Causes of Lower Buttock Pain

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What Structures May be Linked with Causes of Lower Buttock Pain?

Causes of lower buttock pain may include proximal hamstring tendinopathy, ischiogluteal bursitis, ischiofemoral impingement, and pain relating to the deep hip rotator muscles.

Understanding the Muscles Involved with Causes of Lower Buttock Pain?

The muscles of the lower buttock region are involved in providing support for the back of the hip joint and moving the hip into extension and external rotation – taking your leg backwards and turning your knee outwards.  

If you put your hands on the lower half of your bottom you will be touching the lower portion of the gluteus maximus muscle, an important muscle for pushing up from a squat or lunge position or for extending the leg behind especially when walking up a hill or stairs.  

The hamstring muscles (semimembranosis, semitendinosis and biceps femoris muscles) in the back of the thigh help to extend the hip (take the thigh backwards), but also bend the knee. This combined function makes the hamstring muscles very important muscles for transferring forces between the hip and lower leg in actions such as running, kicking, lifting and lunging. 

Lower Buttock Muscles and possible cuases of lower buttock pain including gluteus Maximus and hamstring

Beneath the lower part of the gluteus maximus muscle, sit a group of small muscles, referred to as the deep hip rotators. They work to rotate the thigh and turn the knee outwards. They also have important connections into: 

  • the back of the hip joint, allowing them to provide extra stability for the hip joint 
  • the pelvic floor muscles. 

The hamstring muscles in the back of the thigh also attach deep in the buttock, onto the sitting bones (ischial tuberosities). Directly on top of the hamstring attachment is a small flat, fluid-filled cushion (the ischial or ischiogluteal bursa). This helps reduce friction and allows smooth gliding of the largest buttock muscle (gluteus maximus) over the hamstring tendons.  

Deep muscles of the Lower Buttock and possiple causes of lower buttck pain

Soft Tissue Related Causes of Lower Buttock Pain

Soft tissue-related causes of lower buttock pain may occur for many reasons: 

  • Muscle soreness, tears or strains may occur in this region related to large or unusual forces across the largest buttock muscle (gluteus maximus) or the deep rotator muscles. Tears of the deep rotator muscles may occur with rapid change of direction or a twisting injury. 
  • The deep rotators may also become overactive and painful associated with weakness or excessive activation of other muscles in this area (including the pelvic floor, gluteal or hamstring muscles). 
  • Ischiofemoral impingement is a diagnosis referring to a situation where one of the deep external rotator muscles (quadratus femoris) is repetitively compressed in a smaller than normal gap between the sitting bone (ischial tuberosity) and the thigh bone (femur).  
  • Hamstring tendon pain may come on quickly, in response to a large strain, often a slip or fall, or a rapid change in activity. However, changes in tendon health often evolve more slowly, related to postural, movement or athletic training habits, particularly long distance and hill running.  
  • Ischial or ischiogluteal bursitis is a diagnosis referring to inflammation of the small, flat, fluid-filled cushion called the ischiogluteal bursa that sits over the hamstring tendons at the sitting bone. The bursa may become inflamed and painful when it is struggling to cope with high levels of compression or friction over the sitting bone, possibly associated with sitting on hard surfaces or athletic activity such as running uphill.  
Proximal Hamstring Tendinopathy

Visit our Pain Locator Map to learn more about other causes of lower buttock pain. 

possible causes of lower buttock pain including proximal hamstring tendinopathy, deep hip rotator muscles and ischialtuberosity bursitis

Need Help? A Hip Pain Professional Can:

  • assess the gluteus maximus and deep hip rotator muscles 
  • assess the hamstring muscles and their tendons 
  • provide guidance as to what exercises will be most beneficial, for example, hamstring stretching is usually not helpful for those with hamstring tendinopathy or tendon tears.  
  • assess if weakness is an issue and if so, exactly which of the muscles are weak or activating too much, thus providing you with exercises specific to your individual needs 
  • assess if ‘neuromuscular’ control is an issue, that is, do you move in a way which may irritate or overload the painful structures  
  • provide important advice about sporting activities, such as 
  • ‘how much is too much’ 
  • allowing adequate recovery between sessions 
  • altering activity levels to match soft tissue tolerance 
  • resting from or altering particular actions that place the highest load across the lower buttock region  
  • provide advice on seating if pain while sitting is an issue 
  • advise if injections or surgery may be warranted 
hip joint treatment


Dr. Alison Grimaldi


This blog was written by Dr Alison Grimaldi and Kirsty McNab, physiotherapists who have over 50 years of combined professional clinical experience, dealing with patients suffering from a wide range of hip and pelvic conditions.

Kirsty McNab

Dr. Alison Grimaldi BPhty, MPhty(Sports), PhD is Practice Principal of Physiotec Physiotherapy, an Australian Sports Physiotherapist and Adjunct Senior Research Fellow at the University of Queensland, author and global educator.

Kirsty McNab BSc Hons, MPhty(Sports), is Practice Principal of Physiologix and a highly experienced Sports and Exercise Physiotherapist having worked extensively with elite athletes, the Olympic Winter Institute of Australia, and Tennis Australia.

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

  1. Pain Locator Map  click on this interactive map to learn what may be causing pain in your area
  2. Hip Related Sciatica (piriformis syndrome, deep gluteal syndrome): what, where and how? Read more about possible cuases of pain higher in the buttock muscles
  3. Top Tips for Hip Pain Relief Sitting, when Socialising or Travelling.  If your nerve pain is exacerbated when sitting this blog may be extremely useful in suggesting ideas to help relieve this.

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