Buttock pain may be caused by many activities and sports as various structures are stressed beyond their tolerance. Buttock pain may arise in cases of gluteal muscle strain, particularly in gluteus medius and gluteus maximus, hamstring muscle tears and in the Piriformis syndrome. In addition, there may be an ischial tuberosity bursitis, Sacro-iliac joint strain, referred lumbar pain and rarely, referred hip joint pain. The Perth Physiotherapy and Sports Injuries Centre can help you with the diagnosis and treatment of buttock pain.



During training, our body adapts to the increased load of the activity by thickening and strengthening tissues to cope with the increased strains. If a tissue such as a muscle, ligament or bone is heavily or repeatedly loaded, for example when sprinting but has not had enough training to allow it to cope with these loads, it will accumulate damage. An example would be the office worker who plays football at the weekend but has not trained during the week and then tears a hamstring muscle.


Our body adapts to the increased load of training by thickening and strengthening tissues to cope with the increased strains. If a tissue such as a muscle, ligament or bone is heavily or repeatedly loaded without enough time to recover and heal, it will break down and tear. Over-training and over-use causing buttock pain, occurs in repetitive sports such as distance running, hurdles, football and over zealous training in any other leg based sport. Piriformis Syndrome may occur, resulting in thickening of the Piriformis muscle and irritation of the adjacent nerves.


During an impact there is generally a crush effect which breaks the structures at the point of pressure. Skin, muscles, blood vessels and even nerves and bones may be bruised or broken resulting in instant swelling and acute pain. These injuries are common in all football codes, netball, basket ball and hockey and may affect any of the buttock muscles and other structures. The impact may be by another player, a boot or a backward fall on to the buttock.


All our tissues are elastic to a degree and when properly trained are strong and resilient. When there is a sudden acceleration or deceleration which suddenly stresses tissues to a load greater than they can cope with, they will pull apart and we call this a sprain or tear. Most tears are partial tears, known as strains but some tissues completely tear and we call this a rupture. Overload injuries particularly to the hamstring muscles and their attachments often occur during tennis, squash, during all football codes and athletics due to:-

  • Inadequate warm up
  • Inappropriate training and conditioning
  • Faulty biomechanics such as weakness, muscle flexibility and joint stiffness
  • Previous and now chronic injury

Referred Pain

Lumbar facet joints, discs, muscles and other structures are affected by our positions and movements and the pain may be referred into the buttock. As a general rule, disc pain is worse with bending, lifting and slouching and facet joint strains are worse twisting and bending backward or sideways. Your Physiotherapist will identify whether the damaged structure causing the buttock pain is in the spine or buttock.


The symptoms are different depending on the type of injury. There may be stiffness and ache in a gradual onset over-use injury and severe pain with a tear or crush injury. Generally pain and stiffness is mild initially with a slow onset training type injury while acute strong pain, occurs with tears and ruptures. The more severe the initial pain, the greater the likelihood that severe damage has occurred and this is often followed by swelling and bruising.


If there is buttock pain or another abnormal feeling during or after training, sport or a fall, the diagnosis of the structure damaged and the choice of treatment will need to be made by a  Physiotherapist. It is important for your Physiotherapist to establish a specific and accurate diagnosis, to direct the choice of treatment. In some cases the pain may arise from several tissues and these coexisting pathologies are treated as they are identified. A thorough examination is sufficient to diagnose most problems and other investigations such as x-rays, ultrasound, CT or MRI scans will be arranged if extra information is required.


Buttock injuries heal best when treatment begins as soon as practical following injury. The sports person must immediately stop the sport and avoid any movement which produces the pain. In the case of sudden onset pain the RICE protocol should commence. This is:-

  • Rest:                 Rest from aggravating movements to reduce further bleeding and injury.
  • Ice:                    Real ice wrapped in a wet towel and applied to the injury for thirty minutes.
  • Compression:  Direct pressure such as sitting to reduce swelling.
  • Elevation:         Is not practical with buttock injuries, so the Rest, Ice and Compression are important.

Treatment may also include the following advice and treatment:-

Advice regarding

  • The injury diagnosis
  • Medications: Pain killers may be needed initially and anti-inflammatories may be used after 48 hours when bleeding has stopped.

Direct Physiotherapy Treatment

  • Ultrasound and other electrotherapy
  • Stretches
  • Soft tissue treatment
  • Joint mobilisation
  • Exercises to regain strength, movement

Physiotherapy Management of return to sport

  • Correction of biomechanical anomalies
  • Technique modification
  • Provision of orthotics and footwear advice
  • Providing a return to sport plan

Initial management may require the use of crutches or a walking stick to reduce the load on the tissues. As the injury begins healing, the Physiotherapist will advise a graduated return to exercise program without an increase in symptoms. Depending on which tissues are injured, there may be stretches, strengthening and mobility exercises to return full function and reduce the chance of the injury recurring.

In the event of a severe injury where Physiotherapy is not appropriate, the patient will be referred directly to a doctor or the appropriate professional for further investigation and treatment. In the event surgery is required, Physiotherapy rehabilitation will be arranged afterward.


Buttock injuries recover well with Physiotherapy management. Full recovery may take some time, depending on the injury, with the goals of achieving painless full function and minimizing the chance of a recurrence in the future.

Early treatment assists the fastest, best quality healing. Phone us now on (08) 9481 7677 for your Physiotherapy assessment at the Perth Physiotherapy and Sports Injuries Centre and we will tell you how we can help you.

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