Upper Buttock Pain

Upper buttock pain is pain that is experienced over the upper part of the buttock. There are many potential causes for upper buttock pain. Explore the information under each tab below to understand more about the anatomy of the area and things that may go wrong.

Common conditions associated with upper buttock pain:

Pelvic girdle pain or Sacroiliac joint pain/dysfunction – see Joint-Related Pain
Referred pain from the lower back – see Back-Related Hip Pain
Sciatica (piriformis syndrome or deep gluteal syndrome) – see Peripheral Nerve-Related Pain

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

Pain experienced in the upper buttock region may be related to:

joints of the hip & pelvis, where two bones meet
‘soft tissues’, non-bony structures, such as muscle
bones, such as the femur (thigh bone) or bones of the pelvis
the lower back
nerves that run through and around the hip & pelvis
pelvic organs or blood vessels, or other health issues masquerading as hip pain

What is pain?

Pain is an experience that the brain creates for the purposes of stimulating you to change your behaviour or seek help for a perceived problem with your body.

Irritating or potentially damaging stimuli in your body (like high levels of pressure, tension or extremes of temperature) activate sense receptors (danger sensors) in the area. Signals from danger sensors in the body travel through the nervous system to the brain. Here the information is processed and the brain sometimes (but not always) produces a pain experience.

If you would like to read more about understanding what pain is, please click here.

Joint Related

Soft Tissue Related

Bone Related

Back Related

Peripheral Nerve

Other causes

Joint Related

Joint-Related Pain

A joint is formed where two bones are joined together, with varying amounts of movement occurring between them. Pain may be related to the structures involved in the function and support of a joint. The sacroiliac joint is the joint most likely to be related to pain in the upper buttock region (Figures 1.1 & 1.2).

Pain related to the Sacroiliac Joint

Pain and functional difficulties related to the sacroiliac joint:

most commonly develop during pregnancy or childbirth
may occur after a major trauma, such as a hard fall onto the bottom or a large force through one leg, for example being dragged by one leg after a fall from a horse or water-skis
may develop over time, related to certain types of repetitive forces
can develop when there is a problem with the lower back or hip joints, transferring extra load across the sacroiliac joint

Sacroiliac pain and dysfunction are however, greatly over-diagnosed. While true instability does occur, it is relatively rare and there are many people living unnecessarily in fear, related to a diagnosis of ‘pelvic instability’ or being told their pelvis keeps moving ‘out of place’.

Here are a few facts about the sacroiliac joint that may dispel some of this fear:

The structure of the sacroiliac joint makes it a very stable joint
Asymmetry in the human body is normal
- Differences in tightness of the muscles that join on to either side of the pelvis occur naturally, related to leg or arm dominance, sport and occupation. This asymmetry may cause an appearance of asymmetry in the resting position and movement of the pelvis. This is normal and has not been linked to harm.
- Differences in leg length of up to around 1cm are common and normal. Leg length difference may also produce an appearance of asymmetry in pelvic position in standing.
A click occurring in a joint does not mean it has moved ‘in or out of position’. All of us click and pop, some just a little more than others. These are usually normal joint or tendon sounds.

There are also causes for sacroiliac joint pain that are related to other general health conditions. Sacroiliitis refers to an inflammation of the SIJ’s associated with a systemic inflammatory disease such as Ankylosing Spondylitis. You can read more about non-musculoskeletal causes of hip and pelvic pain here.

Pain related to the sacroiliac joints is most commonly experienced in the upper buttock region, usually right over the joint, in the area of the dimples at the top of the buttocks. As the pelvis is a ring joined at the front by the pubic symphysis, problems with the sacroiliac joints are sometimes associated with pain in the groin region.There are many other causes for groin pain however, so visit our Pain Locator Map to read about different factors that may be related to pain in each of these regions.

Your Hip Pain Professional will be able to assess your sacroiliac joints to determine if they are likely to be the cause of your pain. If you have sacroiliac joint related pain, you may require:

advice on modifications to activities or positions – e.g. workplace set-up
an exercise program to provide optimal muscle support around the joints
advice regarding short term bracing or taping–only appropriate for short term use and usually only for severe pain and during late stage pregnancy or after trauma
an injection for short term relief of severe pain, while you work on your rehabilitation

Soft Tissue Related

Soft Tissue Related Pain

Pain in the upper buttock region may be related to soft tissues. Soft tissues are non-bony structures that connect, support, or surround other structures and include muscles, tendons (which connect your muscles to the bone) and fascia (Figure 2.1).

Fascia is stretchy, thin, white fibrous tissue. All our muscles are enveloped in fascia, like stretchy stockings that help transfer energy from muscle and movement. Fascia also forms sheaths or tunnels for safe passage of blood vessels and nerves and wraps and supports all our bodily organs.

There are many muscles that support and move the hip and pelvis. In the upper buttock region, many muscles and their surrounding thin fibrous wrapping (fascia) converge, joining firmly onto the pelvis and sacrum. These back, abdominal and buttock muscles play a vital role in generating and transferring forces that pass across the pelvis, between the back and hips. The muscles are also covered in strong fascia that continues from the hips (gluteal fascia) into the back (thoracodorsal fascia). This strong, stretchy wrapping helps store and transfer energy through this region (Figure 2.1).

The upper part of the gluteus maximus muscle, and the gluteus medius muscle beneath, run from their anchor points on the pelvis and sacrum, around to the side of the hip (lateral hip region) (Figure 2.1). The piriformis muscle also sits under the gluteus maximus in the upper buttock, having strong connections into the bones and ligaments of the sacroiliac joint (SIJ) at the back of the pelvis (Figure 2.2).

