3 Tips to Relieve the Pain in Your Butt

​No, this isn’t a blog post on how to get rid of that irritating person that causes you so much grief in your life.  This is a post about how to relieve that nagging, grating pain in your rump.  You know, that one that aches when you are sitting, working at your computer.  The one that causes a hot, poker sensation in your tush when you’re going up stairs.  Or the ache that you get when you try to increase your running mileage.  The one you just can’t ignore when you’re picking something up off the floor, standing in line at the grocery store, or trying to get comfortable so you can [finally] drift off to sleep.

​Maybe this is a familiar sensation to you.  Uh oh, another round of “sciatica” or “piriformis syndrome”.  What to do about it this time around?  Will it ever go away…for good?  Or maybe it’s a new sensation to you.  Or different than what you’ve experienced in the past.  Either way, it’s irritating….frustrating….scary… it’s interfering with your life and you want it gone!

​First, let’s talk a little about what may be happening.  You may have a classic case of sciatica or piriformis syndrome, or your pain may be caused by something else.  The sciatic nerve is actually a bundle of nerves that originate from the bottom levels of the spinal cord, exit between the lumbar vertebrae, and merge to make one large nerve which runs through the buttock muscles and down the back of each leg.  Pain in your rear can be caused by tightness in the piriformis, which is a muscle deep in your buttock.  Things other than a sciatic nerve irritation can cause buttock pain (such as arthritis in your low back or sacro-iliac joint, a herniated disk, referral from the coccxygeal area, an unbalanced pelvis, tight hip muscles, bursitis, a muscle strain, or from a more serious issue, like cancer), so it is best to have a qualified medical professional evaluate you and determine the exact cause of your pain.   If you want to try to relieve the pain on your own, but don’t get relief after 3 days of trying these tips OR if your symptoms worsen, please seek additional help.

​The piriformis, a deep gluteal muscle, is routinely blamed for pain in the backside.   It lies deep in the buttock, and runs diagonally from the tailbone to the outer hip.  Use the picture below to get a sense for where this muscle is located.

​Now let’s explore 3 ways to get some relief so you can get back to moving and sleeping without pain and immobility!

Tip #1:  Try Self-Myofascial Release.
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Press around your tush to find any tight, sore, or knotted areas.  That’s the area you’ll want to start with.  Using a small inflatable ball (4-6” diameter)  you can place the ball at or near the area of concern, and either sit or lie on top of the ball in order to relieve your pain.  Simply place the ball at or near the tender/tight spot, then soften your body over top of the ball, allowing the ball to penetrate gently into the area.  You can try using a harder ball, like a tennis ball or Lacrosse ball, but if you find yourself bracing against the ball instead of softening your body, then it’s best to use a softer ball.  Keep in mind, also, that if you try this release while lying on a soft bed versus the floor you may tolerate it better, especially when first beginning this technique.   Allow the ball to release the area for a minimum of 3 minutes, but ideally for 5 minutes or longer.  It takes 90-120 seconds for the soft tissue, called fascia, to start to release, so if you stop too soon you won’t get the intended release.  I recommend doing this type of self-release daily.  Listen to your body and if it’s telling you that something “isn’t right”, it’s okay to stop.
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Option #1: In sitting, place your ankle of the stretch side on the opposite knee, as shown.  For some people simply getting into this position is enough of a stretch.  If you can assume this position without feeling a stretch into your hip or buttock, try placing your hands on your leg and lean forward, bending forward at the hip crease.  You can increase the amount of stretch you feel by leaning more or less onto your bent leg.  Once you get into position with a minimal to moderate amount of stretch, then hold the position for 3-5 minutes.  This time frame allows a myofascial stretch, which lengthens the muscle and helps to release and elongate the fascia, which is the soft connective tissue that overlies the muscles.  Traditional stretches that only hold for 30 sec or a minute do not target the myofascial system, and leads to just a stretch of the elastic and muscular components, which makes up only 20% of the myofascial system.  To get more permanent results it is best if you hold for a full 3-5 minutes, or longer.  Repeat for the other side, if desired.

