Buttock pain when sitting: common causes and what helps
A literal pain in the backside when you sit is common in office workers, drivers, cyclists and runners. Several structures share this small area, and where exactly it hurts, along with what else provokes it, usually points to the source.
What causes buttock pain when sitting?
The main causes are the hamstring tendon at the sit bone, the deep buttock muscles including the piriformis, the tailbone, the sacroiliac joint, pain referred from the lower back, and, less often, the bursa over the sit bone.
What if the pain is right on the sit bone?
Pain at the bony point you sit on, worse on hard chairs and with running, lunges or deadlifts, is often proximal hamstring tendinopathy. A clinical review describes it as deep buttock pain at the hamstring attachment, often long-standing and aggravated by sitting (Goom et al., JOSPT, 2016). Stretching the hamstring usually makes it worse.
See our post on hamstring tendinopathy.
What if it's deep in the middle of the buttock?
A deep ache in the centre of the buttock, sometimes with pain or tingling down the back of the thigh, may involve the piriformis and other deep buttock muscles irritating the sciatic nerve. A systematic review identified four features that characterise piriformis syndrome: buttock pain, pain made worse by sitting, tenderness in the buttock near where the sciatic nerve exits, and pain with movements that tension the piriformis (Hopayian and Danielyan, European Journal of Orthopaedic Surgery & Traumatology, 2018). The same review noted the accuracy of tests for it is uncertain.
See our post on piriformis syndrome.
What if it's at the tailbone?
Pain at the very base of the spine, between the buttocks, that's worst sitting back on a soft seat and when getting up from sitting, is typical of tailbone (coccyx) pain. It often follows a fall, childbirth or prolonged sitting.
See our post on tailbone pain.
Could it be coming from my back?
Often. The lower back commonly refers pain to the buttock. Clues include back pain or stiffness as well, pain that changes when you bend or arch, pain worse with slumped sitting and better with walking, and pain travelling down the leg.
What about the sacroiliac joint?
Pain to one side of the base of the spine, over the dimple at the back of the pelvis, that's worse with sitting unevenly, standing on one leg or rolling in bed, can come from the sacroiliac joint. It's common in pregnancy and after falls onto the buttock.
See our post on sacroiliac joint pain.
Why is buttock pain common in pregnancy?
Changes in the pelvic joints and the way load is carried cause pain at the back of the pelvis and buttock for many pregnant women.
See our post on pelvic girdle pain in pregnancy.
What helps buttock pain when sitting?
Break up sitting every 20 to 30 minutes. Use a cushion: a wedge or a cushion with a cut-out for tailbone pain, or one that takes pressure off the sit bone for hamstring tendon pain. Avoid sitting on a wallet. Sit with your weight evenly on both sides. Standing for part of your working day helps.
Should I stretch my glutes and piriformis?
It depends on the cause. Gentle stretching can ease muscle-related buttock pain. With hamstring tendon pain or an irritated sciatic nerve, strong stretches often aggravate it. If a stretch increases your pain or causes tingling down the leg, leave it out.
What exercises help?
Strengthening the glutes and hamstrings with bridges, hip thrusts, side-lying leg raises and, later, single-leg work helps most causes. Walking is usually well tolerated. The specifics depend on the diagnosis.
Why does it hurt when I drive?
Driving combines sustained pressure, a bent hip, vibration and, on the right side, working the accelerator. Move the seat so your hips aren't sharply bent, use a cushion, and stop for a short walk on longer trips.
How can an osteopath help?
We examine the lower back, sacroiliac joints, hip, hamstring tendon and nerves to find the source, treat hands-on, and give you the right exercises and sitting strategies for that cause.
When should buttock pain be checked urgently?
See your GP promptly for buttock pain that is constant and unrelated to position, pain at night with unexplained weight loss or a history of cancer, a change in bowel habit or bleeding, a hot, red, swollen area, or fever. Go to an emergency department straight away for new difficulty controlling your bladder or bowels, numbness around the groin or inner thighs, or weakness or numbness in both legs. See your GP promptly if weakness in your leg or foot is getting worse.
See our hip and pelvic pain guide. Book an assessment at our Berwick clinic. A 60-minute initial consultation is $149, with no referral needed and HICAPS on-site.
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Book an initial consultation at RISE Sports & Spinal in Berwick. Clear diagnosis, hands-on treatment, and a plan that actually gets you better.
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