Pain in the buttock: causes, including piriformis and sit-bone pain
The common reasons for a deep ache in the buttock, from the lower back and sciatic nerve to the hip tendons and sit bone, and when it needs checking.
A deep ache in one buttock is a very common complaint, and there are several possible sources. It can be referred from the lower back or the sciatic nerve, come from the tendons around the hip, or from the area where the hamstrings attach to the sit bone. Which one it is usually becomes clearer from when and how it hurts.
When to get urgent help
Call 999 or go to A&E straight away if you have back pain together with any of these. They can be signs of a rare but serious condition such as cauda equina syndrome. Do not drive yourself.
- Numbness or tingling around your genitals, buttocks or inner thighs (the saddle area)
- Difficulty passing urine, loss of bladder or bowel control, or being unable to feel when you are passing urine or stool
- Pain, tingling, weakness or numbness in both legs, or sciatica on both sides, or weakness in a leg that is getting worse
- New changes to sexual sensation or function alongside back or leg pain
- Chest pain, or back pain that started after a serious accident such as a car crash
What it can feel like
- A deep ache in the buttock, sometimes spreading into the back of the thigh
- Pain that is worse sitting on hard surfaces, or after long drives
- Pain with climbing stairs, running uphill or standing on one leg
- Sometimes tingling or pain below the knee, which suggests the sciatic nerve may be involved
Common contributors
- Irritation of a nerve root in the lower back (sciatica)
- Overloaded tendons around the hip and buttock muscles (see outer hip pain)
- Strain where the hamstrings attach to the sit bone, common in runners and cyclists
- Tightness and sensitivity in deep buttock muscles, sometimes labelled piriformis syndrome, which is a debated diagnosis
- Stiffness or irritation of the sacroiliac joint where the spine meets the pelvis
General self-care
These are general comfort measures many people find reasonable. They are not a treatment plan, and what suits one person may not suit another.
- Change position often, and avoid long unbroken spells of sitting, especially on hard seats
- Stay gently active. Walking is usually comfortable
- Heat can ease muscle tension for some people
- Build up running, cycling and hill work gradually
- Pain relief as advised by a pharmacist or GP. Note the NHS says paracetamol is unlikely to help sciatica
When to see your GP
See your GP promptly, or call NHS 111, if you have any of the following:
- Feeling hot, cold, shivery or generally unwell, or severe pain that starts suddenly or quickly gets worse
- Unexplained weight loss, or a lump, swelling or change in the shape of your back
- Pain that is worse at night or does not ease with rest, or is worse when you cough, sneeze or open your bowels
- A history of cancer and new, persistent back pain
Consider seeing your GP if:
- Pain that is not improving after a few weeks, or is getting worse
- Leg pain with tingling or weakness spreading below the knee
- Pain in the buttock with fever, unexplained weight loss, or night pain that does not ease
Where an osteopath fits in
There is limited good-quality research showing that hands-on treatment changes the course of buttock pain, so I do not claim that osteopathy treats it.
What an osteopath can usefully do is work out where the pain is likely to be coming from (lower back, nerve, hip tendons, hamstring attachment or sacroiliac joint), advise on positions and load, and guide a graded exercise plan. If your symptoms look like sciatica, the back pain guide explains how NICE guidance treats manual therapy. If the assessment suggests you need your GP, a physiotherapist or a specialist instead, I will tell you.
If you would like your symptoms assessed, you are welcome to book an appointment. Osteopathic care is not right for everyone, and if something needs medical attention first, I will tell you.
Common questions
Is buttock pain sciatica or piriformis syndrome?
The two can feel similar. Sciatica is irritation of a nerve root or the sciatic nerve and often brings leg pain, tingling or numbness. Piriformis syndrome is a popular label for deep buttock muscle pain, but it is a debated diagnosis. An assessment can help to tell which is more likely.
Why does my buttock hurt when I sit?
Sitting loads the sit bone and compresses buttock tissues, and can irritate a sensitive nerve. Changing position often, avoiding hard seats and breaking up long sits usually helps.
Sources and further reading
Links open in a new tab. Sources were checked in October 2026.
Related guides
This page is general information to help you understand common aches and pains. It is not medical advice and cannot diagnose your problem. If you are worried about your symptoms, please speak to your GP or call NHS 111.