irritation the nerve
  • provide nerve gliding or mobility exercises that can be useful in some situations
  • refer you for further tests or to a neurologist, orthopaedic specialist or other pain specialist if required.
  • review if a pressure relief cushion may be of benefit – this is a simple, affordable, transferable cushion that can provide considerable pain relief for many – check out more about this here

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Authors:

This blog was written by Dr. Alison Grimaldi, with contribution from one of our Hip Pain Professionals, Kirsty McNab, experienced physiotherapist.

Dr. Alison Grimaldi is a globally recognised expert physiotherapist, researcher, and educator, who has over 30 years professional clinical experience helping patients recover from a wide range of hip and pelvic conditions.

Dr Alison Grimaldi - Hip Pain Professional

Dr. Alison Grimaldi  BPhty, MPhty(Sports), PhD, FACP 

Dr Grimaldi has completed Bachelor of Physiotherapy, Master of Physiotherapy and  Doctor of Philosophy (Physiotherapy) degrees. She is a fellow of the Australian College of Physiotherapists, Practice Principal of PhysioTec Physiotherapy, an Australian Sports Physiotherapist , an Adjunct Senior Research Fellow at the University of Queensland, as well as an author and global educator. Her passion is helping people with hip pain, and educating other health professionals around how to help more people with hip pain.

Purchase your own self help program “Recovering from Piriformis Syndrome, Deep Gluteal Syndrome or Hip Related Sciatica” Read more here.

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Check Out More You Can Read on this Area at HipPainHelp:

  1. Pain Locator Map visit here to learn more about back or peripheral nerve related pain in different regions around the hip and pelvis.

  2. Hip-related Sciatica, including Piriformis Syndrome and Deep Gluteal Syndrome. Learn more about pain through the buttock related to nerves in that area.

  3. Is My Hip Pain Nerve Pain (Neuralgia or Radicular Pain?  Nerve pain can occur around the hip and pelvis. Nerve pain can be caused by many things. Radicular pain relates to the back, neuralgia to local nerves.

  4. Recovering from Piriformis Syndrome, Deep Gluteal Syndrome or Hip Related Sciatica.  If you feel your symptoms are referred from the back but may be due to the nerves that run directly through the pelvis and hip, this self help program may be for you.
  5. Low Buttock Pain Relief Sitting: Need a Pressure Relief Cushion getting the right cushion can make a world of difference to your pain, and your life
Recovering-from-Piriformis-Syndrome-Deep-Gluteal-Syndrome-or-Hip-Related-Sciatica

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