Buttocks

At Walker and Hall we know how painful pain in the buttocks can be and how it can affect every aspect of your life e.g., sitting, standing, walking, driving, working and sports and leisure activities.

It is an area that people frequently have problems with and the most common types of conditions we treat are

Hamstring strain
Piriformis syndrome
Gluteal muscle strain
Referred pain

If your condition is not listed above please contact us

We have extensive experience in treating these conditions and managing your recovery.

To see how Walker and Hall can help you please see below:

Hamstring Strain (also known as Hamstring Tear, Strained Hamstring, Torn Hamstring Muscle, Pulled Hamstring)

This is one of the most common muscle injuries we treat at Walker and Hall and is characterised by a partial or complete tearing of one or more of the hamstring muscles located at the back of the thigh.

Fortunately hamstring strains respond well to the appropriate physiotherapy treatment.

Anatomy

The hamstrings are a group of 3 muscles located at the back of the thigh and are called:

  • biceps femoris
  • semimembranosus
  • semitendinosus

They attach to the pelvis and insert into the top of the lower leg bones. They are responsible for bending the knee and straightening the hip during activities such as running, jumping and kicking.

During contraction of the hamstrings, tension is placed through the muscles. If this tension is excessive due to too much repetition or too high a force, one or more of the hamstring muscles can tear. This is known as a hamstring strain.

Tears to the hamstring muscles can range from a small partial tear where there is minimal pain and minimal loss of function, to a complete rupture which may require surgery. Like all muscle strains, hamstring strains range from a grade 1 to grade 3 and are classified as follows:

  • Grade 1: a small number of fibres are torn resulting in some pain, but allowing full function.
  • Grade 2: a significant number of fibres are torn with moderate loss of function.
  • Grade 3: all muscle fibres are ruptured resulting in major loss of function.

The majority of hamstrings strains we treat at Walker and Hall are grade 2.

Causes of a hamstring strain

Sudden contraction of the hamstring muscles – this is a common cause of a hamstring strain and mainly occurs when the muscles are in a position of stretch – such as rapid acceleration whilst running or when kicking a long ball in football. They are also seen in sports such as running, hockey and athletics e.g., sprinters, hurdlers and long jumpers.
They tend to occur more frequently in older athletes and particularly following an inadequate warm-up

Whilst these are the main causes of a hamstring muscle strain, other factors may predispose you to developing the condition, viz.

  • muscle weakness (particularly the hamstrings or gluteals)
  • muscle tightness (particularly the hamstrings, quadriceps and hip flexor muscles)
  • inadequate conditioning of the hamstring muscles
  • inappropriate training or technique
  • excessive training or activity
  • inadequate recovery periods from sport or activity
  • poor posture
  • decreased fitness
  • fatigue
  • inadequate warm up
  • joint stiffness (particularly the lower back, hip and knee)
  • poor core stability
  • inadequate rehabilitation following a previous hamstring strain
  • neural tightness
  • muscle imbalances

Signs and symptoms of a hamstring strain

  • Pain – you will often feel a sudden sharp pain or pulling sensation in the back of the thigh during the aggravating activity. In minor cases, you may be able to continue the activity only to have an increase in symptoms upon resting later that night or on waking the following morning. In more severe cases, you may be unable to continue the activity and may limp or be unable to walk off the playing field. You may experience an increase in pain during activities which place tension on the hamstring muscles such as walking, especially uphill, going up and down stairs, running, jumping, kicking and performing a hamstring stretch. It is also common to experience pain and stiffness after the aggravating activity with rest and on waking the next morning
  • Swelling, muscle spasm, weakness, pain on firm palpation of the muscle and bruising in the back of the thigh

There are a number of factors which can predispose you to a hamstring strain, a few of which are

  • muscle weakness (particularly the hamstrings or gluteals)
  • muscle tightness (particularly the hamstrings, quadriceps and hip flexor muscles)
  • inadequate conditioning of the hamstring muscles
  • inappropriate training or technique
  • excessive training or activity
  • inadequate recovery periods from sport or activity
  • poor biomechanics
  • poor posture
  • decreased fitness
  • fatigue
  • inadequate warm up
  • joint stiffness (particularly the lower back, hip and knee)
  • poor core stability
  • inadequate rehabilitation following a previous hamstring strain
  • neural tightness
  • muscle imbalances

How Walker and Hall can help you

A thorough musculoskeletal examination is required to determine the extent of the hamstring muscle strain. This is essential if the optimum recovery is to be achieved.

Following the diagnosis a treatment plan is devised and discussed with you.

