A Real “Pain in the Butt”: Where That Ache Might Actually Be Coming From

If you’ve ever dealt with a stubborn ache deep in the butt or upper hamstring area, you already know—it can be a real pain in the butt. The tricky part? That discomfort doesn’t always come from where you think it does. The image below shows just how many layers of tissue are in this area; making it hard for you to figure out what is going on.

To break things down for you, here are some of the most common sources of posterior hip and buttock pain, especially in active people.

Low Back Referral

Sometimes the problem isn’t the hip or glute at all. Muscles, joints, or even discs in the lower back can refer pain into the buttock region.
Common clue: symptoms may change with spine movement or prolonged sitting/standing.

SI Joint Syndrome

The sacroiliac (SI) joint sits where the spine meets the pelvis. Irritation here can create pain that feels deep, one-sided, and very localized near the back of the pelvis.
Common clue: pain with transitions like standing up, rolling in bed, or single-leg loading.

Glute Strain or Tendinopathy

Overuse or sudden increases in training can irritate the glute muscles or their tendons. This often shows up as soreness or sharp pain during running, climbing stairs, or hill work.
Common clue: pain with muscle activation, hip rotation, or after longer training sessions.

Deep Gluteal Syndrome

This involves irritation of nerves (most commonly the sciatic nerve) as they pass by the deep glute muscles. It can mimic sciatica without coming from the spine.
Common clue: deep buttock pain with sitting, stretching, or prolonged hip flexion (ie sitting on the saddle)

Posterior Hip Impingement

Certain hip positions—especially extension—can cause the back of the hip joint to become irritated.
Common clue: pain during sprinting, kicking, or pushing hard off the back leg.

Proximal Hamstring Tendinopathy

This affects the hamstring tendon right where it attaches to the pelvis. It’s common in runners and triathletes and tends to linger if ignored.
Common clue: pain with sitting, running faster, or long efforts

Hip Osteoarthritis

Not all hip arthritis presents with groin pain. In some cases, it shows up as stiffness or aching deep in the buttock.
Common clue: reduced hip mobility and stiffness, especially first thing in the morning.

The Takeaway

A “pain in the butt” isn’t a diagnosis—it’s a symptom. And as you can see, several structures can be responsible. Identifying the true source is key to managing it properly and keeping you training consistently.

If the pain is persistent, worsening, or affecting performance, getting it properly assessed with Chiro On-the-Go is this first step to recovery. Book for an assessment here.