Deep buttock pain can feel like a dull ache after sitting, a sharp pain when standing up, or pain that travels into the leg. It may affect only the left or right side and can be frustrating when it keeps returning or begins to interfere with sleep, work or exercise.
Several muscles, tendons, bursae, joints and nerves can produce similar symptoms. That means the location of buttock pain can offer clues, but it does not always identify the cause without a clinical assessment.
Who is this guide for?
This guide is for people with deep, persistent or one-sided buttock pain who want to understand common causes and when a private musculoskeletal assessment or scan may be appropriate.
What are the most common causes of deep buttock pain?
Buttock pain may come from the buttock itself or be referred from the hip or lower back. Common possibilities include:
| Condition | Typical symptoms |
|---|---|
| Piriformis-related / deep gluteal pain | Deep buttock pain, often worse with sitting; may spread into the leg. |
| Gluteal tendinopathy | Upper or outer buttock ache, often worse with walking, stairs or lying on that side. |
| Sacroiliac (SI) joint pain | One-sided lower-back or upper-buttock pain, sometimes worse with position changes. |
| Sciatica / lumbar radiculopathy | Buttock pain with pain, tingling, numbness or weakness down the leg. |
| Ischial bursitis/hamstring origin pain | Pain around the 'sit bone', especially on hard seats or with prolonged sitting. |
| Hip osteoarthritis or muscle strain | Hip or groin stiffness with referred buttock pain, or local pain after activity/injury. |
What does it mean if buttock pain is only on one side?
Left or right buttock pain when sitting can occur with a local muscle, tendon, bursal or SI joint problem, but one-sided sciatica can feel similar. The side of the pain helps guide assessment but does not confirm a diagnosis.
Can buttock pain come from the lower back rather than the buttock?
Yes. Lumbar disc problems, nerve-root irritation and spinal joint changes may refer pain mainly into the buttock, sometimes even when back pain is mild.
Why does buttock pain get worse when sitting and what does that suggest?
Sitting increases pressure on tissues around the buttock. Hard surfaces load the ischial tuberosity, the ‘sit bone’, and may aggravate ischial bursitis or the upper hamstring tendon. Prolonged sitting may also worsen deep gluteal or piriformis-related pain.
Pain when lying on one side is more often associated with gluteal tendon or bursal irritation around the outer hip. These patterns are useful clues, but symptoms overlap.
What causes buttock pain that radiates or shoots down the leg?
Buttock pain down the leg raises the possibility of sciatic nerve irritation. Sciatica usually comes from a nerve root in the lower back, while deep gluteal or piriformis-related pain involves structures around the sciatic nerve outside the spine.
How do I know if it is sciatica or piriformis syndrome?
| Sciatica / lumbar radiculopathy | Piriformis-related deep gluteal pain |
|---|---|
| Often linked to the lower back or lumbar nerve root. | Pain is usually centred more clearly in the deep buttock. |
| Frequently travels below the knee; tingling, numbness or weakness may occur. | Sitting commonly aggravates symptoms; pain may stay in the buttock or upper leg. |
| Clinical neurological findings may point towards spinal nerve irritation. | Diagnosis is mainly clinical and requires other causes to be considered. |
Piriformis syndrome versus lumbar radiculopathy cannot be reliably distinguished from a single symptom. A musculoskeletal and neurological examination is important, and imaging is used only when it is likely to add useful information.
Can buttock pain after hip replacement be a serious problem?
Some buttock, hip and leg discomfort is expected during recovery and may take several weeks to settle. Buttock pain months after hip replacement, however, should be reviewed if it is persistent, new or worsening.
Possible causes include tendon irritation, bursitis, muscle weakness, nerve or spinal pain, SI joint problems and changes in walking mechanics. Less commonly, the replacement itself may need assessment. After recent surgery, seek urgent medical advice for worsening pain with fever, wound discharge, increasing redness or swelling, or significant leg swelling.
Are there any serious causes of buttock pain I should not ignore?