The types of physiotherapy treatment used at Walker and Hall for a hamstring muscle strain are:

  • R-I-C-E – For the first 48 to 72 hours the standard soft tissue treatment of R-I-C-E is used. This involves Resting from aggravating activities, the regular use of Ice, the use of Compression and Elevation
  • Pain relieving techniques – electrical therapy e.g., ultrasound and interferential therapy and soft tissue massage to reduce pain and muscle spasm
  • Hip and lumbar spine mobilising techniques e.g., gentle stretching and muscle release techniques
  • Sciatic nerve mobilising techniques e.g., gentle stretching and muscle release techniques
  • Home exercise programme – a graduated strength, flexibility, core stability and balance programme to ensure an optimal outcome
  • Anti-inflammatory advice. Anti-inflammatory medication may also significantly hasten the healing process by reducing the pain and swelling associated with inflammation. To check whether you are able to tolerate non-steroidal anti-inflammatory medication (NSAID) contact your General Practitioner or local pharmacist

Piriformis Syndrome (also known as Piriformis Muscle Syndrome, Piriformis Dysfunction, Piriformis Impingement, Piriformis Muscle Strain)

At Walker and Hall we know through personal experience how painful and disabling Piriformis syndrome can be. It can affect all aspects of your life from caring for your family, sleeping, sitting, climbing stairs, driving and working to leisure activities such as sport and gardening.

Fortunately Piriformis syndrome responds well to the appropriate physiotherapy treatment.

Anatomy

The piriformis muscle lies deep within the buttock originating from the tail bone (sacrum) and attaching to the thigh bone (femur), and is responsible for rotating and stabilizing the hip joint. The sciatic nerve passes directly beneath or occasionally through the piriformis muscle. Due to this anatomic relationship, the sciatic nerve can be compressed due to tightness in the piriformis muscle or following a piriformis strain. When this occurs the condition is known as piriformis syndrome.

Causes of piriformis syndrome

  • Tightness of the piriformis muscle – this may be due to injury, overuse of the muscle, injury to the lumbar spine or due to repetitive strain or trauma. Piriformis syndrome is more common in sports or activities requiring repeated use of the piriformis muscle e.g., running, especially changing direction, sprinting, jumping, squatting and lunging

There are a number of factors which can predispose you to developing Piriformis syndrome and a few of these are

  • muscle tightness (particularly the piriformis and adductor muscles)
  • joint stiffness (particularly the hip, lower back, sacroiliac joints or pelvic joints)
  • muscle weakness (particularly the piriformis and gluteals)
  • lower back injury
  • poor posture
  • excessive or inappropriate training
  • poor biomechanics
  • inadequate warm up
  • poor pelvic or core stability
  • muscle imbalances

Signs and symptoms of piriformis syndrome

  • Pain – usually felt deep within the buttock. It may also radiate into the back of the thigh, calf, ankle or foot. You may experience an increase in pain when the piriformis muscle is stretched – such as taking your knee towards your opposite shoulder or during forceful muscle contraction – such as when running and changing directions. Other activities which may aggravate the pain include sitting, climbing stairs, squatting and lunging
  • Reduced range of hip movements
  • Tenderness on firm palpation of the piriformis muscle

How Walker and Hall can help you

A thorough musculoskeletal examination is required to determine the cause and extent of the muscle strain. This is essential if the optimum recovery is to be achieved.

Following the diagnosis a treatment plan is devised and discussed with you.

The types of physiotherapy treatment used at Walker and Hall for piriformis syndrome are:

  • R-I-C-E – For the first 48 to 72 hours the standard soft tissue treatment of R-I-C-E is used. This involves Resting from aggravating activities, the regular use of Ice, the use of Compression and Elevation
  • Pain relieving techniques – electrical therapy e.g., ultrasound and interferential therapy and soft tissue massage to reduce pain and muscle spasm
  • Hip and lumbar spine mobilising techniques e.g., gentle stretching and muscle release techniques
  • Sciatic nerve mobilising techniques e.g., gentle stretching and muscle release techniques
  • Home exercise programme – a graduated strength, flexibility, core stability and balance programme to ensure an optimal outcome
  • Anti-inflammatory advice. Anti-inflammatory medication may also significantly hasten the healing process by reducing the pain and swelling associated with inflammation. To check whether you are able to tolerate non-steroidal anti-inflammatory medication (NSAID) contact your General Practitioner or local pharmacist

Gluteal Strain (also known as Gluteal Tear, Buttock Strain, Torn Gluteal Muscle)

A gluteal strain is a condition characterized by tearing of one or more of the gluteal (buttock) muscles.

Anatomy

The gluteal muscles are situated at the back of the pelvis and form the buttocks. They comprise 3 individual muscles called

  • Gluteus Maximus
  • Gluteus Medius
  • Gluteus Minimus

They attach to the pelvis and insert into the top of the thigh bone (femur). They are primarily responsible for straightening the hip during activity, stabilizing the pelvis and assisting with outer movements of the hip, e.g., taking the leg to the side and changing direction when running. They are particularly active during running, jumping, squatting and lunging. During contraction of the gluteals, tension is placed through the muscles. When this tension is excessive due to too much repetition or high force, one or more of the gluteal muscles may tear. This condition is known as a gluteal strain.

