A pain in the butt!

With four of our club members joining me for long run in the cold wind and driving rain on Sunday it wasn’t long before our minds wandered away from thoughts of spring and the upcoming race season. The topic of conversation instead turned to human anatomy and more specifically buttocks! One of the group had been experiencing buttock pain associated with running and sitting for a number of weeks. And so another blog topic was born.

Buttock pain is not uncommon in triathletes. Cycling and running, for a number of reasons, can lead to buttock pain. Common causes of buttock pain are: referred pain from the lumbar spine (low back) or sacroiliac joints (two joints within the pelvis); injury to the hamstring origin (the hamstrings originate from those bony points you sit on); ishiogluteal bursitis (inflammation of a small fluid filled structure in the buttock region); myofascial pain (pain from one or more of the muscles within the buttock and the associated ‘connective’ tissues; sciatic nerve related pain or hip related pain.

Less common are bony injuries such as stress fractures e.g. of the sacrum and some other bony injuries that are more common in adolescents. There are of course more serious causes of buttock pain too such as various forms of arthritis, tumours or infections but these are relatively uncommon. If your injury is not responding to treatment as expected it is wise to visit your doctor as these causes of buttock pain require further investigation and/or medical management.

By far the most common causes of buttock pain are referred pain from the lumbar spine, sciatic nerve related pain and myofascial pain. An in depth discussion of the management of buttock pain is beyond this blog (it would take forever!). I do believe a lot of buttock pain of this type can be resolved using simple self-help techniques.

Stretching of the buttock muscles, especially the gluteals and piriformis, is often very useful. Which stretching exercise will help will depend on where the areas of tightness are within the buttock. For a description of the exercises and photos of useful buttock stretches click on this link.

Self-massage of the buttock muscles (don’t laugh!) is also useful to target specific areas within the musculature and the associated connective tissues. This can be performed using something like the AOK Massage Ball. For a description of the exercises and photos of useful self-massage techniques click on this link.

Sometimes myofascial pain and tightness in the buttock muscles can be due to weakness within the buttock musculature. Weakness in the gluteal muscles (gluteus maximus, gluteus medius and gluteus minimus) is common. This can result in the small muscles of the buttock e.g. pirifomis, being overloaded. As a result myofascial pain and tightness can develop either in the gluteal muscles or the smaller muscles of the buttock or both. Which strength exercise will help will depend on the pattern of weakness in the buttock. Gluteus maximus and gluteus medius weakness is suprisingly common. For a description and photos of useful strength exercises click on this link.

Of course you must always treat the cause and not just the symptoms. That means considering your bike set up, riding technique and equipment e.g. type of saddle, and cycling training errors e.g. sudden increase in volume, as a possible cause. Looking at your running technique and running training errors as a possible cause. Looking at your posture and in particular your sitting posture as a possible cause. This is especially important for buttock pain referred from the lumbar spine and sciatic nerve related pain as the majority of people with low back pain experience pain with sitting.

So hopefully that pain in the butt might not be quite such a pain if you try some of the simple self-help techniques above. Tim (LFTC Coach)