Low back pain is notoriously difficult to diagnose, but taking note of any corresponding symptoms will help to narrow down the cause. If you have back and buttocks pain, consider the three common causes below:
Piriformis syndrome is characterized by chronic tension and inflammation of the piriformis muscle. This muscle sits deep in the buttocks, running horizontally from the sacrum to the thigh bone on each side of the body.
The piriformis may become tense in a couple different ways. First, overuse due to activity can cause tightness. People who cycle or run frequently may overwork this muscle leading to chronic strain. On the opposite end, a sedentary lifestyle can also lead to piriformis syndrome. If you sit for long periods of time on a regular basis and don’t exercise much, you likely have weak gluteus muscles in the buttocks. Glutes are largely responsible for rotating the hips; if they’re too weak to perform the job, the piriformis will be forced to compensate. This can lead to overuse of the muscle.
Aside from the aching and stiffness normally associated with muscle strain, an inflamed piriformis can impinge the sciatic nerve which runs nearby. Resolving the problem will entail physical therapy to balance the muscles throughout the core. Myofascial release (or self-myofascial release) can be pursued to relax and re-lengthen the piriformis.
SI Joint Dysfunction
The sacroiliac (SI) joints form where the sacrum meets the hip bones (ilia) on each side. They are supported by a network of ligaments and muscles and normally allowed very little movement. As the connection point between the upper and lower body, these joints absorb shock and help transfer forces from the upper to lower body and vice versa.
SI joint dysfunction occurs when one or both joints allow either too much or too little motion, with hypermobility being the most common problem. Dysfunction can be caused by either overstretching of a ligament supporting the joint or tightening of surrounding muscles. These problems may result from poor body mechanics or imbalanced forces on the body, such as leg length discrepancy.
Whether the joint is stuck or hypermobile, it can become inflamed. Intense localized pain will be felt in the joint itself, and the pain will likely radiate throughout the lower back, hips and buttocks. The inflammation may also impinge the sciatic nerve, which travels near the joint. This can cause shooting pain down the back of the leg.
Physical therapy is the best medicine for SI joint dysfunction. The therapist can help you determine whether you need to increase or reduce joint motion. Strengthening and balancing of the muscles throughout the hips will likely be part of SI treatment. Prolotherapy may be recommended if a damaged ligament is causing the condition.
Sciatica is one of the more common causes of chronic lower back pain. It is characterized by the impingement of the sciatic nerve, the largest nerve in the body which travels from the lumbar spine down the back of each leg to the foot.
The sciatic nerve may be impinged at the root by a herniated disc in the spine. It can also be pinched by a misplaces vertebra. It is also possible for the nerve to be interfered with further on down its path, either by sacroiliac joint misalignment or piriformis syndrome.
Symptoms of nerve impingement are generally experienced along the nerve’s pathway. Sciatica causes sharp, shooting pain from the lower back down the buttocks and into the leg, sometimes as far down as the foot. You may also experience numbness and weakness along this path. If the cause of impingement is an SI joint or piriformis muscle, there will likely be more pain concentrated in the buttocks.
Back and buttocks pain often indicate one of the above problems. Noting all corresponding symptoms and taking into account your habits and activity level will help you narrow down the cause of your pain.