“Pain in the Butt” Syndrome


“Pain in the Butt” Syndrome is my own creation to describe a condition I have seen in several runners and more commonly in ladies. Some books may have described this as “Piriformis” syndrome; however, specific muscle testing of the piriformis is rarely painful. The pain is deeper in the lower portion of the butt and it can be somewhat difficult to locate the exact spot. The location of the pain may even change slightly. Symptoms usually beginning with increasing mileage and can hurt when driving or sitting.Several muscles groups converge in this area – the hamstrings are pulling longitudinally to prevent the trunk from bending too far forward and the deep gluteal muscles are pulling transversely to control rotational forces. My theory is that these symptoms are a result of a muscular imbalance in the region.


It is important to differentiate this from lower back symptoms. Many conditions in the lower back can cause pain in this area. If you have any discomfort in your lower back (lay on your stomach and have a friend press on each vertebra to check) or your butt symptoms are aggravated by bending your spine to the left or right, then see Lower Back Pain first. This condition is also similar to hamstring tenndonitis except that with hamstring tendonitis you can distinctly find the pain by pushing on the boney bump you sit on or just below it.



  • See Principles of Recovery.
  • Consistent stretching can make a big difference. Focus on gluteal, hamstring and lower back stretches. Try to vary the stretches until you can find a stretch that gently stretches the painful spot. Try to spend at least five minutes twice per day, after an exercise session is particularly beneficial.
  • Core Strengthening – try the Plank X 4 for a quick, all around program. Hold each position for twenty to sixty seconds. These are even good enough for women’s marathon record holder Paula Radcliffe who was photographed performing the side position. Don’t stop with just the Plank 4’s, work in some extra abdominal exercises.
  • Multi directional training – sidestepping, grapevine, and stepping forward and backward while moving sideways are excellent warm-up drills. Try three sets of one minute.
  • Balanced Solution DVDSingle leg stand windmill touches are the best exercise I have found for this condition – while standing on one leg, bend forward at the hip, bend forward at the hip keeping your other leg in a straight line with your back, keep your arms out to the side and rotate your trunk to touch the toes – alternate arms. This exercise is excellent for balance, hamstring strengthening and flexibility. It is presented in greater detail in The Injured Runner – A Balanced Solution.
  • Arch supports or orthotics (custom foot supports) may help reduce rotational forces at the hip if your foot / knee rolls inward excessively as you run.
  • Leg length differences may affect this condition. Have a friend observe your pelvis to see if one side is higher than another. A physical therapist or chiropractor can also help you with this. If there is a difference in length try putting an arch support in the shoe of the shorter leg.