Bone Related

Bone Related Pain

Although relatively more rare than soft tissue or joint problems, bony problems such as a fracture, stress fracture or very rarely, infection or tumour within the bone may cause hip and pelvic pain.

The most likely bone-related issues associated with pain in the upper buttock region, are fracture or stress fracture of the sacrum. The sacrum is the wedge-shaped bone that sits between the two bony wings of the pelvis (Figure 3).

A fracture:

is the medical term for a broken bone
usually occurs from a traumatic event like a fall, car accident or more severe sporting injury. A hard fall backwards onto the pelvis may cause a sacral fracture.
is more likely to occur in a weakened bone e.g. osteoporosis or genetic diseases like osteogenesis imperfecta.

A stress fracture:

is the medical term used for a tiny crack in a bone
starts as localised swelling in the area of bone exposed to highest stress (you won’t see this at skin level as it is just within the bone) – this may be called a stress reaction or bony stress response

Stress fractures can be divided into two main types:

Fatigue fracture: where a bone has been exposed to an abnormal accumulation of repeated small traumas e.g. long-distance running
Insufficiency fracture: where the bone strength is insufficient to resist normal daily forces

Sacral fatigue fractures are seen most commonly in long distance runners or triathletes. Compared with bony injuries of the leg and foot, these are relatively much less common. Sacral insufficiency fractures occur most commonly in elderly females with osteoporosis. A diagnosis of sacral stress fracture may be missed or delayed, as the associated pain in the upper buttock region is often assumed to be related to the sacroiliac joint or lower back.

Your Hip Pain Professional can:

perform a thorough assessment and let you know if a bone issue may be suspected. In these cases, you may be advised to undertake further imaging or referral to a medical specialist for further advice
provide or refer you for rehabilitation at an appropriate time following bony injury
provide important information about managing general or sporting activity
address muscular or biomechanical issues that may be contributing to bone-related pain, for example, running style may have an impact

Back Related

Back Related Hip Pain

Pain experienced in the upper buttock regions sometimes has nothing to do with a condition in this area.

Lower back issues are often associated with pain that extends from the back into the upper buttock or pain that occurs only in the upper buttock.There are two main ways this might occur:

Referred pain

Referred pain is pain felt in a part of the body other than its actual source. For example, if there is a problem in the lumbar (lower back) discs or joints, small nerve endings serving these structures generate ‘danger’ messages that are transmitted along small nerve fibres into the spinal cord.

However, this area of the spinal cord also receives information from structures in the hip and pelvis.The brain is unable to distinguish where the information came from, (the back, the hip or the pelvis) so you might feel pain in any one or a combination of these areas (Figure 4.1).

Pain in the buttock may be referred from joints or intervertebral discs of the mid-lower lumbar spine.

Referred pain:

is usually a dull, aching or gnawing pain
can expand into a wide area that is difficult to localize
is not related to a problem of the nerve roots in the spine
is not associated with other nerve-related symptoms such as tingling or numbness

Peripheral Nerve

Peripheral Nerve Related Pain

The nervous system (Figure 5.1) is a complex network of nerves and cells that carry messages between the brain and spinal cord and your body. It is through this system that we feel, move and control our bodily functions.

Nerve roots leave the spinal cord via the intervertebral foramina (holes or spaces between the vertebrae) and join together from various levels of the spine to travel as cord-like structures, called nerves, to their destinations.

It is these nerves that travel outside the spinal cord that are referred to as “peripheral nerves”.

Some peripheral nerves travel only a short distance and others all the way from the lower back to the foot. Along their journey they run between and through muscles and fibrous tunnels.

While radicular pain arises from a problem as the nerve root exits the spine, nerve-related pain may develop due to a problem along the pathway of a peripheral nerve, outside the spine. Pain related to a nerve is called “Neuralgia”.

Other causes

Other causes of hip, pelvic & groin pain

There are other processes that may produce pain around the hip and pelvis.

These include:

Systemic/Rheumatological conditions: eg Rheumatoid Arthritis, Polymyalgia, Polyarthralgia
Infective processes: Septic arthritis, Osteomyelitis, Viral Arthritis
Neoplastic processes (cancer)
Vascular issues: Avascular Necrosis, External Iliac Artery Entrapment, varicotic gluteal vessels compressing the sciatic nerve

These conditions are relatively rare compared to musculoskeletal pain, but when present you will need to see a medical practitioner and usually a specialist for that system or problem, for example, a Rheumatologist, Orthopaedic Specialist, Oncologist, Vascular Specialist.

Anterior Hip pain can also be associated with organ problems (ovaries, uterus, bowel, bladder, prostate). One of the most common causes of organ-related pain in females is endometriosis. This occurs when tissue that is similarto the lining of the uterus (womb) grows outside the uterus attaching to other structures such as the pelvic ligaments or the bladder and bowel. This can lead to debilitating pain that may be cyclic, relating to the menstrual cycle. Diagnosis and management of organ related problems will usually require the assistance of a specialist, for example a gynaecologist (female reproductive organs), urologist (bladder and prostate) or gastroenterologist (gut/bowel).

A skilled assessment by a Hip Pain Professionalwill help clarify if the problem requires further medical attention and whether it is likely to be related to a musculoskeletal problem or not.

Your Hip Pain Professional can:

provide a detailed assessment
assist in determining if the problem is musculoskeletal or not
develop a plan to help if the problem is musculoskeletal
recommend further tests or send you to another specialist if the problem does not appear to be in the musculoskeletal system.