What Causes Pain in the Back of the Hip and Buttock?

What causes pain in the back of the hip and buttock?

Pain in the back of the hip and buttock most often comes from the lower back, such as a pinched nerve or sciatica, or from the sacroiliac joint. Other common causes are proximal hamstring tendinopathy at the sit bone, deep gluteal syndrome, including piriformis syndrome, and less often hip arthritis. A careful exam is needed to tell them apart.

Buttock pain is the trickiest hip complaint to sort out, because the lower back, the pelvis, the hamstring and the hip joint all send pain to the same area. Many patients have been treated for one cause when the pain actually came from another. Dr. Stride checks each possible source in order, so the treatment matches the real problem and you can get back to sitting, driving and running comfortably.

Written and medically reviewed by Dr. Stride, MD, board-certified orthopedic surgeon
Last reviewed October 2026

Woman in a low lunge stretching the front of the hip

Where it hurts

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How patients describe it

Sitting on a hard chair hurts right on the sit boneA deep ache in the buttock that shoots down the back of the legDriving for more than half an hour makes the buttock burnPain sits right next to the dimple at the low backSprinting or running uphill causes a pulling pain high in the back of the thighIt hurts to roll over in bed or step up into a truck

The most common causes

Lumbar spine and sciatica

Adults 30 and older, especially those with past back pain or jobs that involve lifting or long sitting

A herniated disc, arthritis or narrowing in the lower spine can pinch a nerve root, and the pain is often felt in the buttock rather than the back. When the sciatic nerve is involved, pain travels down the back of the thigh and sometimes below the knee. This is the most common source of buttock pain in adults.

The clue: Buttock pain that shoots below the knee with numbness or tingling points to the spine.

Sacroiliac (SI) joint dysfunction

Women during and after pregnancy, people with a leg length difference, and adults after a fall onto the buttocks

The SI joints connect the base of the spine to the pelvis on each side. Irritation or inflammation, called sacroiliitis, causes pain over the dimples at the low back and into the buttock. Inflammatory conditions such as ankylosing spondylitis can also affect these joints.

The clue: Pain you can cover with one finger at the dimple beside the base of the spine is typical of the SI joint.

Proximal hamstring tendinopathy

Distance runners, sprinters, cyclists and anyone who sits for long hours

The hamstring tendons attach to the ischial tuberosity, the sit bone. Repetitive running or long sitting can irritate the tendon where it meets bone. It typically causes a deep ache right at the sit bone that is worse when sitting on firm surfaces.

The clue: Pain on the sit bone when sitting and when running uphill or lunging is the classic pattern.

Proximal hamstring tear

Water skiers, sprinters and older adults who slip into a sudden split

A forceful stretch with the hip bent and knee straight can pull the hamstring tendons off the sit bone. Large bruising often appears on the back of the thigh within a few days. Complete tears with retraction usually heal more reliably when repaired within a few weeks.

The clue: A sudden pop in the buttock during a slip or water skiing fall, followed by bruising down the thigh, needs prompt evaluation.

Deep gluteal syndrome (including piriformis syndrome)

Runners, cyclists, people who sit on a wallet or hard seat for long hours

The sciatic nerve passes through the deep buttock beneath the piriformis and other small muscles. Tight muscles, scar tissue or swollen tissue can irritate the nerve there. Symptoms resemble sciatica, though the back is usually normal.

The clue: Buttock pain with sitting that improves when standing, with a normal back exam, suggests a deep gluteal source.

Hip arthritis felt in the buttock

Adults over 50 with groin stiffness as well as buttock pain

Hip arthritis mostly causes groin pain, but some patients feel it in the buttock too. Losing the ability to rotate the hip inward is a strong sign the joint is involved. X-rays confirm it quickly.

The clue: Buttock pain with stiffness and trouble putting on socks suggests the hip joint itself.

Get seen right away if

Numbness in the groin or inner thighs, or new trouble controlling the bladder or bowels: call 911 or go to an emergency room
Weakness that is getting worse, such as foot drop or a leg that gives way
Buttock pain with fever, chills or a recent infection
A pop in the buttock with large bruising on the back of the thigh after a slip or fall
Pain at rest and at night with unexplained weight loss or a history of cancer

What to expect at your first visit

Dr. Stride examines the lower back and the hip together at every visit. He checks how the back bends, tests reflexes, strength and skin sensation in each leg, and performs a straight-leg raise and slump test to look for nerve tension. SI joint provocation tests, such as the thigh thrust and FABER, help identify the sacroiliac joint. He presses on the sit bone and tests the hamstring against resistance, then rotates the hip to see whether the joint itself reproduces the pain. X-rays of the pelvis and hips start the workup. When the picture is still unclear, an MRI of the hamstring origin or lumbar spine, or a diagnostic injection, pinpoints the source. If the spine turns out to be the main problem, our team coordinates care with a trusted spine specialist.

