Pain in the butt!

Deep gluteal syndrome (DGS) is a challenging condition characterised by pain and discomfort in the buttock region. This comprehensive guide provides insights into the nature of DGS, its causes, symptoms, diagnosis, and treatment options, empowering individuals to navigate this condition with knowledge and confidence.

What is Deep Gluteal Syndrome?

Buttock pain. Let’s begin there! Deep gluteal syndrome (DGS) encompasses a range of disorders involving compression or irritation of structures within the deep gluteal space. This anatomical region, situated deep within the buttock, houses critical structures such as nerves, blood vessels, and muscles. When these structures become compressed or inflamed, individuals may experience a variety of symptoms, including buttock pain, sciatica-like sensations, and impaired mobility.

Causes of Deep Gluteal Syndrome

The causes of DGS are diverse, reflecting the complex interplay of anatomical structures within the deep gluteal space. Here’s a closer look at the primary factors contributing to the development of DGS:

1. Piriformis Syndrome

Piriformis syndrome is one of the most common causes of DGS. It occurs when the piriformis muscle, located deep within the buttock, compresses or irritates the sciatic nerve. This compression can result from muscle spasms, inflammation, or anatomical variations in the relationship between the piriformis muscle and the sciatic nerve. Piriformis syndrome often leads to buttock pain, radiating pain down the leg (sciatica), and discomfort with sitting or walking.

2. Gluteal Medius Tendinopathy

Gluteal medius tendinopathy occurs far more commonly than you think. It may mimic symptoms of low back pain and often is confused with low back pain. Some individuals with gluteal medius tendinopathy may experience low back pain, pain going down the legs or simply pain in the buttock.

Gluteal medius tendinopathy usually occurs when they is a sudden increase in physical activity or when muscles around the gluteal region weakens.

You would experience pain standing on your affected leg or when you lying on affected side.

3. Proximal Hamstring Tendinopathy

Hamstring tendinopathy occurs especially with sports which requires frequent stretching of the legs like hurdling or gymnatstics. You would usually exeprience pain near the sit bone. Hamstring syndrome may lead to buttock pain, tightness, and discomfort, particularly during activities that involve bending or stretching the knee.

4. Sciatic Nerve Entrapment

Sciatic nerve entrapment refers to compression or irritation of the sciatic nerve as it passes through or adjacent to structures within the deep gluteal space. This can occur due to anatomical variations, such as narrow or crowded pathways for the nerve, or from external factors like trauma or inflammation. Sciatic nerve entrapment can cause symptoms similar to piriformis syndrome, including buttock pain and radiating pain down the leg.

5. Vascular Compression

Vascular compression within the deep gluteal space can also contribute to the development of DGS. Compression of blood vessels, such as the inferior gluteal artery, may occur due to anatomical variations, muscle hypertrophy, or external pressure. This can lead to reduced blood flow, ischemia, and pain in the buttock region, along with potential vascular complications.

Symptoms of Deep Gluteal Syndrome

The symptoms of DGS can significantly impact an individual’s daily activities and quality of life. Here are the common symptoms associated with DGS:

– Persistent Buttock Pain

One of the hallmark symptoms of DGS is persistent pain in the buttock region. This pain is often described as dull, aching, or stabbing and may be present on one or both sides of the buttocks. It can be exacerbated by activities such as sitting, walking, running, or climbing stairs.

– Radiating Pain Down the Leg

Many individuals with DGS experience radiating pain that travels down the back of the leg, resembling symptoms of sciatica. This pain can extend from the buttock area into the thigh, calf, or even the foot. It may be accompanied by sensations of numbness, tingling, or burning along the pathway of the sciatic nerve.

– Numbness and Tingling

DGS can cause sensations of numbness and tingling in the buttock, thigh, or leg. These abnormal sensations may occur intermittently or persistently and can be accompanied by a feeling of pins and needles or a loss of sensation in the affected area.

– Hip Discomfort

Individuals with DGS may experience discomfort or pain in the hip joint, particularly during movements that involve bending, extending, or rotating the hip. This discomfort may be felt deep within the hip or on the outer surface and can be aggravated by activities such as sitting for prolonged periods or performing repetitive movements.

– Limited Range of Motion

DGS can lead to a decreased range of motion in the hip joint, making it difficult to perform certain movements or activities. This limitation may manifest as stiffness, tightness, or difficulty bending, squatting, or rotating the hip. Individuals may also experience a sensation of “locking” or “catching” in the hip joint during movement.

– Discomfort While Sitting or Walking

Many individuals with DGS experience increased pain or discomfort while sitting for extended periods or engaging in activities that involve walking or weight-bearing on the affected leg. This discomfort may be localised to the buttock area or radiate down the leg, making it challenging to maintain normal daily activities.

Sometimes, walking for long may reduce the pain! 

Diagnosis of Deep Gluteal Syndrome

Accurate diagnosis of DGS requires a comprehensive evaluation by a healthcare professional. The diagnostic process typically involves:

• Medical History: Assessing symptoms, past injuries, and treatments.
• Physical Examination: Palpating tender points, testing range of motion, and assessing nerve function.
• Imaging Studies: MRI or CT scans to visualize anatomical structures.
• Diagnostic Injections: Injecting medication to alleviate symptoms and confirm diagnosis.

How do I Treat Deep Gluteal Syndrome?

The treatment of deep gluteal syndrome aims to alleviate symptoms and address the underlying cause of the condition. Here’s an overview of treatment options:

A. Conservative Management

• Physiotherapy: Targeted exercises to strengthen your gluteal muscles, improve flexibility, and correct movement patterns can help alleviate symptoms and prevent recurrence.
• Activity Modification: Avoiding activities that exacerbate symptoms, such as prolonged sitting or repetitive movements, can help reduce pain and discomfort.
• Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs), muscle relaxants, or nerve-pain medications may be prescribed to manage pain and inflammation.

B. Lifestyle Modifications

• Ergonomic Adjustments: Making ergonomic adjustments to workstations and seating arrangements can help reduce pressure on the buttock area and alleviate symptoms during prolonged sitting.
• Regular Exercise: Engaging in low-impact exercises such as swimming, cycling, or walking can help maintain overall fitness and improve circulation without exacerbating symptoms.

Deep gluteal syndrome can significantly impact quality of life, but with proper understanding and management, you can find relief from symptoms and regain mobility. Consultation with a Physiotherapist is essential for accurate diagnosis and personalised treatment planning tailored to your needs and preferences. Contact us today to get the appropriate treatment for conditions related to DGS.

DISCLAIMER: This information should not replace the need for a consultation with our Physiotherapist especially if your condition doesn’t improve. Therapeutic exercise should be carefully selected to suit your condition.