Deep Pain Gluteal Syndrome ‘Piriformis Syndrome’: A pain in the butt!
With an abundance of vascular, neural and muscular structures, the deep buttock area can be a complicated area. With limited and rapidly changing research on this condition, this article addresses the symptoms, causes and treatment for Deep Pain Gluteal Syndrome.
What is Deep Pain Gluteal Syndrome?
This condition is defined as pain or numbness in the deep buttock or posterior thigh area, which can manifest into referred sciatic nerve distribution. The causes of this condition are not related to discogenic factors within the lumbar spine, but are however due to entrapment of the sciatic nerve within the gluteal space. If you have ever suffered from deep hip pain, you may have heard of the term ‘piriformis syndrome’ which was once thought to be largely responsible for the entrapment of the sciatic nerve. Since then, there has been progress in our understanding of the gluteal space anatomy, which has assisted in identifying varying sites of sciatic nerve entrapment, resulting in our beliefs of Deep pain Gluteal Syndrome to change.
What are the signs and symptoms of Deep Pain Gluteal Syndrome?
It is important to note that every individual is different and may present with varying symptoms, however the most common reported symptoms of Deep Pain Gluteal Syndrome are:
- Deep hip or buttock pain
- Intolerance to sitting more than 20-30mins
- Tenderness, tingling or burning sensation in the centre of the buttock
- Night pain that improves during the day
- Lower back pain
- Pain when rotating the hip inwards or outwards
- Loss of sensation and/or muscle weakness
Whilst this condition affects less than 1% of the population, the direct cause of Deep pain Gluteal Syndrome is multifactorial and unknown. Several risk factors have been shown to increase the likelihood of developing this condition:
- Females commonly over 40 years old
- Sedentary individuals
- A fall
- Acute injury or trauma to the area
- Sedentary individuals
- Weakness/imbalance within the hip
- Anatomical variations
How is Deep Pain Gluteal Syndrome Diagnosed?
The diagnosis of Deep Pain Gluteal Syndrome requires a comprehensive evaluation of subjective history and physical examination. Your musculoskeletal physiotherapist will want to know important information such as your past medical history, aggravating/easing factors and any other information relating to your injury. Your physiotherapist will then perform a series of special tests as part of your assessment, this will assist in ruling out other potential structures and facilitate an accurate diagnosis. While not usually required, in unusual presentations, your physiotherapist may send you for necessary imaging like an MRI to establish a definitive cause of your pain. Following your assessment, your physiotherapist will arrange regular follow-up appointments to provide and tailor your treatment plan accordingly, which will ensure you continue to make progress.
How can Deep Gluteal Pain Syndrome be treated?
Physiotherapy is the front line treatment for Deep Pain Gluteal Syndrome. Your physiotherapist will develop a personalised exercise programme consisting of both stretching and strengthening. Manual techniques such a massage and trigger point therapy performed by your physiotherapist can assist in alleviating tension in the surrounding tissues to better manage your pain. Other modalities such as acupuncture can further provide relief from pain and promote healing. In cases where physiotherapy hasn’t worked, other intrusive treatment options such as steroid injections may be considered at an appropriate time.
How can I self-manage Deep pain Gluteal Syndrome at home?
Identifying the contributing factors that make your pain worse will be crucial in promoting long-term recovery and prevention. Whilst your physiotherapist will be on hand to help formulate and effective treatment plan some simple management strategies that may help include:
- avoiding prolonged sitting
- Sleeping with a pillow in between your legs or sitting on a cushion
- Reaching out to your GP for certain medications that can assist in the management of your pain
- Staying consistent with your exercise programme
- Heat packs/warm baths to promote blood flow and muscle relaxation
- Yoga/Pilates
- Maintaining a healthy active lifestyle
The recovery for individuals with Deep Pain Gluteal Syndrome varies depending on treatment effectiveness, the severity of the condition, the requirements of the person and the individuals commitment to their rehabilitation programme. With timely intervention, and support from your physiotherapist, many individuals see significant improvement to their function, pain and overall quality of life.
References
https://fyra.io (n.d.). From Piriformis Syndrome to Deep Gluteal Syndrome. [online] Practical Neurology. Available at: https://practicalneurology.com/articles/2018-sept/from-piriformis-syndrome-to-deep-gluteal-syndrome.
Hopayian, K. and Heathcote, J. (2019). Deep gluteal syndrome: an overlooked cause of sciatica. British Journal of General Practice, 69(687), pp.485–486. doi:https://doi.org/10.3399/bjgp19x705653.
Hu, Y.-W.E., Ho, G.W.K. and Tortland, P.D. (2021). Deep Gluteal Syndrome: A Pain in the Buttock. Current Sports Medicine Reports, 20(6), pp.279–285. doi:https://doi.org/10.1249/jsr.0000000000000848.
Martin, H.D., Reddy, M. and Gomez-Hoyos, J. (2015). Deep gluteal syndrome. Journal of Hip Preservation Surgery, [online] 2(2), pp.99–107. doi:https://doi.org/10.1093/jhps/hnv029
Pure Physiotherapy. (n.d.). Deep Gluteal/Piriformis Syndrome – MSK Condition. [online] Available at: https://purephysiotherapy.co.uk/conditions/piriformis-syndrome/.
This article was written by Jason Needham
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