“Bring your outside X-rays and MRI. I’ll go through them with you, but how your hip moves on the exam table tells me just as much as the pictures.”
Dr. Stride, MD

The hip-spine connection

Could it start in your back?

Pain in the buttock that runs down the back of the thigh often starts in the lower back, not the hip. A short back exam is part of every hip visit.

Is it your hip or your back? →

Treatment options, from simplest to most involved

Step 1
Activity and sitting changes
A cushion with a cutout under the sit bones, a wallet out of the back pocket and breaks from sitting every 30 minutes can take pressure off the hamstring and the sciatic nerve.
Hip Activity & Weight Plan →
Step 2
Physical therapy
Therapy is the core treatment for hamstring tendinopathy, SI joint pain and deep gluteal syndrome. It focuses on gradual tendon loading, hip and core strength and nerve gliding exercises over 6 to 12 weeks.
Hip Physical Therapy →
Step 3
Medication for flares
A short course of an anti-inflammatory, or a nerve pain medicine for sciatic symptoms, can make sleep and therapy easier.
Hip Pain Medication →
Step 4
Diagnostic injection
An ultrasound-guided injection into the hip joint, SI joint or around the hamstring helps confirm which structure is causing the pain, and may provide relief at the same time.
Diagnostic Hip Injection →
Step 5
PRP for chronic hamstring tendinopathy
When sit bone pain persists despite several months of good rehab, PRP is an option Dr. Stride may discuss.
PRP Hip Injection →
Step 6
Hamstring repair
A complete proximal hamstring tear with retraction usually needs surgical reattachment, ideally within a few weeks of the injury.
Proximal Hamstring Repair →

What you can do at home now

Sit on a cushion and avoid hard bleachers and church pews during flares
Take the wallet out of your back pocket before driving
Get up and walk for a few minutes every 30 minutes during long drives or desk work
Avoid deep hamstring stretches in the early stages, which compress the sore tendon
Ice the buttock for 15 minutes after activity that flares it
Gentle walking is usually better than bed rest for back-related buttock pain

Frequently asked questions

How can you tell sciatica from piriformis syndrome?

Sciatica from the lower back often comes with back pain, pain below the knee and changes in reflexes or sensation. Piriformis and other deep gluteal problems tend to cause buttock pain with sitting and a normal back exam. An exam, and sometimes an MRI, sorts them out.

Why does the sit bone hurt when sitting?

Pain right on the sit bone when sitting is usually proximal hamstring tendinopathy, an irritation of the hamstring tendon where it attaches to bone. Sitting presses the tendon against the bone. A cutout cushion and a tendon-loading program typically help within a few months.

Does a torn hamstring need surgery?

Most hamstring strains heal without surgery. A complete tear of the tendons off the sit bone, especially when two or three tendons are torn and pulled down the thigh, usually does better with repair. These repairs work most reliably within a few weeks of the injury, so prompt evaluation matters.

Can hip arthritis cause buttock pain?

Yes, hip arthritis can cause buttock pain, although groin pain is more typical. A hip that has lost rotation and is stiff in the morning suggests the joint is involved. Standing X-rays usually confirm it.

Treatments for back of hip

Fracture

Proximal Hamstring Repair

Proximal hamstring repair is a surgery that reattaches hamstring tendons torn off the sitting bone (ischial tuberosity) at the bottom of the buttock.

Diagnostic Hip Injection

A diagnostic hip injection places a numbing medicine directly into the hip joint under ultrasound or X-ray guidance.

Hip Physical Therapy

Physical therapy helps many types of hip pain, including arthritis, gluteal tendinopathy, hip impingement and many labral tears.

Hip Exam & Gait Analysis

A hip exam with an orthopedic hip specialist is a hands-on check of range of motion, labral and impingement signs, tendon strength and walking pattern.

Other types of hip pain

Hip pain · Front of hip

From the Hip Health Library

Questions patients ask about this

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SourcesReferences used for this page3

Medically reviewed by Dr. Stride, MD against current guidance from these sources. Last reviewed October 2026. How we write and review content

Piriformis Syndrome: Symptoms, Causes and Treatment (opens in a new tab) Cleveland Clinic
Sacroiliitis: Causes, Symptoms & Treatment Options (opens in a new tab) Cleveland Clinic
Hamstring Muscle Injuries (opens in a new tab) AAOS OrthoInfo