A Patient's Guide to Deep Gluteal Syndrome

The sciatic nerve originates in the base of your spine and travels through your buttock into the back of the leg. It can sometimes be irritated or compressed as it runs through the muscles and soft tissues of the buttock. The term deep gluteal syndrome has been suggested to include all causes of irritation of the sciatic nerve in the buttock.

The nerve may be compressed or irritated as it runs under or between the deeper buttock muscles or through the tunnel formed by the outer side of the sitting bone and thigh bone.

The basic anatomy of the deep gluteal space:

Anywhere through the buttock, muscles and soft tissues may apply more pressure on the nerve. This may cause restricted movement of the nerve or effect the normal healthy blood flow to the nerve. This sometimes develops after trauma such as a fall onto the buttock or due to inflammation related to muscle or tendon injury or overuse.

Patterns in the way you move or habits of maintaining certain postures (e.g. pattern of walking, running or standing) that cause reduced space for the nerve to travel through the buttock may also contribute to symptoms.

Deep gluteal syndrome will often present as deep buttock pain, which may extend into the back of the thigh. In some cases, you may experience pain further into the lower leg and foot or even tingling sensations or numbness in the leg, which may feel similar to sciatica.

Pain is usually aggravated in positions where the hip is in a more flexed position such as in sitting, particularly when the knee is higher than your hip. Driving may therefore aggravate your symptoms.

You may experience pain with activities that cause strong activation of the deep buttock muscles such as walking, running uphill, climbing stairs or doing exercises that target the buttock muscles.

In more severe cases, you may start walking with a limp.

In most cases, your doctor or physiotherapist will diagnose deep gluteal syndrome from your symptoms and a number of tests when examining your hip. Imaging such as MRI may be used to gain more information but is not always necessary.

Recent evidence suggests that the first line management for deep gluteal syndrome is:

Education, exercise and modification of activities.

Education: Understanding what the problem is and the positions and activities that are likely to irritate the sciatic nerve, can help in controlling the symptoms of deep gluteal syndrome.

Activity modification: Reducing sitting time and using a cushion when sitting on hard surfaces may be useful. It may also help to avoid putting your wallet or items in your back pocket when sitting, which may contribute to increased pressure on the buttock and soft tissues.

Exercise: Exercise may be used to help reduce symptoms and function in the following ways:

• Improving movement and blood flow to the nerve.

• Improving the health of the muscles and tendons in the buttock.

• Improving control of the pelvis during activities such as standing and walking to allow adequate space for the sciatic nerve.

Your therapist can you give you specific advice and exercises tailored to your needs

Pacing your activities: Try to break your activities into smaller, more manageable chunks and taking regular rest breaks in between as needed.

Walking aids: Walking aids may be useful to improve walking pattern and therefore reduce compression on the sciatic nerve. They can also be helpful to manage your pain in the short term and allow you to walk more with less pain.

Other options that can help in the management of your symptoms include:

Medications: Some medications to calm nerve irritation may be prescribed by your doctor to help control pain, maintain activity levels and assist with sleep.

Injections: Your doctor may suggest an injection to assist with diagnosis and/or pain relief. Injecting local anaesthetic around the sciatic nerve in the buttock may, if the pain is relieved, assist in determining if this is the problem area. A corticosteroid injection may be used to reduce inflammation and pain associated with nerve irritation. Sometimes botox injections are used to reduce muscle activity.

Manual therapy: In some cases, techniques by your physiotherapist can be useful to temporarily reduce tension in the muscles of the buttock. Exercise provided by your physiotherapist will also be required together with this treatment in order to achieve long- term changes.

Surgery: The first line treatment for deep gluteal syndrome is non-operative management, however, if your symptoms do not improve with these measures your surgeon may discuss if surgery is appropriate for you

Byrd, J. (2015). Disorders of the Peritrochanteric and Deep Gluteal Space. Sports Medicine and Arthroscopy Review, 23(4), pp.221-231.

Hu, Yao-Wen Eliot MD, MBA, FAAFP, RMSK1,2,3; Ho, Garry W.K. MD, FACSM, FAAFP, RMSK4,5,6,7,8; Tortland, Paul D. DO, FAOASM, RMSK9,10,11. Deep Gluteal Syndrome: A Pain in the Buttock. Current Sports Medicine Reports 20(6):p 279-285, June 2021. | DOI: 10.1249/JSR.0000000000000848

Martin HD, Reddy M, Gómez-Hoyos J. Deep gluteal syndrome. J Hip Preserv Surg. 2015 Jul;2(2):99-107. doi: 10.1093/jhps/hnv029. Epub 2015 Jun 6. PMID: 27011826; PMCID: PMC4718497