What Can Cause Pain in the Back of Your Upper Thigh, Under Your Buttocks?

There are different potential causes of co-occurring buttock and upper thigh pain, a few of which involve your sciatic nerve. Below are the potential conditions a doctor may consider.

Piriformis syndrome

Piriformis syndrome affects the piriformis muscle. This muscle is located between the lower part of your spine and upper thighs.

Piriformis syndrome is marked by inflammation that develops as a result of the piriformis muscle pressing against your sciatic nerve, which runs down your back to your feet.

Experts estimate between 0.3% and 6% of people who experience sciatica or low back pain have piriformis syndrome.

Traumatic and overuse injuries, anatomical issues, and sitting for long periods of time can all cause it. It’s most common in middle-aged adults.

Piriformis syndrome is also sometimes called deep gluteal syndrome.

Spinal stenosis

Spinal stenosis occurs when the spaces in your spine narrow, whether from aging, injury, or a health condition. Symptoms include:

• leg or arm weakness
• numbness in your legs or buttocks
• lower back pain when upright
• balance issues

Aging and certain conditions may cause spinal stenosis. With age, tissues in your spine may thicken and bones may get bigger, compressing the nerves.

Herniated disk

A herniated disk occurs when a disk, a cushion in your spine, pushes through a ring of tissue called the annulus. It can push on the spinal cord or nerve roots.

A herniated disk may develop along any part of your spine, but it’s most common in the lower back. Herniated disks are more common with age, but injuries can also cause them.

Back pain is common with a herniated disk. It can also cause sciatica, particularly if your lower back is affected. As a result, you might experience back pain from the herniated disk as well as buttock and leg pain from pressure placed on the sciatic nerve.

Hamstring injury

Your hamstrings are important leg muscles located along the backs of your thighs. Sometimes, a hamstring injury may also cause pain in this area, along with pain in the hips and buttocks.

Athletes and those who participate in high impact activities are most prone to hamstring injuries.

The extent of a hamstring injury depends on whether you’ve experienced a strain or a tear. Hamstring strains can heal on their own within a few days. A partial to complete muscle tear can take up to several weeks to heal.

Sacroiliac joint dysfunction

Sacroiliac joint dysfunction, also called sacroiliitis, is inflammation of one or both the joints on either side of your spine. Causes include:

• injury
• pregnancy-induced gait changes
• arthritis
• various back or spine issues
• infection, in some cases

The more common symptom is pain in the lower back, hip, buttocks, and down the legs. It’s sometimes accompanied by a low fever. The pain is often worse while standing or walking.

Conditions that may cause pain that begins in your buttocks and shoots down your leg include:

• piriformis syndrome
• damage or injury to the sciatic nerve
• herniated disk in the lower back

Buttock and leg pain that worsens while sitting or lying down may be caused by piriformis syndrome or a herniated disk that presses on your sciatic nerve.

Consider contacting a doctor if you’re experiencing ongoing pain in the back of your upper thigh and under your buttocks that worsens despite rest and home treatments, especially after a recent injury.

Numbness and tingling are other reasons to seek medical help.

To help make an accurate diagnosis, a doctor may conduct a series of stretching tests to determine the underlying cause of your pain.

A flexion, adduction, and internal rotation (FAIR) test may help diagnose or rule out piriformis syndrome as a cause of your pain. This is done while lying on your back.

During a FAIR test, a doctor has you flex your hips, and they rotate your leg to apply pressure on your piriformis muscle. They will examine where tension might result, and you will watch for any symptoms you experience.

Other stretching tests may include:

• internal rotation of your thigh while it’s extended (Freiberg stretch)
• external thigh rotation with abduction resistance (Pace maneuver)
• lying on your side while flexing your knee above the examination table (Beatty maneuver)
• lying down while holding up the affected leg, also called a leg raise

Aside from a physical exam with stretches, a doctor may also order imaging tests to determine the exact source of your thigh and buttock pain. These may include:

• X-ray
• ultrasound
• MRI

Treatment for this type of pain depends on the cause. It may include a combination of the following options, as recommended by a doctor:

• Home remedies: Short-term rest of up to 48 hours may help with piriformis syndrome, hamstring injuries, or a herniated disk. Stretches, myofascial release, and deep massages may also help. Staying active can help with sciatica symptoms.
• Medications: You can take over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen (Advil) or acetaminophen (Tylenol), for pain and inflammation as recommended by a doctor. In some cases, stronger prescription formulas may be needed, such as muscle relaxants for a herniated disk.
• Injections: Corticosteroid injections may offer quick relief from inflammation and pain. In some cases, botulinum toxin injections may also treat piriformis syndrome, though these don’t address the underlying inflammation that may be causing your pain.
• Physical therapy: A doctor may recommend physical therapy to help improve mobility and reduce pain in the affected muscles.
• Surgery: This is only considered when other treatment measures haven’t worked. Options include decompression surgery for sciatica or severe cases of herniated disks.

Since pain in the back of your upper thigh and under the buttock may be attributed to a few different causes, you may have many questions about your symptoms. Here are a few common questions you may wish to discuss with a doctor.

What does an inflamed piriformis muscle feel like?

When your piriformis muscle is inflamed, you may experience pain that starts in your buttock and then shoots down the back of your leg. You may also feel tingling and numbness along the same area.

How do I release my piriformis muscle?

To release a tight piriformis muscle, a doctor may recommend certain stretches. When done regularly, these stretches may also help prevent piriformis muscle inflammation.

Examples of stretches for piriformis syndrome include seated twists and pretzel stretches, also called Reverse Pigeon. The general recommendation is stretching two to three times per day for 5 to 10 minutes at a time.

It’s important to talk with a doctor and receive a correct diagnosis before attempting to begin any stretching routine to treat your pain.

What can be mistaken for piriformis syndrome?

People who experience symptoms of piriformis syndrome may mistakenly attribute these to a herniated disk and vice versa. Since the symptoms are so similar, it’s important to have a doctor evaluate the underlying cause.

How do I get my sciatic nerve to stop hurting?

You can help reduce sciatic nerve pain by being physically active as much as possible, applying heat packs, and practicing gentle stretches. A doctor may also recommend physical therapy or pain relievers if home remedies don’t help.

Experiencing pain in the back of your upper thigh and under your buttocks can be attributed to a few different causes. Some of these causes, such as piriformis syndrome and a herniated disk, may also press on the sciatic nerve and lead to sciatica.

While minor pain may resolve on its own within a few days after resting, it’s best to talk with a doctor if you’ve experienced a significant injury or have shooting pain that persists while sitting and lying down. They can help diagnose the exact cause and treat it appropriately.