Watching Michael Phelps and other American athletes go for the gold in China is causing many people to spend hours on their couches glued to their TVs. Often this makes us non-Olympians feel bad about not working out or exercising enough. Sometimes, however, being in a seated position for that long can cause real pain in susceptible individuals.
Buttock pain can be persistent and annoying. Many patients with buttock pain are told that it is a muscle strain or that they are “out of alignment”. Despite rest, medication, and treatments, the pain persists.
For active individuals, exercise can worsen the pain and lead to early fatigue while exercising. Most people have discomfort while sitting for long periods of time either at work or while driving. Remedies such as new chairs and shifting weight from the affected side are not always effective. So what is going on?
“Your buttock pain may actually be coming from your back”, says Dr. Peter Moley, a specialist in musculoskeletal disorders from the Hospital for Special Surgery in New York City. Back pain is the second most common reason for emergency room visits. Dr. Moley explains that “up to 80% of Americans will suffer from some back pain during their lives. Often patients will have had an episode of low back pain that has resolved, but the buttock pain persists”. All the stretching and massage in the world do not seem to help. What causes this pain?
The sciatic nerve is a grouping of many nerves exiting from the lumbar and sacral spine. Classically, “sciatica” is described as a pain that shoots from the low back down the back of the thigh to the knee. Many people have had one or more incidents of “sciatica”. The pain of “sciatica” can be very disabling. Dr. Moley adds that “most people will not associate a nagging persistent pain with what they remember from their previous episodes of severe low back pain. That is where a medical spine specialist comes into the equation.”
The nerves that make up the sciatic nerve also innervate the muscles of the buttocks. When a nerve is compressed or irritated, the muscles it innervates can also become irritated or weak. Sitting or exercising may be causing nerve root irritation. Dr. Moley further explains that although buttock pain is the symptom, physicians often find during a physical exam that many patients have other muscles in the leg that are involved.
The positive side of this problem is that there are effective treatments. Dr. Moley states that “the diagnosis is the hardest part of buttock pain.” The patient must undergo a very good musculoskeletal physical exam. In addition studies like MRIs and electrodiagnostic can be very helpful in determining the problem.
Once diagnosed, patients can often be treated with physical therapy alone. Adjuncts to the physical therapy would include steroid injections around the nerve and oral medications. Success rates in the properly diagnosed and treated patients are good. It is important to note that a problem that has persisted for months will not go away in a day.
What should a patient do for persistent buttock pain? Evaluation by a medical spine specialist is the best course of action. Whatever is causing the irritation will not get better with neglect. Exercise that is not properly supervised can also be harmful in some patients. Dr. Moley states, “This is not a problem to sit on. See a medical spine specialist sooner rather than later.”