What is it about ?
There are many causes of pain in the buttock and hip. The hip itself can be the problem. But it is often a pain felt there when the problem is elsewhere; we are talking about radiating pain. This distinction is important and the search for the cause is often difficult. Radiating pain mainly originates from the lower back and the pelvis.
How to recognize it?
Buttock or hip abnormalities
In case of’inflammation of the joints (arthritis) orarthritis hip, pain usually begins in the groin and radiates forward from the thigh to above the knee. Complaints increase with walking and running, and subside at rest. If there are small loose pieces of cartilage in the joint (articular mice), you may suddenly feel violent, painful throws. You may also feel that your legs are wobbling as you walk down the stairs.
THE’inflammation of a bursa (bursitis) instead triggers local pain, often on the outside of the thigh or in the ischium (hip bone).
In a child who has a sore groin and limps, it could be a serious condition, such as inflammation of the joints, dislocation or birth defect. But most of the time, the cause of these symptoms is a ‘hip cold’ (an inflammation of the membrane (synovial membrane) that surrounds the hip joint (hip synovitis)). It is a benign condition, in which an injury or viral infection can play a role.
The muscle damage such as elongations or small tears are easier to recognize. They usually appear suddenly, accompanied by searing pain (like a whiplash), and the pain is felt at the exact site of the injury, without radiation.
the piriformis muscle syndrome can, meanwhile, trigger pain in the buttock. Complaints occur when the piriformis muscle (a deep muscle in the buttock) irritates or compresses the sciatic nerve (the large nerve that starts from the lower back and goes down into the buttock, thigh, and then the leg). The diagnosis is made on the basis of symptoms and physical examination. During the examination, the doctor also looks for signs oflumbar disc herniation.
Lower back abnormalities
In the lower back, nerve roots can get stuck. Often the pain is not felt in the lower back, but radiates along the affected nerve.
The cause may be a tear in an intervertebral disc (hernia). The symptom table depends on where in the back the nerve root is compressed (for example we speak of a hernia in L3, i.e. at the level of the third lumbar vertebra or in S1, to designate the first vertebra. sacred). In addition to pain, other problems can arise, such as numb areas, tingling, tingling, and loss of strength. The pain is often at its peak in the morning and usually increases as you lean forward. Walking can relieve it.
A compression of nerves can also occur from the vertebrae being too close together, such as in advanced stages ofarthritis. Because of this, the holes through which the nerves must pass to exit the spine are too narrow (stenosis). This can cause pain and numbness in just one or both legs. The complaints get worse when you stand and when you walk, and go away when you sit down.
Pain can also be felt in the joints between the iliac bones and the sacrum (sacroiliac joints). In this case, the pain is mainly in the buttock and sometimes changes sides, alternating between left and right. You experience stiffness in your lower back in the morning and after sitting for a long time. The pain may also increase when you move. This phenomenon is quite common in the Bechterew’s disease. In addition to the lower back, other joints are often affected at the same time.
Abnormalities of the organs or blood vessels in the pelvis
The pain can also originate in the organs of the pelvis, for example with bleeding, abscesses and tumors in the prostate in men or the uterus in women. A normal pregnancy can also cause pain in the buttock and hip.
If the large arteries in the pelvis are narrowed or blocked, pain appears in the leg (often the calf) when you walk. This prevents you from continuing your walk (limp) but if you rest, the pain will go away (intermittent claudication) and you can start again after 5 to 15 minutes of rest. The shorter the distance you walk without pain, the more severe the narrowing.
How is the diagnosis made?
The doctor always begins with a discussion and examination of the hip joint and spine. THE’arthritis and thearthritis, unlike the bursitis, are accompanied by a characteristic table of movement limitation. In addition to mobility, the doctor also tests for strength, sensitivity and reflexes. Blockage of the arteries can be seen by difficulty in palpating the blood vessels in the groin, knee, ankle, and back of the foot. Depending on your symptoms and any other complaints or conditions, the doctor will consider the treatment to be adopted.
If in doubt, he will send you for additional radiological examinations (for example a CT scan). If he suspects an underlying rheumatic condition instead, he may order a blood test and refer you to a musculoskeletal specialist (rheumatologist). If he thinks the cause is in the pelvis, he will refer you to another specialist.
What can you do ?
In case of inflammation of the hip joint, you need to relieve the joint. But relieving does not necessarily mean standing still. If the cause is in the lower back, it is even recommended to move to a certain extent. Either way, being overweight is bad. So always try to keep your weight under control and, if necessary, lose weight.
What can your doctor do?
In case of’inflammation of the joints, the doctor will prescribe rest and possibly an anti-inflammatory drug (eg ibuprofen). He will check that you are not suffering from a rheumatic disease, as this sometimes requires basic treatment.
The bursitis generally does not respond well to anti-inflammatory drugs. One or more injections of cortisone, given directly into the bursa, may provide relief.
In case of back problems, the priority is to move every day, do exercises to strengthen the muscles, take a correct posture and, if necessary, relieve pain. Painkillers are always administered in a gradual manner, starting with paracetamol and then eventually progressing to more powerful agents.
For the muscle damage such as stretching and tearing, you can consult a physiotherapist after seeking the advice of the general practitioner. Piriformis syndrome can also be managed with a piriformis stretching exercise program.
Causes localized in the pelvis often require surgery. Clogged arteries can, for example, be cleared by placement of a stent or by bypass.
Want to know more?
- Paracetamol – CBIP – Belgian Center for Pharmacotherapeutic Information
- Ibuprofen – CBIP – Belgian Center for Pharmacotherapeutic Information
- Atheromatous arterial disease (stent and bypass), here, Where to find on this page of Cliniques St Luc UCL
Are you looking for more specialized help?
- Find a registered dietitian – Professional Union of French-speaking dieticians
- Find a nutritionist doctor – Belgian Society of Nutritionist Doctors