Gluteal pain is classified according to its cause and location:

1. Muscular gluteal pain:
   • Pain due to tension or overuse of the gluteal muscles, often associated with the piriformis syndrome.
2. Neurological gluteal pain:
   • Pain due to pressure on nerves, such as the sciatic nerve, which typically causes radiating discomfort.
3. Arthrogenic gluteal pain:
   • Pain due to joint diseases, such as osteoarthritis in the hip joint or sacroiliac joint problems.
4. Inflammatory gluteal pain:
   • Pain due to inflammatory diseases such as sacroiliitis or rheumatic diseases.
5. Post-traumatic gluteal pain:
   • Pain resulting from injuries such as bruises or strains after falls or accidents.

The causes of gluteal pain are varied and can be both mechanical and neurological in nature:

• Muscular tension and overload:
  • Poor posture, overuse, or prolonged sitting often lead to tension in the gluteal muscles. The piriformis muscle is a common trigger.
• Piriformis syndrome:
  • Due to tension imbalances in the piriformis muscle, the underlying sciatic nerve is compressed, which can cause pain in the buttocks and along the leg.
• Nerve compression:
  • Herniated discs or spinal canal stenosis can put pressure on the sciatic nerve and cause gluteal pain.
• Joint diseases:
  • Osteoarthritis or dysfunctions of the sacroiliac joint (SIJ) often lead to localized pain in the buttocks.
• Inflammatory diseases:
  • Sacroiliitis or rheumatoid diseases cause inflammatory changes that lead to gluteal pain.
• Injuries:
  • Trauma, such as falls or bruises, can trigger acute pain and swelling in the buttock area.

The symptoms of gluteal pain vary depending on the cause and severity:

- Localized pain:

- Often unilateral pain in the buttock area, which is intensified by movement or pressure.

- Radiating pain:

- Pain that radiates to the lower back, hip, or leg, especially when the sciatic nerve is involved.

- Movement restrictions:

- Difficulties with walking, climbing stairs, or sitting.

- Neurological symptoms:

- Tingling, numbness, or muscle weakness, especially with nerve compression.

- Swelling and tenderness:

- Visible or palpable reactions in inflammatory or traumatic causes.

The diagnosis is based on a thorough medical history, physical examination, and, if necessary, imaging techniques:

• Medical history:
  • The doctor inquires about the course of the pain, possible triggers, and accompanying symptoms such as neurological deficits.
• Physical examination:
  • Checking mobility, tenderness, and specific pain points. Tests like the Piriformis test can provide insight into muscular causes.
• Imaging techniques:
  • MRI: Visualization of soft tissues, intervertebral discs, and nerves.
  • X-ray: For assessing bone or joint changes.
  • Ultrasound: Examination of muscles and tendons for inflammation or injuries.

Conservative Therapy

Most cases of gluteal pain can be treated without surgical intervention:

• Physiotherapy:
  • Targeted stretching and strengthening exercises to relax the muscles and improve mobility.
  • Manual therapy to relieve tension and blockages.
• Pain Therapy:
  • Use of nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen to relieve pain and inflammation.
  • Muscle relaxants for severe muscle tension.
• Local Applications:
  • Cold or heat therapy, depending on the cause, for pain relief and relaxation.
• Ergonomics:
  • Adjustment of workplace and seating to avoid poor posture.

Invasive Therapy

For persistent or severe symptoms, the following measures may be necessary:

• Injections:
  • Cortisone or local anesthetics to relieve pain and inflammation, especially in cases of sacroiliac joint dysfunction or piriformis syndrome.
• Surgery:
  • Rarely necessary, for example, in cases of anatomical bottlenecks or herniated discs.

To prevent gluteal pain, the following measures are recommended:

1. Regular exercise: Promote flexibility and strengthen the gluteal and back muscles through sports such as yoga or swimming.
2. Ergonomic workplace design: Adjust the sitting position and take regular breaks during predominantly sedentary activities.
3. Avoid overloading: Warm up before physical activity and gradually increase the load.
4. Stretching exercises: Regularly stretch the piriformis muscle and hip muscles to prevent tension.
5. Early treatment: Immediate clarification and therapy at the first signs of pain to prevent chronic complaints.