LEAP

Persistent buttock pain- its probably not sciatica.

A PAIN IN THE BUTT

The most common cause of persisting deep buttock pain or lateral (on the outside) hip pain is not sciatica, but caused by tendinopathy of the gluteal tendons: usually Gluteus Medius and Gluteus Minimus tendons. It’s also often misdiagnosed as bursitis, and treated (ineffectively) with cortisone or other injections.

This very common condition, also called greater trochanteric pain syndrome, is irritated by lying on either side at night. This puts pressure on those tendons between the greater trochanter ( ateral hip bone) and the bed surface when lying on the painful side, or pressure from the position of the top thigh as it crosses the midline when lying on the good side. It’s also made worse by sitting too low and getting up from sitting, crossing the legs, walking up hills and when climbing stairs. Lunges and Clam exercises can aggravate it. It can get so bad as to disturb sleep, create a painful limp and prevent walking & exercise altogether!

Affecting women much more than men, one study from Scandinavia (1) showed one in four women have got underlying Gluteal Tendinopathy, often becoming symptomatic with a spike in load. An event like overseas travel, extra walking or new impact exercise can trigger it, especially if the gluteal muscles (the buttocks) have weakened. This is so common, can last for years and its a pain in the butt !! However unlike sciatica, the pain will usually not refer below the knee or cause any nerve symptoms like tingling or numbness.

The good news is that clinical research (2) proves the right exercise program and advice on sitting and sleeping posture can resolve the pain and prevent it becoming chronic. Clifton Hill Physiotherapy / CHPR Physios Dr Henry Wajswelner and Dr Sallie Cowan were involved as treating physiotherapists in a landmark study called the LEAP trial, published in the British Medical Journal in 2018, that proved a physiotherapy program was the most effective form of management both in the short and long term. Education on the right ways to sit, stand, lie at night and move to minimise tendon compression is a key early component of the physiotherapy treatment program. Then a very gradual build-up of the right type of exercises to restore the gluteal, thigh and trunk muscles is the main form of longer-term management.

If you have persisting buttock/ lateral hip pain that is not responding: you probably have gluteal tendinopathy !!! Make an appointment with one of our physios to be assessed and get the right advice and exercises so you can get rid of this annoying pain in the butt!!

 

Clinical Research Studies mentioned in this blog :

  1. Segal NA, et al (2007) Greater trochanteric pain syndrome: Epidemiology and associated factors. Archives of Physical Medicine and Rehabilitation 88:988-992.
  2. Mellor R, Bennell K Grimaldi A, Hodges P, Kaszka J, Nicolson P, Wajswelner H, Vicenzino B (2018) Effects of education plus exercise versus corticosteroid injection versus no treatment on patient rated global outcome and pain among patients with gluteal tendinopathy: a randomized clinical trial ( LEAP trial ). British Medical Journal; 361:k1662