We hear this question frequently in our practice. While it may seem like an easy question to answer, often times the answer is anything but simple. We may even hear about these symptoms in the form of a statement from a patient such as “It’s not my back, it’s my hips!”
The first step in solving the puzzle involves taking a careful history:
• Was there a specific injury before the pain started?
• Did the pain come on suddenly, or over a long period of time?
• Does the pain always stay on one side or does go back and forth?
• What treatments have been tried to try to fix the problem?
Oftentimes this line of questioning will provide clues into the nature of the problem:
• For instance, we might hear that the patient feels the sacroiliac (SI) joint going “in and out of joint” —making us suspect that there are loose ligaments around the SI joint.
• Other times the patient might say that stretching the piriformis muscle helps tremendously but it “keeps coming back” — making the diagnosis of piriformis syndrome more likely.
• If the pain tends to go back and forth from one side to the other, or if it affects both sides equally we might suspect one of the lumbar intervertebral discs.
Knowing the precise location where a patient is experiencing pain can be very important. “Butt pain” (or if we are using its more forma clinical term, “buttock pain”) can be localized to many different areas including:
• The upper buttock (gluteus maximus muscle, gluteus medius muscle)
• The outer buttock (gluteus minimus muscle
• The deep central buttock (piriformis muscle, gemellus and obturator internus muscle)
• The lower buttock on the “sitting bones” or ischial tuberosity (biceps femoris muscle)
• The tailbone area, off to either side of midline, overlying the sacroiliac joints.
• The outside hip region on the sides of the hips, in the region of the greater trochanteric (hip) bursa.
The next step is asking whether or not the pain travels from its origin (the place where it starts) to any other place — such as into the lower back, the leg (front, side, or back of the leg), or the groin (the crease between your lower abdomen and upper thigh).
• Lumbar intervertebral discs (in the low back) can cause pain radiating into the buttocks
• The L4 nerve (2nd from lowest nerve in the lumbar spine) can cause a lot of buttock/hip pain.
• The L5 nerve (lowest nerve in the lumbar spine) can be responsible for a lot of “groin pain”.
• The sacroiliac joint can cause pain in the buttock; the groin; and the back.
• A recent study of people experiencing problems with the “ball and socket” hip joint showed that these people could feel pain in MANY different areas including the buttock and back, and even all the way down the leg into the foot!