Ten Things to Know About Butt Pain

That agony in your butt–it’s not just any pain; it can be sharp, electric, and stabbing, and it can be accompanied by numbness and tingling.  If you’ve ever experienced sciatic pain, you’re on first name terms with the kind of pain that starts in your butt and travels down the back or side of your leg. It may keep you up nights, bench you completely, and make you feel like yuo’re 100 years old.

My brush with butt pain happened about three days into a week long kayaking trip in the middle of nowhere.  I woke up one morning and tried to walk down to the beach to wash my face, but my leg, or more accurately, my butt wouldn’t cooperate.  I could walk, but just barely, because a nagging pain on the right side of my low back and butt was causing my leg to fold up like a card table.

I managed to get through the kayaking trip—surprisingly; I was able to paddle without much pain, but once I got out of my kayak, I was pretty well hobbled.  It wasn’t until a week or two later that I learned that I had something called Piriformis syndrome. 

Since then, I have made it my business to know as much as possible about sciatic nerve pain.  If you suffer from this kind of pain, here are some things you should know:

  1. Not all pain that begins in your butt and radiates down your leg is sciatica.  True sciatica is due pressure on your sciatic nerve from compressed lumbar disks, trauma, or degeneration in your lower back.
  2. Piriformis syndrome often feels just like sciatica, but the cause is from a spasm in the Piriformis muscle.  Your Piriformis is a core stabilizing muscle that runs deep from your sacrum (at the base of your spine) to your hip (the bone on the outside top of your thigh.)  Your sciatic nerve runs under, and for some people, through the Piriformis muscle.  When your Piriformis is injured, it can compress the sciatic nerve where it passes through the pelvis.  Beyond pain deep in your butt, Piriformis syndrome usually causes pain that radiates down the back or side of your leg, and can travel through your knee and into your foot.  The pain can be achy and dull, sharp, nagging, and even cause numbness and tingling.
  3. It can be tough to tell the difference between true sciatica and Piriformis syndrome, because the symptoms tend to mimic each other, but there are a few clues.  With sciatica, you will usually have pain radiating all the way into your lower leg and foot, but with Piriformis syndrome, the pain often radiates only as far as your knee.  Areas of complete numbness along the pathway of the nerve indicate sciatica.  Also, Piriformis syndrome is associated with some very tender trigger points in your butt.  For a definitive diagnosis, your doc will need to rule in or out disk problems as the source of your pain.
  4. Overuse is a common cause of Piriformis syndrome, and it can be a common injury that sidelines athletes.  Prolonged sitting and trauma can also aggravate the Piriformis muscle, causing it to swell or go into spasms, which causes the sciatic nerve to be pinched. 
  5. I have found in my acupuncture practice that Piriformis syndrome is frequently caused by cold.  It seems to be more prevalent in the winter or after a patient has been outdoors in the cold.  I believe that my kayaking debacle was caused by sitting in a cold, wet kayak for hours on end.  (No pun intended.)
  6. In my experience, Piriformis syndrome is far more common than true sciatica.  The good news is that I find that my patients with Piriformis syndrome respond far more quickly to treatment than those with sciatica.
  7. Treatment for butt pain in Chinese medicine would include acupuncture, heat, body work, stretching, and at home care. Acupuncture speeds healing by promoting circulation to the area of injury.  In addition, research has documented that acupuncture works by increasing the release of pain-relieving chemicals in the brain.
  8. I have found that electro acupuncture, in which the inserted needles are hooked up to a small machine that painlessly contracts or “vibrates” the muscle is especially effective in relieving pain and speeds up the healing process.  Electro acupuncture works by relaxing the muscles that are tight or in spasm.
  9. Western treatments for butt pain may include rest, physical therapy, injections of local anesthetics or steroids, and prescription medications for pain or to relax the muscles.  For difficult or chronic cases, your doctor may recommend surgery.
  10. At home treatments include heating the painful area, rolling on a tennis ball to release trigger points (points that are especially tender), and gentle stretching.  A simple stretch for the Piriformis muscle:  Sit in a chair with both feet on the floor.  To stretch the right side, place your right ankle across the top of your left knee.  Then gently lean forward until you feel the stretch in your butt. Repeat on the other side by reversing the action.

As for my own butt injury, once I was out of the wilderness, I enlisted the help of an acupuncturist to relieve my pain.  I was lucky; it took about a week before I stopped limping, and a few more before I was completely pain-free.  Combined with some daily stretching and strengthening exercises from a physical therapist, I haven’t had a recurrence.  My butt’s just fine, thank you.

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