Literal pain in the butt
July 27, 2015 11:13 AM   Subscribe

My dad is experiencing pain in one side of his buttock. It is worse in the morning after waking up and is relieved by vigorous walking. What could it be?

My dad has been having shooting pain in one side of his buttock. It is worse in the morning after he wakes up. It does not really go away unless he goes on a rigorous walk. He tried to reproduce the relief by simply going on a treadmill but it's not having the same effect. Heat provides provide some relief but not that great.

He's 80 years old and in generally good health. He walks 30+ minutes everyday. He's perhaps 20 or so lbs overweight. He's been experiencing this pain for a few weeks now. He has been to his doctor with no clear answer. He has tried acupuncture and is now trying yoga though both provided no relief so far.

I did a bit of a search on the green and elsewhere and sciatica seems to fit the bill. Though it's baffling to me why it's worse in the morning and gets better with vigorous walking.
So my questions (YANMD etc):
1. does it sound like sciatica or something else?
2. what sort of doctor should he go to? As I mentioned, his general doctor is next to useless. Another GP? Physiotherapist? others?

Thank you in advance
posted by 7life to Health & Fitness (14 answers total) 6 users marked this as a favorite
IANYD but I have been a pregnant lady with horrible sciatica. I'm not familiar with the exact science of it, but sciatica has somethig to do with pressure on the nerve. If it's worse in the morning then he must be putting pressure on it while he sleeps. He should try to change his sleeping position to relieve some of pressure on the nerve.

My mother in law also has terrible sciatica, and she goes to a massage therapist once a week, which really helps. The only thing that helped me was heat (especially hot baths) and giving birth.
posted by lollymccatburglar at 11:20 AM on July 27, 2015 [4 favorites]

Yup, sounds like sciatica to this amateur internet non-doctor. The timeliness of the pain could be that when lying down there's more pressure on the nerve, but when he gets up and moves around there's less pressure so the pain goes away, particularly if it's about how he lays down and not from a spine problem, e.g. fat wallet syndrome.

Edit: I'm amused by the fact that your title, in a more vulgar form, pulls up all sciatica links.
posted by AzraelBrown at 11:21 AM on July 27, 2015

Absolutely sounds like sciatica, especially since it's relieved by walking.

If he goes back to his regular doctor and discusses sciatica and the doctor is still useless, try another GP. I'd recommend a massage therapist who is familiar with sciatic pain as well.
posted by erst at 11:23 AM on July 27, 2015

IANAD but I do have a pain in the butt (sorry). In my case it's my piriformis muscle getting wonky. Apparently this can happen for many reasons from sciatica to neck issues to feet issues. In my case it's because of my neck. I got myself sorted at a sports medicine clinic and after a few PT sessions I learned how to stretch the piriformis and I no longer have a pain in the butt and limp.

Doing pigeon or modified pigeon pose is what gets rid of it.
posted by kinetic at 11:25 AM on July 27, 2015 [1 favorite]

Sounds like sciatica that originates from the piriformis muscle (rather than the lumbar spine). Piriformis stretches can also help a lot. I'd also check the wallet sitting factor as many men get this from sitting on a wallet (even a thin one).
posted by quince at 11:46 AM on July 27, 2015 [1 favorite]

nthing the pigeon pose.

I have also found that, when lying on my back, elevating the offending leg with a pillow, helps.
posted by H21 at 11:46 AM on July 27, 2015

Almost certainly sciatica and the reason it's worse in the morning is that the discs absorb fluid while we are horizontal overnight. Walking creates a pumping action that removes some of this fluid, which can relieve the pressure on the nerve. You're at somewhat greater risk of rupturing a disc first thing in the morning because the discs are more turgid.
posted by HotToddy at 11:48 AM on July 27, 2015

Have battled with this myself. Among other things I did to address it:

- piriformis stretches (you can find youtube videos online of these; I like the one where you sit upright in a chair, cross your leg, then lean forward from the hip while pushing down gently on the knee)
- switched out a bad mattress that was making things worse
- bought a better office chair
- switched to standing desk
- saw a chiropractor for a few weeks

All of these, together, seem to have brought it generally under control. Or for all I knew it got better on its own.
posted by jquinby at 11:49 AM on July 27, 2015

I'm not a doctor, but I've had issues with my piriformis / sciatic nerve which resemble your father's. Pigeon pose is great. If he's able, he can pin a tennis ball between the offending buttock and the wall or floor and roll it around, as a kind of self-directed at-home massage - this helps get the kink out of the piriformis muscle, which is buried pretty deep in there.

I recommend visiting a PT if that's at all possible.
posted by erlking at 11:50 AM on July 27, 2015 [1 favorite]

Best answer: Massage therapist here. Could be sciatica, could be something else. Last I read, 70% of pain is due to myofascial (muscle and connective tissue) problems. That leaves 30% due to something else - just something to keep in mind.

That said, here's the massage application of Occam's Razor: take a look at these buttock pain maps. The red markings show where the pain is felt (heavy red for most common pain areas, red stippling/dots for less common pain areas). The "X" marks are the key points in the muscle that bind it up. You can tell which muscle(s) is the culprit by pressing on the X spot: does it reproduce the pain? Bingo!

Now give each of the X marks 6-8 slow deep strokes (or at least to a point before it really hurts - it might not take much) OR just put pressure on that spot for 30 seconds (depends on one's dexterity/patience). It may be helpful to use a tool like a tennis ball or lacrosse/hard bouncy ball. (See erlking's comment above.) Work on the X spots ideally every couple of hours for a few days (i.e until the pain goes away). Some discomfort is necessary, but go to a level of "hurts so good," not "YEOW!".

Additional help: heat and stretching after treating the muscles (try this piriformis stretch either lying down or sitting in a chair).

He might consider seeing a physical/physiotherapist, massage therapist, or chiropractor, if the pain won't go away with the self-treatment.
posted by sazanka at 12:18 PM on July 27, 2015 [2 favorites]

My experience with sciatica sounds just like what you're describing. In my case I had jammed my L4, which tightened up the piriformis muscle, which tightened around the sciatic nerve causing pain. To get relief, I got a physical therapist, started with massage therapy for instant relief, then started specific stretches, some exercises, walking, and a bit of work with foam rollers for long term therapy. My L4 needed to be put back into place and the core muscles strengthened to keep it in place, the piriformis had to loosen, and then the sciatic nerve calmed down and stopped hurting.

What I'm trying to say is that stretching will help, yes, as will the self massage (once you know the right spot) but there might be more he should be doing to make sure it gets better overall. See a physical therapist!
posted by clone boulevard at 12:36 PM on July 27, 2015

Could be piriformis syndrome (increased tension in the muscle compressing the sciatic nerve) as others have suggested or it could be an si joint pathology, including osteoarthritis. Pain in the mornings that dissipates with activity is a pretty common OA presentation.
posted by legendarygirlfriend at 12:37 PM on July 27, 2015 [1 favorite]

I just wanted to stress legendarygirlfriend's point from above. Your father's age and the description of pain would point me to OA and I would think that x-rays of the lumbar spine and hips would be a good idea.

I would recommend seeing a sports medicine specialist and then ask for a referral to a PT also.

For future reference if you ever feel that your GP is "next to useless" you need a new GP.
posted by Broken Ankle at 1:37 PM on July 27, 2015

Yup. Sciatica. Probably a bulging lumbar disc.
posted by Thorzdad at 2:10 PM on July 27, 2015

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