Tears to the gluteal muscles can range from a small partial tear where there is minimal pain and minimal loss of function, to a complete rupture. As with all muscle tears, gluteal strains range from a grade 1 to a grade 3 tear and are classified as:

  • Grade 1 – a small number of fibres are torn resulting in some pain, but allowing full function
  • Grade 2 – significant number of fibres are torn with moderate loss of function
  • Grade 3 – all muscle fibres are ruptured resulting in major loss of function

The majority of gluteal strains seen at Walker and Hall are grade 2 tears.

Causes of a gluteal strain

  • Sudden muscular contraction – this usually occurs when the muscles are in a position of stretch and may be associated with sudden / rapid acceleration e.g., running, especially up hill, when performing an explosive jump and when lifting excessive weight e.g., lunges in a gym. Gluteal strains are occasionally seen in running and jumping sports such as football, basketball, soccer, rugby, and athletics e.g., sprinters, hurdlers and long jumpers, and during weight training. Gluteal strains tend to occur more commonly in the older athlete and particularly following an inadequate warm-up.

Signs and symptoms of a gluteal strain

  • Pain – sudden onset of sharp pain or pulling sensation in the buttock region during the provocative activity. In minor cases, you may be able to continue the activity only to have an increase in symptoms when cooling down. However in more severe cases you may be unable to continue the activity and may limp or be unable to walk off the playing field.

The pain usually increases during activities which place a load on the gluteal muscles, e.g., walking, especially uphill, going up and down stairs, running, jumping, squatting, lunging, sitting or when firmly contracting the gluteal muscles – squeezing the buttocks together. It is also common to experience pain and stiffness after the aggravating activity with rest, especially when waking the next morning. The pain may also increase when firmly touching the affected muscle and when performing a gluteal stretch

  • Swelling, muscle spasm, weakness and bruising in the gluteal region

Whilst these are the main causes of a gluteal muscle strain, other factors may predispose you to developing the condition, viz.

  • muscle tightness (particularly the gluteal and hip flexor muscles)
  • inadequate conditioning of the gluteal muscles
  • muscle weakness (particularly the gluteals and hamstrings)
  • inappropriate or excessive training or activity
  • inadequate recovery periods from sport or activity
  • poor running technique
  • poor biomechanics
  • poor posture
  • inadequate fitness
  • fatigue
  • inadequate warm up
  • joint stiffness (particularly the lower back or hip)
  • poor core stability
  • inadequate rehabilitation following a previous gluteal or lower back injury
  • neural tightness
  • muscle imbalances

How Walker and Hall can help you

A thorough musculoskeletal examination is required to determine the extent of the gluteal muscle strain. This is essential if the optimum recovery is to be achieved.

Following the diagnosis a treatment plan is devised and discussed with you.

The types of physiotherapy treatment used at Walker and Hall for a gluteal muscle strain are:

  • R-I-C-E – For the first 48 to 72 hours the standard soft tissue treatment of R-I-C-E is used. This involves Resting from aggravating activities, the regular use of Ice, the use of a Compression bandage and Elevation
  • Pain relieving techniques, electrical therapy e.g., ultrasound and interferential therapy and soft tissue massage to reduce pain and muscle spasm
  • Hip mobilising techniques e.g., gentle stretching and muscle release techniques.
  • Home exercise programme – a graduated strength, flexibility, core stability and balance programme to ensure an optimal outcome.
  • Anti-inflammatory advice. Anti-inflammatory medication may also significantly hasten the healing process by reducing the pain and swelling associated with inflammation. To check whether you are able to tolerate non-steroidal anti-inflammatory medication (NSAID) contact your General Practitioner or local pharmacist

Referred Pain

Not all buttock pain is necessarily coming from the buttocks. Occasionally the pain can be referred or caused by a problem in another area of the body such as the back or spine. This is called referred pain.

What is Referred Pain?

Referred pain occurs when pain is experienced in an area away from the actual injury or problem. This is not uncommon, an example being sciatica, where pain is felt down the leg whilst the problem is in the back, or a heart attack, where the pain is felt in the shoulder, arms and neck.

What structures can refer pain into the buttocks?

The main source of referred pain into the buttocks is the lumbar and sacral spines (from the 1st lumbar vertebra to the 5th sacral vertebra – L1 to S5). Any problems affecting the intervertebral discs, ligaments, nerves and muscles of this area of the spine can mimic a buttock problem.

How can Walker and Hall help you distinguish between a buttocks problem and referred pain?

At Walker and Hall you will receive a thorough musculoskeletal examination which will examine all the structures that could possibly be responsible for the buttock symptoms.

It is only following such an accurate examination and diagnosis that a treatment plan can be devised to address your problems.

You will be involved in all stages of your treatment given every opportunity to ask questions.