Most buttock pain is musculoskeletal, but urgent assessment is needed for new loss of bladder or bowel control, numbness around the genitals or saddle area, severe or progressive leg weakness, significant trauma, fever with worsening pain, or rapidly deteriorating symptoms.
Arrange medical review for unexplained weight loss, a new lump or swelling, or persistent severe night pain. Pain that changes with movement or posture and follows activity or prolonged sitting is more suggestive of a musculoskeletal cause, but persistent symptoms still deserve assessment.
When do I need a scan for buttock pain and what will it show?
A scan is not needed for every episode of buttock pain. It becomes more useful when symptoms persist despite appropriate treatment, the diagnosis is uncertain, a soft-tissue injury is suspected, or the result is likely to change management.
Musculoskeletal ultrasound uses sound waves and does not involve radiation. Depending on the area, it may assess selected gluteal tendons, bursae, proximal hamstring tendons, muscle injuries and fluid collections, and it can guide an injection when a suitable target has been identified.
Ultrasound cannot assess every deep structure equally well and does not show the inside of bone. If symptoms suggest a lumbar nerve-root problem, deeper pelvic condition or an issue within the hip joint, MRI or another investigation may be more suitable. NICE advises that imaging for low-back pain or sciatica should generally be used when it is expected to change management.
What happens during a musculoskeletal ultrasound?
Little preparation is usually needed. Wear clothing that allows access to the painful area. Gel is placed on the skin and the probe is moved over selected tissues; you may be asked to move the hip or leg so structures can be assessed dynamically. The scan itself is usually straightforward, although pressure over a tender area may reproduce familiar discomfort.
Do I need a GP referral for a private buttock pain assessment at RAD Clinics?
At RAD Clinics, we accept self-referrals for private musculoskeletal assessments. However, a GP or hospital assessment may still be the right first step if symptoms suggest a spinal emergency, infection, or postoperative complication.
What treatments are available for deep buttock pain at RAD Clinics?
Treatment depends on the diagnosis. At RAD Clinics, we may use a clinical assessment and musculoskeletal ultrasound scanning to help determine the most appropriate treatment, which may include physiotherapy, exercise, and rehabilitation advice. For selected diagnosed conditions, we also offer a range of ultrasound-guided injections for pain management.
Key takeaways
- Deep buttock pain can arise from muscles, tendons, bursae, the SI joint, the hip, the sciatic nerve or the lower back.
- Pain that is worse with sitting may involve the sit-bone region, hamstring origin, bursae or deep gluteal structures.
- Pain travelling down the leg may suggest sciatica or another form of sciatic nerve irritation.
- Persistent or worsening buttock pain after hip replacement should be reviewed.
- Ultrasound can assess selected soft tissues, but MRI or another test may be more suitable for deeper or spinal causes.
- We accept self-referral and offer assessment, physiotherapy, ultrasound and selected image-guided treatments where appropriate.
Common Questions About tendonitis ultrasound scans
How can I tell if my buttock pain is sciatica or piriformis syndrome?
Sciatica usually causes pain that travels from the lower back or buttock down the leg, while piriformis syndrome typically causes deep buttock pain linked to irritation around the piriformis muscle. Clinical assessment helps distinguish between these conditions.
Can lower back problems cause buttock pain?
Yes, lower back problems can cause buttock pain when irritated spinal nerves refer pain into the buttock or surrounding areas. A clinical assessment helps determine whether the pain originates from the spine, hip, or local soft tissues.
Is buttock pain after hip replacement normal?
Buttock pain after hip replacement requires assessment when it persists, worsens, or affects movement. Causes include muscle and tendon irritation, changes in movement patterns, or problems around the hip, so persistent symptoms require clinical evaluation.
Can an ultrasound diagnose the cause of buttock pain?
A musculoskeletal ultrasound scan examines muscles, tendons, soft tissues, and some joint structures that contribute to buttock pain. Ultrasound provides real-time imaging and helps clinicians identify soft-tissue abnormalities that require targeted treatment.
What treatments are available for deep buttock pain?
Treatment may include activity modification, exercise-based rehabilitation, physiotherapy and ultrasound-guided injections if appropriate.
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