Pain in the Butt!
While there are many causes of buttock pain, one of the more common causes that I see is Greater Trochanteric Pain Syndrome (GTPS) - ie, a pain on the outside of the buttock or hip.
As you can see from the image above, GTPS presents with pain on the outside of the hip. Pain generators for this can include the trochanteric bursa, or tendonitis of the gluteus medium or minimus. This is most commonly seen in females aged 40-60, however it can often happen in males or in younger females especially during pregnancy. GTPS is a cause of hip pain in 10-20% of cases (which means, it is common, but there are many issues that can affect a hip so it isn't the only cause).
Causes of Greater Trochanteric Pain Syndrome
-Direct fall onto the outside of the hip
-Prolonged direct pressure on the outside of the hip (I will sometimes see this in patients that sleep on only one side during the night)
-Repetitive strain injury from prolonged walking or running (long distance runners seem to be particularly affected)
-Lateral hip instability
-Prolonged weight bearing on one leg only (this causes the gluteus medius and minimus to be overly active for too long causing strain)
-Traumatic sporting injury
-Tightness or pain in the IT band
Signs & Symptoms of Greater Trochanteric Pain Syndrome
-Pain along the outside of the hip and buttock, potentially down the side of the thigh
-Pain is worse when lying on the affected side (ie it hurts to sleep on that side)
-Pain with running or walking long distances
-Pain sitting with legs crossed
-Likely hip abductor weakness (ie Gluteus Medius and Minimus are likely weak and have a difficult time supporting the pelvis effectively)
-Sensitive to palpation of affected muscles and greater trochanter (sometimes palpation of these areas can lead to the patient 'jumping' off the table in particularly acute cases)
Treatment of Greater Trochanteric Pain Syndrome
-Relative rest (trying to avoid activities that cause undue stress and discomfort of the affected area)
-Self stretching of affected musculature (Gluteus Medius, Gluteus Minimus, IT Band, Tensor Fascia Latae)
-Active Release Technique to affected musculature to stretch out tight and tender muscles
-Strengthening of Gluteus Medius and Minimus to enhance lateral hip stability and instruction on proper hip mechanics to reduce loads here in the future
-Low Intensity Laser Therapy to reduce any inflammation and speed up healing
-In cases where response is minimal to targeted chiropractic care with mobilizations of the hip and Active Release technique are slow to respond, corticosteroid injections are a consideration (but please consult your physician first).