Option #2: An alternative way to stretch the piriformis is by lying on your back in a figure-four position.  Place your ankle on the opposite knee, as shown, and then reach through your legs to grasp the opposite knee.  Gently pull your knee up toward your head until a stretch is felt in the buttock and hip of the stretch leg.  To increase the stretch you can gently push your leg outward with your elbow, opening the hip further.  Hold this stretch for 3-5 minutes and repeat for the other side, if desired.  Some people have a hard time holding their leg up in this position for the full 3-5 minutes, so you can try using a towel, sheet or belt to pull the opposite knee up.  Using an aide like a belt, strap or towel can help take some tension off your arms and upper back/neck during the stretch.

Option #3: Another way to stretch the piriformis that doesn’t require as much strain to hold the position for the full 3-5 minutes is using a bed, bench, or high table.  Stand facing your bed and place the leg you want to stretch up onto the bed, with your knee and lower leg perpendicular to your body.  Make sure your back leg is pointing behind you, so your hips are pointing square ahead.  For some people this position may be enough to stretch the desired area.  To increase the stretch trying leaning forward, bending at the hips, and rest your forearms or hands on the bed, until you feel a stretch in the buttock or hip.  You can turn your hips slightly in or out to target your particular tight or tender area.  Rest here for 3-5 minutes, softening the piriformis muscle.  Repeat to opposite side, if desired.  Note: when using a bench your stance leg will be closer to the floor, so you will be resting on your knee, instead of standing.

Option #4: Lastly, you can stretch the piriformis by getting into a yoga position called Pigeon.  This is for those people who are more flexible and have good enough balance to safely get on and off the floor.  You can use a yoga mat, but it’s not necessary.  From a plank position, or from all fours, bring the knee of the leg you want to stretch up toward your head, placing the knee on the floor and then rotating your foot inward until you can feel a stretch in your hip.  Next, slowly bring your body weight down to rest on the floor.  From there, rest on your outstretched arms, elbows or hands, depending on your flexibility.  Your back leg should be stretched out behind you, with your hips squared up so that both hips are pointing forward.  You can elongate the back leg further back to stretch the hip flexors (front of hip) on that side, while you are stretching the piriformis of the bent leg.  Again, shoot for the recommended 3-5 minute hold to release the piriformis and improve the flexibility of the myofascial system.

Pick ONE of the options above and do the stretch daily until you get relief.  Again, if at any point something just doesn’t “feel right” then it’s okay to stop.   You can switch how you stretch as you get more flexible.  For instance, if you’re super tight starting out, you might start with option #1 but you may find after a while that you need to move to option #3 to feel a stretch.​

Tip #3:  Consider Physical Therapy.
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Physical Therapists are trained in evaluating the body for proper mobility, strength, flexibility, and posture, to determine the root cause of pain.  Pain can lead to immobility and an inability to complete activities of daily living (like sleeping, walking, self-care, dressing, grooming), work tasks, or recreational activities (like cycling, running, yoga, golf, hiking).  In most states you don’t even need a doctor’s referral in order to be evaluated and treated by a physical therapist. This makes it even easier to be seen and get some real solutions for your problem, so that you can recover quickly and get back to doing the things you need to do or enjoy doing. If your buttock pain is thought to be caused by something other than an orthopedic condition, your physical therapist will recommend that you see your physician for further testing.  The majority of the time tests, like XRays, MRIs or CT Scans, are NOT required in order for a physical therapist to evaluate you, guide you to recovery and give you tips on preventing a re-occurrence.
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​If you would like some help in determining the cause of your “pain in the butt” seek out a professional.  It will take the guess work out of what’s causing your pain and what you can do about it.  If this kind of pain is familiar to you and it seems to “come and go”, maybe it’s time to break the pattern once and for all.
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